Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients

Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its an...

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Bibliographic Details
Published in:	Journal of the American Society of Nephrology Vol. 16; no. 9; pp. 2769 - 2777
Main Authors:	WEIJMER, Marcel C, VAN DEN DORPEL, Marinus A, SIEGERT, Carl E. H, STAS, Koen J. F, VAN DE VEN, Peter J. G, TER WEE, Pieter M, VAN GEELEN, Jos A. C. A, GROENEVELD, Johannes O, VAN JAARSVELD, Brigitte C, KOOPMANS, Marjon G, LE POOLE, Caatje Y, SCHRANDER-VAN DER MEER, Anita M
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 01-09-2005
Subjects:	Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Infective Agents - adverse effects Anticoagulants - adverse effects Bacteremia - etiology Bacteremia - prevention & control Biological and medical sciences Catheters, Indwelling - adverse effects Citrates - adverse effects Double-Blind Method Emergency and intensive care: renal failure. Dialysis management Female Hemorrhage - etiology Hemorrhage - prevention & control Heparin - adverse effects Humans Intensive care medicine Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Renal Dialysis - adverse effects Renal Dialysis - instrumentation Renal Dialysis - methods Safety Solutions Thrombosis - etiology Thrombosis - prevention & control Human Nephrology Catheterization Hemodialysis Catheter Citrate Cardiovascular disease Anticoagulant Hemorrhage Thrombosis Urology Vascular disease Infection Prevention Extrarenal dialysis Glycosaminoglycan Complication Clinical trial Heparin Comparative study
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Summary:	Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.
ISSN:	1046-6673 1533-3450
DOI:	10.1681/asn.2004100870