A Randomized Controlled Clinical Trial of Trisodium Citrate 30% versus Heparin as a Lock Solution for the Prevention of Catheter-Related Infections in Adult Hemodialysis Patients

Abstract

Abstract Background Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. Interdialytic hemodialysis catheter-locking solutions could contribute to reduction of catheter-related complications, especially infections. Aim of the Work To assess the possible effect of using Trisodium citrate 30% (TSC 30%) in comparison to unfractionated heparin, as a lock solution for hemodialysis catheters, on inflammatory status in HD patients Patients and Methods This was a randomized controlled clinical trial, conducted on 70 patients on regular hemodialysis, selected from hemodialysis unit in Nasser Institute Hospital in Cairo government, divided into two groups: (Citrate Group); 35 patients received trisodium citrate, (Heparin Group); 35 patients received unfractionated heparin (5000i.u) as a hemodialysis lock solution after the end of HD session and followed up for 3 months. Result In our study, the catheter-related bacteremia episodes were significantly lower in the Citrate group when compared with those in the Heparin group. Only 2 patients (5.7%) in Citrate group had CRBSI, whereas in Heparin group, 8 patients (22.9%) had CRBSI (P = 0.04). Also, Bacteremia-free time was longer in the Citrate group. The mean bacteremia free time in Citrate group was 10.97 ± 2.36 weeks, while in Heparin group it was 9.43 ± 3.91 weeks (P = 0.032). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.596) and WBCs (P = 0.528). While after 3 months of using TSC 30% as a lock solution, there was a significant difference as regards levels of hsCRP (P = 0.030) and WBCs (P = 0.036), with the higher levels of inflammatory markers showed in Heparin group. There was no difference between the two studied groups regarding thrombosis, however, catheter performance was higher in citrate group after 3 months assessed by URR (P = 0.005) compared to baseline (P = 0.108), Conclusion We found that Trisodium citrate 30% may be a better alternative to heparin as a catheter lock solution as it reduces the inflammatory markers and CRBSI incidence. We therefore believe that TSC 30% may be used safely as catheter lock solution in Hemodialysis