#3055 Efficacy and safety of recombinant tissue plasminogen activator (r-TPA) in assisted home hemodialysis: a retrospective study from Qatar

Abstract Background and Aims Qatar's national assisted home hemodialysis (AHHD) is an innovative care model developed to address the distinct challenges of elderly hemodialysis patients with limited mobility. This vulnerable patient population exhibits a high prevalence of central catheter utilization as dialysis vascular access, necessitating comprehensive management of associated complications, primarily dysfunction and infection. Many in this population have exhausted other options and required recombinant tissue plasminogen activator (r-TPA) to maintain good catheter function. This study assessed the efficacy and safety of utilizing the high-risk medication, r-TPA, as a tunneled catheter lock solution in a home healthcare setting. Method This retrospective descriptive study examines patients undergoing AHHD between January 1, 2023, and December 31, 2024. Clinical data were extracted from medical records, including demographic information, treatment specifics, and key outcomes. The primary efficacy outcomes assessed included dialysis adequacy (measured by KT/V), blood flow rate (BFR), arterial pressure average and the incidence of catheter-related bloodstream infections (CRBSI). Safety outcomes were evaluated based on the occurrence of adverse events during the study period. Results A total of 38 patients on r-TPA maintenance catheter lock were included in the study (24.5% of total AHHD patients), with a mean age of 74.5 years, reflecting the elderly population served by the program. In all instances, diluted r-TPA at a concentration of 1 mg/mL was administered, with the dose adjusted based on the catheter lumen size. Dwell times ranged between 24 and 72 hours, and patient follow-up ranged between 1 and 24 months with a mean of 9.13 months. The r-TPA successfully maintained adequate BFR >250 mL/min in 86.84 % of cases. Dialysis adequacy (measured by KT/V) remained within acceptable ranges in 86.84 % with a mean of 1.45. CRBSI occurred in 4 patients over the study period (0.19/1000 catheter days). No major adverse events were reported (allergic reaction or bleeding), and minor bleeding occurred in 5.2 % of cases. Overall, catheter replacement was required in 9 cases (23.6 %) (4 for CRBSI and 5 for persistent catheter malfunction). Conclusion The use of r-TPA as a tunneled catheter lock solution in the AHHD program demonstrated excellent efficacy and safety. The incidence of CRBSI and serious bleeding was very low, underscoring the safety of this high-risk medication in a home healthcare setting when used properly. Despite These findings, highlight the feasibility and safety of incorporating r-TPA into AHHD programs.