Abstract
IntroductionTo prevent infection and thrombosis of central venous catheters (CVCs) in hemodialysis patients, different CVC lock solutions are available. Taurolidine-based solutions and citrate in different concentrations are frequently used, but no definite conclusions with regard to superiority have been drawn.MethodsIn this retrospective, observational, multicenter study, we aimed to assess the risk for removal of CVC due to infection or catheter malfunction in hemodialysis patients with CVC access for different lock solutions: taurolidine, high-concentrated citrate (46.7%) and low-concentrated citrate (4 or 30%). A multivariable Cox-regression model was used to calculate hazard ratio’s (HR).ResultsWe identified 1514 patients (median age 65 years, 59% male). In 96 (6%) taurolidine-based lock solutions were used. In 1418 (94%) citrate-based lock solutions were used (high-concentrated 73%, low-concentrated 20%). Taurolidine-based lock solutions were associated with a significantly lower hazard for removal of CVC due to infection or malfunction combined (HR 0.34, 95% CI 0.19–0.64), and for removal of CVC due to infection or malfunction separately (HR 0.36, 95% CI 0.15–0.88 and HR0.33, 95% CI 0.14–0.79). High-concentrated citrate lock solutions were not associated with a decreased hazard for our outcomes, compared to low-concentrated citrate lock solutions.ConclusionRemoval of CVC due to infection or catheter malfunction occurred less often with taurolidine-based lock solutions. We present the largest cohort comparing taurolidine- and citrate-based lock solutions yet. However, due to the retrospective observational nature of this study, conclusions with regard to superiority should be drawn with caution.
Highlights
To prevent infection and thrombosis of central venous catheters (CVCs) in hemodialysis patients, different Central venous catheters (CVC) lock solutions are available
We aimed to evaluate the efficacy of taurolidine- and citrate-based lock solutions in reducing the risk of infectious complications and catheter malfunction in a large cohort of patients with CVC for hemodialysis
If patients objected against use of their medical record for research purposes, if a CVC was used for continuous venovenous hemofiltration or if the patient underwent hemodialysis in a non-participating center during the CVC period, they were not included in the database
Summary
To prevent infection and thrombosis of central venous catheters (CVCs) in hemodialysis patients, different CVC lock solutions are available. In patients with kidney failure, arteriovenous fistulas (AVF) are first choice option for vascular access for hemodialysis [1]. CVC are associated with an increased risk for infectious complications and catheter malfunction, when compared to AVF [2]. Infections are the leading cause of catheter removal and contribute significantly to morbidity and mortality in hemodialysis patients [2, 3]. The risk for bloodstream infections is over fifteen-fold increased in patients with CVC access, compared to patients with AVF access [2]. Besides the risk for infectious complications, catheter malfunction is a frequent problem in hemodialysis with CVC as vascular access. Mortality is higher in patients with CVC in comparison to those with grafts and fistulas, this may be due to other factors such as the general condition and comorbidity [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
