Comparison of trisodium citrate and heparin as catheter-locking solution in hemodialysis patients.

INTRODUCTION The high incidence of patients beginning dialysis treatment with venous catheters, as well as the growing number of patients with permanent catheter access, has increased catheter- related blood infections and their consequences. Thus the search for substances with anticoagulant properties that also prevent catheter contamination is necessary. OBJECTIVE This study aimed at comparing heparin and trisodium citrate used as long-term catheter locking solutions regarding the occurrence of pyrogenic reaction, bacteremia, infection- related hospitalizations, thrombosis, and death. METHODS Retrospective study on the infection data from the Infection and Adverse Event Prevention Control Program registry, which included all hemodialysis patients using long-term catheters from April, 2006 to March, 2008. During the first 365 days, catheters were locked with heparin (Heparin group) and, during the following 365 days, with 46.7% trisodium citrate (Citrate group). Sixty-five patients were included in the study using 92 catheters. The groups were compared regarding the occurrence of pyrogenic reaction, bacteremia, hospitalization, catheter thrombosis, and death. RESULTS The catheter-related bacteremia episodes were significantly lower and hospitalization time was significantly shorter in the Citrate group when compared with those in the Heparin group. A tendency towards a lower occurrence of access site infection-related hospitalization was observed in the Citrate group (p = 0.055), and no difference was observed in catheter thrombosis leading to dysfunction between groups. Bacteremia-free and hospitalization-free times were longer in the Citrate group. The occurrence of bacteremia was associated with the presence of diabetes and heparin use. In multivariate analysis, being in the Heparin group was the only factor associated with bacteremia. CONCLUSION The use of 46.7% citrate solution effectively reduced bacteremia episodes and hospitalization in chronic kidney disease patients on hemodialysis with long-term catheters.