Targeted Alteplase Administration to Improve Hemodialysis Catheter Patency: A Quality Improvement Pilot Study
Bibliographic record
Abstract
Background: Catheter dysfunction (CD) is a frequent complication during the provision of hemodialysis. Thrombolytic agents (i.e. alteplase) are the mainstay for resolving CD, however, alteplase usage has increased 16% (˜$440,000CAD) annually in the Alberta Kidney Care South program without improved patient or dialysis outcomes. We assessed the implementation of a protocolized algorithm to reduce alteplase usage. Methods: In this pilot quality improvement study, we designed an algorithm where CD was treated with high-dose (2mg) alteplase therapy to the problematic lumen only, after meeting pre-specified criteria (Fig 1). This protocol was implemented in a satellite hemodialysis unit (˜110 patients) from Jan 2021 to Mar 2021. The baseline comparison period was Jan 2020 to Dec 2020 when CD was treated with low-dose 1mg/lumen alteplase. Outcome measures included total alteplase usage, changes in Kt/V, recirculation, clearance, line interventions and hospitalization rates. Statistical analysis was completed using Mann-Whitney and Z-score calculations. Results: Sixty-nine alteplase administrations occurred over the two-month period, versus 438 in the baseline period. Patients in the 2mg group were more likely to achieve an increase in Kt/V of at least 10% in the next dialysis session (34.7% vs 28.9% p=0.04). Otherwise the 2mg alteplase with our protocol was not inferior to baseline with respect to blood volume processed (26.1% vs 20.1% p=0.13) and average clearance (37.7% vs 28.5% p=0.37). A 12% decrease (88 vs 100mg/mo p<0.05) in alteplase use was observed with no differences in frequency of hospitalizations (8% vs 5.9% p=0.39) or line interventions (12.3% vs 7.3% p=0.20). Conclusions: Our protocol with 2mg alteplase therapy to the problematic lumen was not inferior with respect to patient outcomes compared to baseline practices and resulted in lower alteplase use. An expanded multi-center prospective study is underway to further assess the broader applicability of these findings.Alteplase administration protocol.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".