Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients

Marcel C. Weijmer, Marinus A. Van Den Dorpel, Peter J.G. Van De Ven, Pieter M. Ter Wee, Jos A.C.A. Van Geelen, Johannes O. Groeneveld, Brigitte C. Van Jaarsveld, Marjon G. Koopmans, Caatje Y. Le Poole, Anita M. Schrander-Van Der Meer, Carl E.H. Siegert, Koen J.F. Stas

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.

Original languageEnglish
Pages (from-to)2769-2777
Number of pages9
JournalJournal of the American Society of Nephrology
Volume16
Issue number9
DOIs
Publication statusPublished - 1 Dec 2005

Cite this

Weijmer, M. C., Van Den Dorpel, M. A., Van De Ven, P. J. G., Ter Wee, P. M., Van Geelen, J. A. C. A., Groeneveld, J. O., ... Stas, K. J. F. (2005). Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. Journal of the American Society of Nephrology, 16(9), 2769-2777. https://doi.org/10.1681/ASN.2004100870
Weijmer, Marcel C. ; Van Den Dorpel, Marinus A. ; Van De Ven, Peter J.G. ; Ter Wee, Pieter M. ; Van Geelen, Jos A.C.A. ; Groeneveld, Johannes O. ; Van Jaarsveld, Brigitte C. ; Koopmans, Marjon G. ; Le Poole, Caatje Y. ; Schrander-Van Der Meer, Anita M. ; Siegert, Carl E.H. ; Stas, Koen J.F. / Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. In: Journal of the American Society of Nephrology. 2005 ; Vol. 16, No. 9. pp. 2769-2777.
@article{37f42e9f99a94a70bfbea85a3564905c,
title = "Randomized, clinical trial comparison of trisodium citrate 30{\%} and heparin as catheter-locking solution in hemodialysis patients",
abstract = "Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30{\%} was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46{\%} of catheters had to be removed because of any complication compared with 28{\%} in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87{\%} (P < 0.001) and for untunneled catheters was 64{\%} (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30{\%} improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.",
author = "Weijmer, {Marcel C.} and {Van Den Dorpel}, {Marinus A.} and {Van De Ven}, {Peter J.G.} and {Ter Wee}, {Pieter M.} and {Van Geelen}, {Jos A.C.A.} and Groeneveld, {Johannes O.} and {Van Jaarsveld}, {Brigitte C.} and Koopmans, {Marjon G.} and {Le Poole}, {Caatje Y.} and {Schrander-Van Der Meer}, {Anita M.} and Siegert, {Carl E.H.} and Stas, {Koen J.F.}",
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Weijmer, MC, Van Den Dorpel, MA, Van De Ven, PJG, Ter Wee, PM, Van Geelen, JACA, Groeneveld, JO, Van Jaarsveld, BC, Koopmans, MG, Le Poole, CY, Schrander-Van Der Meer, AM, Siegert, CEH & Stas, KJF 2005, 'Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients' Journal of the American Society of Nephrology, vol. 16, no. 9, pp. 2769-2777. https://doi.org/10.1681/ASN.2004100870

Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. / Weijmer, Marcel C.; Van Den Dorpel, Marinus A.; Van De Ven, Peter J.G.; Ter Wee, Pieter M.; Van Geelen, Jos A.C.A.; Groeneveld, Johannes O.; Van Jaarsveld, Brigitte C.; Koopmans, Marjon G.; Le Poole, Caatje Y.; Schrander-Van Der Meer, Anita M.; Siegert, Carl E.H.; Stas, Koen J.F.

In: Journal of the American Society of Nephrology, Vol. 16, No. 9, 01.12.2005, p. 2769-2777.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients

AU - Weijmer, Marcel C.

AU - Van Den Dorpel, Marinus A.

AU - Van De Ven, Peter J.G.

AU - Ter Wee, Pieter M.

AU - Van Geelen, Jos A.C.A.

AU - Groeneveld, Johannes O.

AU - Van Jaarsveld, Brigitte C.

AU - Koopmans, Marjon G.

AU - Le Poole, Caatje Y.

AU - Schrander-Van Der Meer, Anita M.

AU - Siegert, Carl E.H.

AU - Stas, Koen J.F.

PY - 2005/12/1

Y1 - 2005/12/1

N2 - Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.

AB - Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, double-blind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P = 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P = 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P = 0.028). There were no differences in catheter flow problems and thrombosis (P = 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P = 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.

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