Diabetes decreases patency of tunneled catheters in hemodialysis patients after first effective thrombolysis with urokinase

Abstract

Introduction: Fibrinolysis is one of the methods extending the use of vascular access in patients with tunneled venous catheters thrombosis. The aim of this study was to assess one-year maintenance of tunneled catheters patency after first effective thrombolysis with urokinase and identify its predictors.Methods: Retrospective analysis included 85 patients (age 69 ± 13 years) with permanent venous catheter thrombosis treated with urokinase at one center in the period 2010–2016. Urokinase was used (depending on weight) at a dose of 10,000 or 20,000 IU in an 8 h infusion to each catheter line. Assessment of one-year efficacy of fibrinolysis included the time between fibrinolysis and following thrombosis of the same catheter in patients that have previously obtained at least partial blood flow. The analysis included medication, comorbidities, catheter patency time and INR value during first thrombosis episode.Results: There were 62.4% patients with type-2 diabetes and 11.8% with neoplasm. The thrombolysis procedure was effective in 73 patients (85.9%). An analysis of the one-year efficacy of thrombolysis procedure included 73 patients. Among them, 23 experienced next episode of catheter-related thrombosis within a year postprocedure. Diabetes increased the risk for recurrent thrombosis [HR =3.19 (1.09-9.41); p = .03].Conclusions: Patients with diabetes are at higher risk of recurrent catheter-related thrombosis and therefore may require more aggressive anticoagulation therapy for its prevention.

Outcomes of Tunneled Dialysis Catheter In Hemodialysis Patients In A Tertiary Care Hospital

“…A similar study from India reported that during three years period total 45% catheters of which majority were electively removed due to death with functioning catheter, switch to AVF and renal transplant [19]. Increasing age and diabetes were documented as independent factors negatively affecting catheter patency but our data did not suggest any such association [21,33].…”

Impacts of age, diabetes, gender, and access type on costs associated with vascular access among Chinese patients on hemodialysis

“…Hence these studies might not be of much help for long-term medical planning and future resource allocation. Although age, 8,9 diabetes 10,11 and gender 12,13 are well recognized as the risk factors for maturation and function of VA, studies on whether these factors increase the VA associated economic burden are scarce.…”

A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis

“…Second, there were more diabetes mellitus patients at baseline of demographic characteristics in the sodium bicarbonate group compared with the heparin group (66.7% vs 42.6%, P = .01; Table 1 ). Wójtowicz et al 26 showed that diabetes mellitus was one of the poor predictors of catheter survival (HR = 0.31, 95% CI = 0.11-0.92, P = .03) due to its pro-thrombotic state. This could be explained by endothelial injury, hyperfibrinogenemia, and platelet hyperreactivity related to increased glucose levels as well as hyperinsulinemia.…”