RESUMO
Heparin is used as an interdialytic locking solution for hemodialysis (HD) central venous catheters (CVCs). The purpose of this study was to compare effectiveness of two heparin concentrations (10,000 and 1,000 U/mL) in preventing catheter malfunction. We compared two time periods: a 6-month period with heparin 10,000 U/mL and a 3-month period with heparin 1,000 U/mL. Adults on HD using a CVC (tunneled or untunneled) in Calgary, Alberta, were included. The primary outcome was catheter malfunction. A total of 139 and 134 patients in the heparin 10,000 and 1,000 U/mL periods, respectively, were included. The crude rate of catheter malfunction, per 1,000 HD sessions, was similar for heparin 10,000 (7.6; 95% CI, 5.3 to 10.8) and 1,000 (6.7; 95% CI, 4.3 to 10.3) U/mL periods, respectively (p = 0.76). After adjusting for CVC characteristics and use of recombinant tissue plasminogen activator (rt-PA), there was no association between heparin concentration and CVC malfunction (hazard ratio, 0.77; 95% CI, 0.37 to 1.61). In conclusion, the use of a lower concentration of heparin was not associated with an increased risk of catheter malfunction but may be associated with greater rt-PA use. The association between heparin concentration and rt-PA use requires further study.
Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Heparina/administração & dosagem , Heparina/efeitos adversos , Diálise Renal , Idoso , Anticoagulantes/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Falha de Equipamento/estatística & dados numéricos , Feminino , Fibrinolíticos/uso terapêutico , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Heparina/uso terapêutico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Reprodutibilidade dos Testes , Medição de Risco , Soluções , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
Repeated episodes of headache and muscle cramp were hypothesized to contribute to increased patient perceptions of illness intrusiveness and to compromised quality of life. Standard measures of pain, illness intrusiveness, and quality of life were obtained on 2 occasions, each 6 weeks apart, from 100 end-stage renal disease patients. The impact of recurrent muscle cramps on perceptions of illness intrusiveness was conditional upon the occurrence of headache symptoms. Perceptions of illness intrusiveness were significantly higher when both muscle cramp and headache symptoms occurred during one or more assessment intervals as compared to when muscle cramps or headaches, only, occurred. Illness-related concerns and general feelings of pessimism were also significantly higher among patients who experienced recurrent episodes of muscle cramp. Although no direct relations were observed between pain and other quality of life indicators, previous research has documented a relation between illness intrusiveness and quality of life. Recurrent pain problems, thus, appear to contribute to increased illness intrusiveness and to reduced quality of life in end-stage renal disease patients.