Efficacy of reteplase in poorly functioning hemodialysis catheters

Clin Nephrol. 2004 Jan;61(1):47-53. doi: 10.5414/cnp61047.

Abstract

Aim: This is a retrospective study of reteplase efficacy for restoration of flow in occluded and poorly functioning hemodialysis catheters.

Patients and methods: From May 1, 2001 to December 31, 2001, all hemodialysis patients seen at our university dialysis center with occluded or poorly functioning (< 200 ml/min blood flow) catheters treated with reteplase were included in the study. All catheters had been in place for more than 48 hours. Reteplase 0.4 U was instilled into each port; dwell time was 30 minutes. If aspiration had not been possible, reteplase had remained in the catheter for an additional 30 minutes. If flow was established (> 200 ml/min), the catheter was used for dialysis. If flow was not adequately established after 1 hour, the patient was referred for catheter exchange.

Results: Reteplase (0.4 U) was used in 50 instances to restore or improve blood flow rates in a total of 23 catheters in 19 patients. Reteplase was effective in establishing adequate blood flow rates during the current and next dialysis session in 44/50 (88%) cases; 6 cases required 1-hour dwell time. Six cases (in 5 patients) required catheter exchange; in these, an anatomic or pathologic complication was responsible for catheter malfunction. No adverse events were related to reteplase instillation during the study.

Conclusion: Data suggest that reteplase is safe and effective in restoring flow to malfunctioning hemodialysis catheters. Results are comparable to those achieved with alteplase.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Catheterization*
  • Child
  • Child, Preschool
  • Equipment Failure
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Recombinant Proteins / therapeutic use*
  • Renal Dialysis / instrumentation*
  • Retrospective Studies
  • Tissue Plasminogen Activator / therapeutic use*

Substances

  • Fibrinolytic Agents
  • Recombinant Proteins
  • reteplase
  • Tissue Plasminogen Activator