Trisodium citrate 4% versus heparin as a catheter lock for non-tunneled hemodialysis catheters in critically ill patients: a multicenter, randomized clinical trial

Annals of Intensive Care

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[1] 0000 0000 8928 6711, grid.413866.e, CHRU de Strasbourg, Nouvel Hôpital Civil, Service de Réanimation Médicale, 67000, Strasbourg, France;grid.503388.5, Université de Strasbourg, UMR 1260, régénérative nanomédicine, FMTS, 67 000, Strasbourg, France;0000 0004 0593 8241, grid.411165.6, CHU de Nîmes, Service de Réanimation Médicale, 30 000, Nîmes, France;0000 0004 0638 9213, grid.411158.8, CHU de Besançon, Service de Réanimation Chirurgicale, 25000, Besançon, France;0000 0004 0638 9213, grid.411158.8, CHU de Besançon, Service de Réanimation Médicale, 25000, Besançon, France;0000 0001 2188 3779, grid.7459.f, Université de Franche-Comté, EA 3920, 25000, Besançon, France;0000 0004 0638 9213, grid.411158.8, CHU de Besançon, Service de Soins intensifs Néphrologie, 25000, Besançon, France;0000000121866389, grid.7429.8, INSERM, CIC 1432, module Epidémiologie Clinique, 21000, Dijon, France;grid.31151.37, CHU de Dijon, Centre d’Investigation Clinique, module Epidémiologie Clinique/Essais cliniques, 21000, Dijon, France;CH Belfort-Montbéliard, Service de Réanimation Polyvalente, 25200, Montbéliard, France;CH de Belfort-Montbéliard, Service de Réanimation Polyvalente, 90000, Belfort, France;CH de Bourg en Bresse, Service de Réanimation polyvalente, 01000, Bourg en Bresse, France;Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Dijon Bourgogne, B.P 77908, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France;0000 0004 4910 6615, grid.493090.7, Université Bourgogne Franche-Comté, Lipness Team UMR 1231 et LabExLipSTIC, 21000, Dijon, France;Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Dijon Bourgogne, B.P 77908, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France;0000 0004 4910 6615, grid.493090.7, Université Bourgogne Franche-Comté, Lipness Team UMR 1231 et LabExLipSTIC, 21000, Dijon, France;0000000121866389, grid.7429.8, INSERM, CIC 1432, module Epidémiologie Clinique, 21000, Dijon, France;grid.31151.37, CHU de Dijon, Centre d’Investigation Clinique, module Epidémiologie Clinique/Essais cliniques, 21000, Dijon, France;grid.31151.37, CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l’Innovation (DRCI), 21000, Dijon, France;grid.31151.37, CHU Dijon Bourgogne, Service de Néphrologie, 21000, Dijon, France;grid.31151.37, CHU Dijon Bourgogne, Service de Réanimation Neuro-Traumatologique, 21000, Dijon, France;grid.31151.37, CHU Dijon Bourgogne, Unité de Soutien Méthodologique à la Recherche (USMR), 21000, Dijon, France;grid.31151.37, Département de Pharmacie, CHU Dijon Bourgogne, 21000, Dijon, France;0000 0001 2298 9313, grid.5613.1, Université de Bourgogne Franche-Comté, LNC-UMR 1231, 21000, Dijon, France;

关键词: Citra-Lock;    Heparin;    Catheters;    Acute renal failure;    Hemodialysis;    Critical illness;   

DOI  :  10.1186/s13613-019-0553-4

来源: publisher

【 摘 要 】

BackgroundNon-tunneled hemodialysis catheters are currently used for critically ill patients with acute kidney injury requiring extracorporeal renal replacement therapy. Strategies to prevent catheter dysfunction and infection with catheter locks remain controversial.MethodsIn a multicenter, randomized, controlled, double-blind trial, we compared two strategies for catheter locking of non-tunneled hemodialysis catheters, namely trisodium citrate at 4% (intervention group) versus unfractionated heparin (control group), in patients aged 18 years or older admitted to the intensive care unit and in whom a first non-tunneled hemodialysis catheter was to be inserted by the jugular or femoral vein. The primary endpoint was length of event-free survival of the first non-tunneled hemodialysis catheter. Secondary endpoints were: rate of fibrinolysis, incidence of catheter dysfunction and incidence of catheter-related bloodstream infection (CRBSI), all per 1000 catheter-days; number of hemorrhagic events requiring transfusion, length of stay in intensive care and in hospital; 28-day mortality.ResultsOverall, 396 randomized patients completed the trial: 199 in the citrate group and 197 in the heparin group. There was no significant difference in baseline characteristics between groups. The duration of event-free survival of the first non-tunneled hemodialysis catheter was not significantly different between groups: 7 days (IQR 3–10) in the citrate group and 5 days (IQR 3–11) in the heparin group (p = 0.51). Rates of catheter thrombosis, CRBSI, and adverse events were not statistically different between groups.ConclusionsIn critically ill patients, there was no significant difference in the duration of event-free survival of the first non-tunneled hemodialysis catheter between trisodium citrate 4% and heparin as a locking solution. Catheter thrombosis, catheter-related infection, and adverse events were not statistically different between the two groups.Trial registration Registered with Clinicaltrials.gov under the number NCT01962116. Registered 14 October 2013.

【 授权许可】

CC BY