Efficacy of 5%, 10% Trisodium Citrate and Heparin as Catheter-Locking Solution for Central Venous Hemodialysis Catheters: A Prospective Randomized Controlled Study

Abstract

Background: The use of central venous catheter (CVC) is inevitable for hemodialysis in acute kidney injury (AKI) and in end-stage renal disease patients when arteriovenous fistula (AVF) is ineligible. The catheter-locking anticoagulant (CLA) is mandatory for maintaining the patency of CVCs. Trisodium citrate (TSC) is an alternative CLA to unfractionated heparin (UFH). However, the optimal concentration of TSC that yield the best efficacy and safety remains questionable. Objective: To evaluate the efficacy of 5%, 10% TSC and UFH as CLA for CVCs. Materials and Methods: The present study was a randomized controlled study of patients with non-tunneled cuffed catheters (NTCC) and tunneled cuffed catheters (TCC). Patients were stratified according to types of CVCs and randomized to receive UFH, 5%, and 10% TSC as a CLA for three months. The primary outcome was the development of catheter dysfunction (CD), defined as a persistent inability to obtain blood flow rate of 250 mL or more per minute despite flushing and repositioning the patient, or the use of recombinant tissue plasminogen activator. The secondary outcomes are the rates of catheter-related bloodstream infection (CRBSI), exit-site infection (ESI), bleeding, and all-cause death. Results: Three hundred forty patients were randomized, and 249 were analyzed. One hundred thirty-four patients were in the NTCC group , and 115 were in the TCC group. There were 83, 79, and 87 patients in UFH, 5%, and 10% TSC group. The CD rates were 2.2, 1.6, and 1.2 per 1,000 catheter-day in UFH, 5% and 10% TSC groups. Compared to UFH group, the incidence rate ratio (IRR) of CD in 5% and 10% TSC group were 0.74 (p=0.55) and 0.55 (p=0.24). The IRR for CRBSI, ESI, and all-cause death were not significantly different to UFH group in both types of TSC. There was no serious adverse events and major bleeding episodes. Conclusion: The efficacy and safety of UFH, 5% TSC, and 10% TSC as CLA were not significantly different. Keywords: Catheter-locking anticoagulant, Citrate, Hemodialysis