Hemodialysis Catheter Locking Solution Improves Outcomes

Adding recombinant tissue plasminogen activator reduces catheter malfunction and bacteremia

WEDNESDAY, Jan. 26 (HealthDay News) -- The incidence of catheter malfunction and bacteremia is reduced among patients undergoing hemodialysis with catheter locking solutions that include the addition of recombinant tissue plasminogen activator (rt-PA) as compared to heparin alone, according to a study in the Jan. 27 issue of the New England Journal of Medicine.

Brenda R. Hemmelgarn, M.D., Ph.D., of the University of Calgary in Canada, and colleagues randomized 225 patients undergoing long-term hemodialysis, in whom a central venous catheter had been inserted, to a catheter-locking regimen of heparin three times weekly or rt-PA in place of heparin at the midweek session (with heparin used in the other two sessions).

The investigators found that a catheter malfunction occurred in 34.8 percent of the patients assigned to heparin only and 20 percent of the patients assigned to rt-PA. The investigators also found that catheter-related bacteremia occurred in 13.0 percent of patients assigned to heparin only, compared with 4.5 percent assigned to rt-PA. The risk of adverse events, including bleeding, was similar between those who received heparin alone and those who received rt-PA.

"The findings were consistent between patients for whom this was the first use of a catheter and those who had had previous catheters," the authors write.

The study was supported by Hoffmann-La Roche; several authors disclosed financial relationships with pharmaceutical companies, including Hoffmann-La Roche.

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