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Comparative effectiveness of 30 % trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters: a randomized controlled trial (CITRIM trial)

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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. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients.

Methods

Randomized, double-blind controlled trial comparing the event-free survival of non-tunneled CVC locked with heparin or TSC30 % in adult hemodialysis patients.

Results

The study included 464 catheters, 233 in heparin group, and 231 in TSC30 % group. The CRBSI-free survival of TSC30 % group was significantly shorter than that of heparin group. When stratified by insertion site, heparin was better than TSC30 % only in subclavian CVC. The dysfunction-free survival was not different between groups in the main analysis, but there is also a shorter survival among subclavian CVC locked with TSC30 % in stratified analysis.

Conclusion

There was no difference on CRBSI-free or dysfunction-free survival between jugular vein CVC locked with heparin or 30 % citrate. However, subclavian CVC locked with 30 % citrate presented shorter event-free survival. This difference may be related to anatomical and positional effects, CVC design, and hydraulic aspects of the lock solution.

ClinicalTrials.gov identifier

NCT02563041.

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Authors and Affiliations

  1. Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil

    Franklin Correa Barcellos, Luciana Jorge Valle, Thiago Lopes, Bianca Orlando, Cintia Scherer, Marcia Nunes, Gabriela Araújo Duarte & Maristela Böhlke

  2. Department of Nursing, Federal University of Pelotas, Pelotas, Brazil

    Bruno Pereira Nunes

Authors
  1. Franklin Correa Barcellos
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  2. Bruno Pereira Nunes
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  3. Luciana Jorge Valle
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Correspondence to Maristela Böhlke.

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Conflict of interest

The authors of this study have no conflict of interest. The results presented in this paper have not been published previously in whole or part, expect in abstract form. There is no funding source.

Additional information

The randomized controlled study CITRIM has compared 30 % trisodium citrate with heparin as lock solutions in 464 non-tunneled hemodialysis central venous catheters and found similar dysfunction-free survival and an increased CRBSI-free survival in heparin lock group.

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Correa Barcellos, F., Pereira Nunes, B., Jorge Valle, L. et al. Comparative effectiveness of 30 % trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters: a randomized controlled trial (CITRIM trial). Infection 45, 139–145 (2017). https://doi.org/10.1007/s15010-016-0929-4

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  • DOI: https://doi.org/10.1007/s15010-016-0929-4

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