Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion

Background

Peritoneal dialysis (PD) catheter complications account for 20% of all transfers from PD to hemodialysis. One complication is outflow obstruction caused by fibrin deposits within the lumen of the catheter. Alteplase is frequently used to clear fibrin deposits in PD catheters that are refractory to other therapies. However, the literature basis for this practice is unclear.

Method

A review of the literature was conducted to determine the evidence existing for alteplase use in PD catheter occlusion due to fibrin. A literature search of MEDLINE (1967-present) was conducted using the search terms "alteplase", "peritoneal dialysis catheter", "occlusion", "fibrin", and "tissue plasminogen activator". Referenced citations were also searched for pertinent material. All data concerning the use of alteplase for peritoneal dialysis catheter occlusion were included in this review. The search resulted in 1 open-label pilot study, 3 case series, and 2 case reports of alteplase use in declotting occluded PD catheters.

Results

Based on the data, alteplase therapy cleared the occlusion of PD catheters in the majority of cases. In those that were unsuccessful, other surgically correctable and mechanical causes were identified in most cases.

Conclusion

Alteplase appears to be an intriguing alternative to the surgical removal of the PD catheter in patients with catheter occlusion due to fibrin. Although not inexpensive, it appears safe and may decrease the need for surgical correction of occluded catheters.