International Journal of Nephrology / 2012 / Article / Tab 1

Review Article

Minimizing Hemodialysis Catheter Dysfunction: An Ounce of Prevention

Table 1

Studies evaluating therapies for the prevention of HD catheter dysfunction.

โ€ƒReferenceStudy design N Treatment groupsOutcomeEffectP

Catheter locking agents

HeparinThomas, 2007 [7]P
๐‘ = 2 7 3
Heparin
(1000โ€‰U/mL)
Heparin (10โ€‰000โ€‰U/mL)Catheter dysfunction (per 1000 HD sessions)Low H/high H
6.7 versus 7.6
NS
Thrombolytic therapy (per 1000 HD session)Low H/high H
26.6 versus 8.2
<0.001

HeparinHolley, 2007 [8]R
๐‘ = 6 4
Heparin
(1000โ€‰U/mL)
Heparin (10โ€‰000โ€‰U/mL)Thrombolytic therapy (per 6 months)Low H/high H
63% versus 31%
<0.001

Citrate (4%)Buturovic, 1998 [9]RCT
๐‘ = 3 0
Citrate 4%Heparin
(1666โ€‰U/mL)
Polygeline (3.5%)Catheter survival (days)C/H/P 51/23/32<0.01

Citrate (4%) Lok, 2007 [10]P
๐‘ = 2 5 0
Citrate
4%
Heparin (5000โ€‰U/mL)Thrombolytic rate (per 1000 days)C/H 3.3 versus 5.5<0.001
Catheter removal for poor flow (per 1000 days)C/H 1.65 versus 2.980.042

Citrate (4%)โ€ƒ Grudzinski, 2007 [11] โ€ƒR
๐‘ = 3 0 7 โ€ƒ
Citrate*
4%โ€ƒ
Heparin** (10โ€‰000โ€‰U/mL) โ€ƒThrombolytic rate (per 1000 days)C/H 3.23 versus 4.100.07
Catheter removal for poor flow (per 1000 days)C/H 1.88 versus 1.81NS

Citrate (4%)MacRae, 2008 [12]RCT
๐‘ = 6 1
Citrate
4%
Heparin (5000โ€‰U/mL)Thrombolytic therapy
(6 months)
C/H 41% versus 45%NS

Citrate (5%)โ€ƒ Hendrickx, 2001 [13] โ€ƒRCT
๐‘ = 1 9 โ€ƒ
Citrate
5%โ€ƒ
Heparin (5000โ€‰U/mL) โ€ƒThrombolytic therapy (per HD session)C/H 8% versus 1%NS
Aspiration of thrombus (6 months)C/H 14% versus 7%<0.001

Citrate (30%)Stas, 2001 [14]P
๐‘ = 1 1
Citrate
30%
Heparin (5000โ€‰U/mL)Aspiration of thrombusC=HNS

Citrate (30%)โ€ƒ Weijmer, 2005 [15] โ€ƒRCT
๐‘ = 2 9 1 โ€ƒ
Citrate
30%โ€ƒ
Heparin (5000โ€‰U/mL) โ€ƒThrombolytic Therapy (6 months)C/H 47% versus 44%NS
Catheter removal for poor flow (per 1000 days)C/H 3.2 versus 3.6NS

Citrate (47%)Bayes 1999 [16]P
๐‘ = 1 0
Citrate,
46.7%
Heparin (5000โ€‰U/mL)Blood flow rateC=HNS

Citrate (47%)Power, 2009 [17]RCT
๐‘ = 2 3 2
Citrate,
46.7%
Heparin (5000โ€‰U/mL)Thrombolytic therapy (per 1000 days)C/H
8.2 versus 4.3
<0.001

Tissue plasminogen activatorโ€ƒ Schenk, 2000 [18] โ€ƒP
๐‘ = 1 2 โ€ƒ
r-TPA (1โ€‰mg/mL interdialytic lock) โ€ƒHeparin (1000โ€‰U/mL) โ€ƒBlood flow rate mL/minTPA/H
237 versus 208
0.001
Thrombolytic therapy (4 months)TPA/H
0% versus 20%
โ€”

Tissue plasminogen activatorโ€ƒ Gittins, 2007 [19] โ€ƒP
๐‘ = 9 โ€ƒ
r-TPA (1โ€‰mg/mL interdialytic lock) โ€ƒHeparin (1000โ€‰U/mL) โ€ƒAspiration of thrombusH > rTPA:
O.R. 2.4
0.001
Clot volumeH > rTPA:
O.R. โ€‰=โ€‰โ€‰1.9
<0.001

Tissue plasminogen activatorHemmelgarn, 2011 [20]RCT
๐‘ = 2 2 5
r-TPA (1โ€‰mg/mL interdialytic lock midweek heparin 5000โ€‰U/Ml in other 2 sessions)Heparin (5000โ€‰U/mL)Catheter malfunctionrTPAโ€‰โ€‰<โ€‰โ€‰heparin
HR 1.91
0.02

โ€ƒโ€ƒโ€ƒโ€ƒโ€ƒCatheter-related bacteremia (episodes/1000 catheter days)rTPA<Heparin
0.40 versus 1.37
0.02

Modified catheters

Heparin-
coated
cathetersโ€ƒ
Clark, 2009 [21] โ€ƒR
๐‘ = 8 8 โ€ƒ
Heparin-coated catheter (+ heparin lock 5000โ€‰U/mL) โ€ƒNoncoated catheter (+ heparin lock 5000โ€‰U/mL) โ€ƒPrimary patency (at 3 months)HCC/NCC
82% versus 76%
NS
Thrombosis rate (per 1000 days)HCC/NCC
0.8 versus 0.4
NS

Heparin-
coated
cathetersโ€ƒ
Jain, 2009 [22] โ€ƒR
๐‘ = 1 7 5 โ€ƒ
Heparin-coated Catheter (+ Hepain lock 5000โ€‰U/mL) โ€ƒNon-coated Catheter (+ Hepain lock 5000โ€‰U/mL) โ€ƒCumulative catheter survival (at 6 months)HCC/NCC
48% versus 41%
NS
Thrombolytic therapy (per 1000 days)HCC/NCC
1.8 versus 1.8
NS

Oral agents

Warfarin (mini dose)โ€ƒ Mokrzycki, 2001 [23] โ€ƒRCT
๐‘ = 8 5 โ€ƒ
Warfarin (1โ€‰mg) โ€ƒPlaceboโ€ƒPrimary catheter patency (at 1 year)W/P
58% versus 48%
NS
Assisted primary catheter patency (at 1 year)W/P
20% versus, 18%
NS

Warfarin (low intensity)โ€ƒโ€ƒ Wilkieson, 2011 [24] โ€ƒโ€ƒRCT
๐‘ = 1 7 4 โ€ƒโ€ƒ
Warfarin (INR 1.5โ€“1.9) โ€ƒโ€ƒPlaceboโ€ƒโ€ƒPrimary catheter patencyW/P
46% versus 47%
NS
Catheter removal for dysfunctionW/P
HRโ€‰โ€‰=โ€‰โ€‰0.87
NS

Warfarin (low intensity)Zellweger, 2005 [25]P
๐‘ = 6 5
Warfarin (INR 1.5โ€“2.0) (high-risk pts)Controls (low-risk pts)Primary catheter patency (at 9 months)Anticoagulation
(adequate versus inadequate)
47% versus 8%
0.01

Warfarin
(high intensity)โ€ƒ
Obialo, 2003 [26] โ€ƒP
๐‘ = 6 3 โ€ƒ
Aspirin 325โ€‰mg/d โ€ƒWarfarin (INR 2-3)Controlโ€ƒPrimary catheter patency (number of days)A/W/C
114/111/68
<0.001
Catheter survival (at 4 months)A/W/C
91%/73%/29%
<0.001

Warfarin
(medium intensity)
and ticlodipineโ€ƒ
Coli, 2006 [27] โ€ƒRCT
๐‘ = 1 4 4 โ€ƒ
Primary prevention Warfarin (INR 1.8โ€“2.5) + ticlodipine 250โ€‰mg/day (1ยฐW + T) โ€ƒSecondary prevention (INR 1.8โ€“2.5) + Ticlodipine 250โ€‰mg/day (2ยฐW + T) โ€ƒCatheter dysfunction (1 year) 1ยฐW + T/2ยฐW + T
12% versus 52%
<0.01
Catheter dysfunction (events per pt/year)PWT/RWT
0.16 versus 1.65
<0.001

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