Hemodialysis: Diabetes decreases catheter patency
Hemodialysis (HD) patients for whom arteriovenous fistula formation is not recommended or in whom several attempts to create a workable arteriovenous fistula have failed often receive tunneled catheters as a permanent vascular access.
The most common complication associated with this approach is catheter-related thrombosis; fibrinolysis is one of the methods used to extend the use of vascular access in patients with this complication. In the present retrospective analysis, Polish nephrologists at the Medical University of Silesia aimed to assess one-year maintenance of tunneled catheters patency after first effective thrombolysis with urokinase (Wójtowicz D et al, Diabetes decreases patency of tunneled catheters in hemodialysis patients after first effective thrombolysis with urokinase; Ren Fail. 2018 Nov;40(1):384-389).
The study included 85 patients with permanent venous catheter thrombosis treated with urokinase (dosage depending on weight: 10,000 or 20,000 IU in an 8 h infusion to each catheter line). 62.4 percent of patients had type-2 diabetes, 11.8 percent had been diagnosed with neoplasm. The authors evaluated 1-year efficacy of fibrinolysis by assessing the time between fibrinolysis and following thrombosis of the same catheter.
The thrombolysis procedure was effective in 73 patients. 23 patients experienced an episode of catheter-related thrombosis within a year after the procedure. Diabetes increased the risk for recurrent thrombosis more than threefold (HR =3.19; p = 0.03).
The authors warn that patients with diabetes have a significantly higher risk of recurrent catheter-related thrombosis and consequently a decreased one-year catheter survival. These patients may therefore require more aggressive anticoagulation therapy.
Link to the study: https://www.tandfonline.com/doi/full/10.1080/0886022X.2018.1487856