P52
LOW DOSE UROKINASE INFUSION TO RESTORE THE PATENCY OF TUNNELED
CENTRAL VEIN HAEMODIALYSIS CATHETERS
Georgios Spanos, Seema Singh, Rawya Charif, Adam McLean, Andrew Frankel, Elaine
Clutterbuck, Damien Ashby, Jeremy Levy, Neill Duncan
Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College
Healthcare NHS Trust, London
Background: Catheter dysfunction is common, results in inadequate haemodialysis treatment
and remains a significant cause of catheter loss and interrupted haemodialysis sessions. A
number of regimes using urokinase infusion have been used but optimum management remains
undetermined.
The purpose of this study was to evaluate the West London Renal Transplant Centre’ s policy of
a low dose (12500 units over a period of 3 hours, per lumen) urokinase infusion in the clearance
of poorly functioning tunneled haemodialysis catheters (blood flow rate <350ml/min and
spkt/v<1.6).
Methods: We retrospectively analysed all the cases of poorly functioning catheters that were
admitted on our planned investigation unitfrom April 2011 until October 2014.
Results: One hundred thirty admissions, 99 patients (51 female) had urokinase infusion. The
infusion resulted in an improvement in blood flow rate (262.6 ± 74 vs 322 ± 85.6ml/min,
p=0.001) and spkt/v (1.32 ± 0.43 vs 1.57 ± 0.55, p=0.001). Ten patients needed a second
infusion within 6 weeks, (6 of them within a week).Sixty patients needed a central venous
catheterexchange; median (IQR) 40.5 (16/115) days post urokinase infusion. Ten of those 60
patients had additional indication of catheter removal (catheter related infection or cuff
dislocation).Thirty-nine patients had fully restored catheter patency after the low dose urokinase
infusion.No adverse reactions to urokinase were seen,no bleeding nor allergic reactionsin any
patient.
Overall the catheter survival was 46.9% with a median (IQR) follow-up of 102.5 (30/434.5)
days. But when patients where divided in to two groups according to the blood flow, patients
whose blood flow was above 250ml/min had a significant higher catheter survival rate (37%
versus 56.1%, p=0.011) and the risk of catheter exchange was 49% lower, HR 0.51, (95%
CI:0.29-0.89)
Conclusion: Our results are in accordance to the existing literature. A 3-hour low dose
urokinase infusion of 12500 units in each lumen can safely salvage function of obstructed
catheters that otherwise may require urgent replacement. Patients with low blood flow are more
likely to need exchange.