Low concentration trisodium citrate as a non-inferior locking agent for non-tunneled dialysis catheters in the Asian Setting

Low concentration trisodium citrate as a non-inferior locking agent for non-tunneled dialysis catheters in the Asian Setting

Introduction: Unfractionated heparin is the commonly used catheter lock solution in patients with temporary dialysis catheters as hemodialysis access. The effectiveness of trisodium citrate as an alternate catheter lock agent has not been studied in Asian population. Methods: In this prospective qua...

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Published in:Indian journal of nephrology Vol. 29; no. 6; pp. 410 - 414
Main Authors: Jayaprakash, Varadharajan, Jagadeswaran, Dhakshinamoorthy, Ezhilmathi, Krishnamoorthy, Sathiapriya, Arumugam, Vamsikrishna, Makkena, Indhumathi, Elayaperumal, Jayakumar, Matcha
Format: Journal Article
Language:English
Published: India Wolters Kluwer India Pvt. Ltd 01-11-2019
Medknow Publications and Media Pvt. Ltd
Scientific Scholar
Wolters Kluwer - Medknow
Subjects:
Anticoagulants
Blood clots
Catheters
Comorbidity
Diabetes
Health aspects
Hemodialysis
Infection
Infections
Medical research
Mupirocin
Nephrology
Original
Pharmacy
Population
Statistical analysis
Studies
South Asia
Central venous catheter
citrate lock
heparin lock
cost effectiveness
CRBSI
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Summary:Introduction: Unfractionated heparin is the commonly used catheter lock solution in patients with temporary dialysis catheters as hemodialysis access. The effectiveness of trisodium citrate as an alternate catheter lock agent has not been studied in Asian population. Methods: In this prospective quasi-experimental study, which included 180 patients with central venous dialysis catheter, patients were randomly allotted to citrate 4.67% and heparin 5000 units/ml arms in the ratio of 2:1. Baseline demographic and dialysis related data, incidence of catheter-related bloodstream infections, and mean catheter days in both the study cohorts were collected and compared. Formal cost analysis for citrate 4.67% use as catheter lock was done. Results: The mean age of the total study population was 50.49 ± 14.87 years. Sixty-six females (36.7%) and 80 (44.4%) diabetic patients were included in the study. The overall incidence of catheter-related bloodstream infection (CRBSI) was 11.11%. The majority had nontunneled dialysis catheters (95%; n = 114). On analyzing the data of patients with nontunneled catheters, it was found that the total number of catheter days for the citrate and heparin groups were 4,795 and 2,419 days, respectively. The number of CRBSI episodes per 1,000 catheter days for the citrate and heparin groups were 2.711 and 2.89, respectively. Citrate catheter lock cost only 6% of that of heparin lock. Conclusions: The incidence of catheter related bloodstream infections was comparable between the heparin and citrate 4.67% lock cohorts. The use of low concentration citrate as catheter lock was cost-effective when compared with heparin.
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ISSN:0971-4065
1998-3662
DOI:10.4103/ijn.IJN_360_18