Trisodium citrate 4%--an alternative to heparin capping of haemodialysis catheters

Lok, Charmaine E.; Appleton, D.M.; Bhola, Cynthia; Khoo, Brian; Richardson, Robert

doi:10.1093/ndt/gfl570

Cited by 82 publications

(92 citation statements)

References 28 publications

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“…The cost-effectiveness of rt-PA/heparin in comparison to other locking agents, such as citrate, 10 and in comparison to other prophylactic strategies, such as the use of topical polysporin triple, or mupuricin 19 is uncertain. How might renal programs use the results of this study?…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Given these adverse outcomes and high costs, further research on strategies to optimize the use of hemodialysis catheters is required, particularly with regard to preventing the most common adverse catheter outcomes of malfunction (i.e., inability to initiate or continue dialysis because of to inadequate bloodflow, often the result of catheter thrombosis) and bacteremia. 5,6 Heparin has traditionally been used as an intradialytic catheter locking solution, although other agents are now used, including citrate 10,11 and recombinant tissue plasminogen activator (rt-PA). 12 Intradialytic locking with a thrombolytic agent has many appealing features.…”

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confidence: 99%

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An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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In a recent randomized trial, weekly recombinant tissue plasminogen activator (rt-PA), 1 mg per lumen, once per week, and twice-weekly heparin as a locking solution (rt-PA/heparin) resulted in lower risks of hemodialysis catheter malfunction and catheter-related bacteremia compared with thrice-weekly heparin (heparin alone). We collected detailed costs within this trial to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the 6-month trial. Nonparametric bootstrap estimates were used to derive 95% confidence intervals (CIs) and mean cost differences between the treatment groups. The cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. Overall, the difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was Can$323 (95% CI, 2$935 to $1581; P=0.62). When the costs were extrapolated over a 1-year time horizon using decision analysis, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. This finding was sensitive to plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term. In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin. Cost savings due to a lower risk of hospitalization for catheter-related bacteremia partially offset the increased cost of rt-PA.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Manns

Scott-Douglas²,

Ravani

et al. 2014

Journal of the American Society of Nephrology

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“…Two prospective observational studies conducted in Canada (40,41) showed either equivalence or a lower rate of TDC exchange and tPA use without a change in hospitalization for TSC 4% versus heparin. The largest experience reported is that from Grudzinski et al (42) during a conversion study from heparin 10,000 U/ml to 4% citrate locks.…”

Section: Maintaining Patency With Catheter Locking Solutions Between mentioning

confidence: 99%

Catheter Management in Hemodialysis Patients

Besarab

Pandey²

2011

Clinical Journal of the American Society of Nephrology

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SummaryOver 330,000 individuals in the United States depend on hemodialysis (HD), the majority as a result of endstage renal disease. Sustainable vascular access can be achieved through arteriovenous fistulas, arteriovenous grafts, or tunneled catheters. Tunneled dialysis catheters (TDCs) often remain in use for months or even years, long beyond their initial intended use as a bridging device. Research efforts are focused on identifying strategies to prevent/minimize the risk of the most common catheter-related complications: thrombotic occlusion and infection. Thrombotic occlusion of TDCs prevents adequate dialysis but can be managed successfully through thrombolytic agents to restore/improve blood flow in the majority of patients, allowing immediate HD delivery and prolonging usability of the TDC. Occasionally, catheter exchange with fibrin sheath disruption is needed to preserve the site. Surface-treated catheters could improve the morbidity and mortality associated with HD delivery via an indwelling catheter, but results from studies have been disappointing to date. We review the etiology of catheter-based access failure and the monitoring and interventional steps that should be taken to maintain the patency and safety of catheters for HD. Wherever possible we note the areas in which there is scant data where further randomized clinical trials are needed.

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“…Various concentrations of TSC have been used as catheter lock solutions. Lok et al investigated the clinical effectiveness, safety and cost of 4% citrate vs. heparin and found that 4% citrate lock solution had equivalent or better outcomes in terms of catheter exchange, thrombolytic use and access-related hospitalizations compared with the heparin lock solution (36). In our study, although not statistically significant, the development of thrombosis was lower in E-TSC group than heparin group (23.5% vs. 33.3%, respectively).…”

Section: Referencesmentioning

confidence: 42%

Locking of Tunneled Cuffed Hemodialysis Catheters with a Mixture of 45% Ethanol and 4% Trisodium Citrate is Effective in Preventing Catheter-Related Infections and Thrombosis

Arıkan¹,

Oymak²,

Yılmaz³

et al. 2016

Turk Neph Dial Transpl

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OBJEcTIVE: In this study, we aimed to investigate the effect of a mixture consisting of 45% ethanol and 4% trisodium citrate (E-TSC) on the development of catheter-related infection (CRI) and catheter thrombosis in hemodialysis patients. mATErIAl and mEThODS: A total of 114 patients were included in the study. Patients were separated into two groups according to the type of catheter lock solution as the E-TSC and classic heparin groups. There were 51 patients in the E-TSC group and 63 patients in the heparin group.

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Trisodium citrate 4%--an alternative to heparin capping of haemodialysis catheters

Cited by 82 publications

References 28 publications

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

An Economic Evaluation of rt-PA Locking Solution in Dialysis Catheters

Catheter Management in Hemodialysis Patients

Locking of Tunneled Cuffed Hemodialysis Catheters with a Mixture of 45% Ethanol and 4% Trisodium Citrate is Effective in Preventing Catheter-Related Infections and Thrombosis

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