Results of a clinical trial reported in the New England Journal of Medicine suggest that the use of recombinant tissue plasminogen activator as a lock solution improves catheter patency and reduces the risk of catheter-related infections. These effects have important clinical and economic ramifications. So why is tissue plasminogen activator not more widely used?
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Hemmelgarn, B. R. et al. for the Prevention of Dialysis Catheter Lumen Occlusion with rt-PA versus Heparin (PreCLOT) Study Group. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N. Engl. J. Med. 364, 303–312 (2011).
Schenk, P., Rosenkranz, A. R., Wölfl, G., Hörl, W. H. & Traindl, O. Recombinant tissue plasminogen activator is a useful alternative to heparin in priming Quinton Permcath. Am. J. Kidney Dis. 35, 130–136 (2000).
US Renal Data System. USRDS 2010 Annual Data Report: Atlas of chronic kidney disease and end-stage renal disease in the United States [online], (2010).
Moist, L. M., Trpeski, L., Na, Y. & Lok, C. E. Increased hemodialysis catheter use in Canada and associated mortality risk: data from the Canadian Organ Replacement Registry 2001-2004. Clin. J. Am. Soc. Nephrol. 3, 1726–1732 (2008).
Besarab, A. & Pandy, R. Catheter management in hemodialysis patients: delivering adequate flow. Clin. J. Am. Soc. Nephrol. 6, 227–234 (2011).
Raad, I. I. et al. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 271, 1014–1016 (1994).
Vascular Access Work Group. Clinical practice guidelines for vascular access. Am. J. Kidney Dis. 48 (Suppl. 1), S176–S273 (2006).
Jaffer, Y., Selby, N. M., Taal, M. W., Fluck, R. J. & McIntyre, C. W. A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am. J. Kidney Dis. 5, 233–241 (2008).
Rocco, M. V., Bleyer, A. J. & Burkart, J. M. Utilization of inpatient and outpatient resources for the management of hemodialysis access complications. Am. J. Kidney Dis. 28, 250–256 (1996).
Manierski, C. & Besarab, A. Antibiotic and antimicrobial locks: putting the lock on catheter infections. Adv. Chronic Kidney Dis. 13, 245–258 (2006).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Besarab, A., Moore, C. Two for the price of one: is rt-PA ready for prime time?. Nat Rev Nephrol 7, 310–311 (2011). https://doi.org/10.1038/nrneph.2011.54
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2011.54