Yaseen Obead, El-Masri Maher M, El Nekidy Wasim S, Soong Derrick, Ibrahim Mohammed, Speirs John W, Kadri Albert
Department of Nephrology, Hotel-Dieu Grace Hospital, Windsor, Ontario, Canada.
Hemodial Int. 2013 Jul;17(3):434-40. doi: 10.1111/hdi.12004. Epub 2012 Nov 26.
Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence-based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.0-mg vs. 2.0-mg tPA dwell protocols in restoring the HDC function in thrombotic dysfunctional catheters. A retrospective, single-center study was conducted on two independent cohorts of patients; the first (n = 129) received 2.0 mg tPA/catheter lumen, while the second (n=108) received 1.0 mg tPA/catheter lumen. Kaplan-Meier and Cox regression analyses were performed to compare the catheter survival time between patients who received 1.0 mg tPA and those who received 2.0 mg tPA. Catheter removal occurred in 25 (19.4%) of those catheters treated with 1.0 mg tPA compared with 11 (10.2%) of catheters treated with 2.0 mg tPA (P = 0.05). The hazard ratio (HR) for catheter removal was 2.75 (95% confidence interval [(95%) CI] = 1.25-6.04) for the 1.0-mg tPA cohort compared with the 2.0-mg tPA cohort. Correction added on 3 December 2012, after first online publication: The tPA cohort values were changed. Female gender (HR = 2.51; (95%) CI = 1.20-5.27) and age (HR = 0.96; (95%) CI = 0.94-0.98) were also associated with catheter survival. Our findings suggest that treatment of dysfunctional HDC with 2.0-mg tPA dwells is superior to 1.0-mg tPA dwells.
因血栓形成导致的血液透析导管（HDC）功能障碍很常见，在使用1年内功能障碍发生率可达50%。尽管腔内注射阿替普酶（组织型纤溶酶原激活剂[tPA]）是从药理学角度恢复HDC功能的标准做法，但尚无关于最佳tPA剂量的循证指南。本研究的目的是比较1.0毫克与2.0毫克tPA留存方案在恢复血栓性功能障碍导管的HDC功能方面的疗效。对两个独立患者队列进行了一项回顾性单中心研究；第一组（n = 129）每导管腔接受2.0毫克tPA，而第二组（n = 108）每导管腔接受1.0毫克tPA。进行了Kaplan-Meier分析和Cox回归分析，以比较接受1.0毫克tPA的患者与接受2.0毫克tPA的患者之间的导管存活时间。接受1.0毫克tPA治疗的导管中有25根（19.4%）被拔除，而接受2.0毫克tPA治疗的导管中有11根（10.2%）被拔除（P = 0.05）。与2.0毫克tPA队列相比，1.0毫克tPA队列导管拔除的风险比（HR）为2.75（95%置信区间[(95%)CI]=1.25 - 6.04）。2012年12月3日首次在线发表后更正补充：tPA队列值发生了变化。女性（HR = 2.51；(95%)CI = 1.20 - 5.27）和年龄（HR = 0.96；(95%)CI = 0.94 - 0.98）也与导管存活有关。我们的研究结果表明，用2.0毫克tPA留存治疗功能障碍的HDC优于1.0毫克tPA留存。
