Kidney Week

Abstract: FR-PO466

Tissue Plasminogen Activator (tPA) Use for Peritoneal Dialysis Catheter Dysfunction

Session Information

• Home Dialysis - 1
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States

Caroline M. Hsu, MD

• Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States

Harold Manley, PharmD, FASN

• Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States

Antonia Harford, MD

• Gibson, Austin, Dialysis Clinic Inc, Nashville, Tennessee, United States

Austin Gibson

• Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States

Nien Chen Li, MS, PhD, MPH

• Born, Scot E., Dialysis Clinic Inc, Nashville, Tennessee, United States

Scot E. Born, MD, PharmD

• Shieu, Monica, Dialysis Clinic Inc, Nashville, Tennessee, United States

Monica Shieu, MS, PhD

• Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States

Daniel E. Weiner, MD, MS, FASN

• Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States

Dana Miskulin, MD

• Meyer, Klemens B., Tufts Medical Center, Boston, Massachusetts, United States

Klemens B. Meyer, MD

• Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States

Doug Johnson, MD

• Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States

Eduardo K. Lacson, MD, MPH, FASN

Background

Peritoneal dialysis (PD) catheter dysfunction accounts for 10-14% of PD to hemodialysis (HD) transfers. Tissue plasminogen activator (tPA) is sometimes used for PD catheter dysfunction, but reports of its effectiveness vary.

Methods

This retrospective study included all instances of tPA used for poor flow or catheter dysfunction in PD patients from January 1, 2020 to December 31, 2023, excluding tPA use for peritonitis. Data collected from the electronic health record included the number and timing of tPA doses and whether the patient subsequently continued PD therapy, underwent PD catheter revision, or transferred to HD within 30 days of the initial tPA treatment. Manual chart review collected additional detail on reasons for tPA use.

Results

Among 5297 patients receiving PD at DCI during the study period, tPA was administered 114 times for poor flow or catheter dysfunction in 85 patients (catheter vintage median 11 months [IQR 2, 22]). Per manual chart review, 48 instances were for both poor inflow and poor outflow, 52 instances were for poor outflow only, and the indication for tPA could not be determined in 14 instances. Among 64 patients who received a single dose of tPA, 41 continued PD, 22 transferred to HD without further intervention, and one continued PD after catheter revision (Figure). Among 21 patients who received two or more tPA doses, 11 continued PD and 10 transferred to HD, with one transferring to HD after PD catheter revision. Primary reasons for transfer to HD included PD catheter failure (N = 14), intra-abdominal pathology (5), peritonitis (4), ultrafiltration failure (4), inadequate clearance (1), and not documented (4).

Conclusion

Among 85 patients who received 114 tPA treatments, 53 patients (46%) continued PD. More granular data on patient selection, catheter position, and potential causes of catheter failure will inform optimal use of tPA for PD catheter dysfunction.

Funding

• Other NIH Support