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A hemostasis study in CAPD patients during fibrinolytic intraperitoneal therapy with urokinase (UK)
P Strippoli1, D Pilolli, G Mingrone
1Renal Unit, S.S. Annunziata Reg. Hospital, Taranto, Italy.
Insights
Urokinase (UK) effectively clears fibrin obstructions in continuous ambulatory peritoneal dialysis (CAPD) catheters, restoring fluid outflow and preventing peritonitis without adverse effects.
Area of Science:
- Nephrology
- Vascular Access Management
- Peritoneal Dialysis
Background:
- Fibrin deposits commonly obstruct Continuous Ambulatory Peritoneal Dialysis (CAPD) catheters.
- This obstruction leads to poor peritoneal fluid outflow and recurrent peritonitis, complicating patient management.
Purpose of the Study:
- To evaluate the safety and efficacy of Urokinase (UK) in treating fibrin-induced CAPD catheter obstruction.
- To assess UK's impact on restoring catheter function and preventing subsequent peritonitis episodes.
Main Methods:
- Ten CAPD patients with fibrin-obstructed catheters received 75,000 IU of diluted Urokinase (UK) infusion.
- A 2-liter peritoneal fluid exchange was performed 60 minutes post-infusion.
- Hemostasis and blood cell parameters were monitored before and after UK infusion.
Main Results:
- All patients experienced restored normal catheter outflow after UK treatment.
- No significant adverse reactions or hematological changes were observed, apart from a transient, normal decrease in white blood cells.
- No peritonitis episodes occurred during the follow-up period.
Conclusions:
- Urokinase (UK) fibrinolytic therapy is a safe and effective treatment for fibrin obstruction in CAPD catheters.
- This approach successfully restores catheter function, avoids catheter removal, and prevents recurrent peritonitis.
Abstract:
Catheter obstruction due to fibrin deposits during CAPD can cause poor outflow of peritoneal fluid and recurrent peritonitis. In order to treat this complication, 75,000 IU of diluted Urokinase (UK) were infused into catheters obstructed by fibrin in 10 CAPD patients (4 of which had peritonitis), without adverse reactions. After 60 minutes, a 2 liter exchange of peritoneal fluid was performed. In all the cases a normal outflow was restored. Hemostasis parameters (PT, PTT, TT, Fibrinogen, FDP, Fibrin monomers, BT, AT III) and blood cells count (RBC, HGB, HCT, WBC, PTL), were assayed before and two hours after the UK infusion, and did not show any significant variation, except for a decrease of white blood cells, which remained, however, within the normal range. No peritonitis episode occurred in the follow-up period. UK fibrinolytic therapy is safe and effective in treating fibrin obstruction of CAPD catheters without catheter removal and prevents recurrent peritonitis.