Comparative efficacy of low-concentration trisodium citrate and low-concentration heparin for locking central venous hemodialysis catheters: a randomized controlled study.

In 30 seconds

This randomized controlled study compared 5% trisodium citrate (TSC) with unfractionated heparin (UFH) 1,000 U/mL as locking solutions in 204 patients receiving hemodialysis through central venous catheters. At 180 days, catheter dysfunction rates were 1.11 and 1.73 per 1,000 catheter-days, respectively; the difference was not statistically significant (incidence rate ratio 1.55, 95% CI 0.72–3.45; p = 0.23). Catheter-related bloodstream infection, exit-site infection, bleeding, and mortality were also comparable overall. A possible reduction in infectious complications with TSC was observed only in the tunneled cuffed catheter subgroup.

Key findings

• At 180 days, catheter dysfunction rates were 1.11 with TSC and 1.73 with UFH per 1,000 catheter-days (incidence rate ratio 1.55, 95% CI 0.72–3.45; p = 0.23).
• Overall, catheter-related bloodstream infection and exit-site infection rates were comparable between groups.
• Bleeding and mortality did not differ significantly between the TSC and UFH groups.
• In the tunneled cuffed catheter subgroup, exit-site infection was higher with UFH, while catheter dysfunction remained not significantly different.

Why it matters

Catheter dysfunction and infectious or bleeding complications can affect the safety and continuity of hemodialysis. This trial provides a direct comparison of two low-concentration catheter-locking options and found no significant overall differences in the measured outcomes. The subgroup infection finding may be relevant to further evaluation, but does not establish a general advantage for either solution.

What to keep in mind

The abstract reports a 180-day follow-up; longer-term outcomes are not described. The possible infection difference was confined to a catheter subgroup.