Predicting tissue plasminogen activator use and success in in-center hemodialysis patients.

Abstract

Hemodialysis catheter malfunction is problematic. We aimed to determine clinical, catheter, and hemodialysis variables that predict: (i) catheter malfunction requiring recombinant tissue-plasminogen activator (TPA) treatment and (ii) the success of TPA administration. Clinical, catheter, and hemodialysis variables were collected from a cohort of 559 catheters (141,526 catheter days) in 175 hemodialysis patients (2008-2011). Time to, and predictors of, catheter malfunction were determined for all catheters and primary catheters only, analyzed by Cox-proportional hazard model, multi-variable logistic regression model, and mixed-effect logistic regression models. Success of TPA use was determined immediately, next day, and two weeks after use. Shorter time to first TPA administration in all patient's catheters was associated with increased body mass index (hazard ratio [HR] = 1.06, 1.01-1.11, p = 0.03) and being of black race (HR = 3.05, 1.65-5.67, p<0.01). Primary TPA administration success at two weeks among primary catheters was associated with increased mean peak venous pressure before TPA administration (odds ratio [OR] = 1.03, 1.01-1.06, p<0.01) and decreased mean of the lowest systolic blood pressure measure for the three dialysis sessions prior to TPA administration (OR = 0.95, 0.91-0.99, p = 0.02). TPA administration success at two weeks among all catheters was associated with decreasing body mass index (OR = 0.84, CI 0.73-0.96, p = 0.01) and having diabetes (OR = 7.19, 1.40-36.81, p = 0.02). Both patient and dialysis predictors of TPA use and success were identified in this study, which may be useful for fine-tuning catheter management protocols to target hemodialysis patients at high risk of catheter malfunction.