Alteplase v.s. Trisodium Citrate and Infection and Obstruction Incidence of Permanent Tunneled Dialysis Catheters

This study is testing whether using a clot-dissolving drug called alteplase as a lock solution in dialysis catheters once a week can reduce the rate of serious infections and blockages compared to the standard solution (trisodium citrate). People on kidney dialysis often have a permanent catheter (tube) inserted into a large vein, and these catheters can sometimes get blocked or infected. Participants will be randomly assigned to receive either alteplase or the standard solution to lock their catheter between dialysis sessions. You may be eligible if: - You have end-stage kidney disease - You have recently had a permanent tunneled dialysis catheter inserted - You receive dialysis three times a week - You are willing to take part in the trial You may NOT be eligible if: - You are on blood thinners and your INR is above 1.4 - Your platelet count is below 60 x 10^9/L - Your catheter is inserted in the groin (femoral) vein - Your catheter was inserted over a guidewire exchange - You have active pericarditis with fluid around the heart - You are allergic to alteplase or trisodium citrate - You are pregnant or breastfeeding Talk to your doctor about whether this trial might be right for you.