SP429CITRATE-BASED LOCKINGSOLUTIONS ARE MORE EFFICIENT THAN TAUROLIDINE-BASED LOCKING SOLUTIONS TOPREVENT THROMBOTIC DYSFUNCTION OF TUNNELLED HEMODIALYSIS CATHETERS: ARETROSPECTIVE COHORT STUDY

Abstract

Introduction and Aims: The optimal catheter lock to prevent thrombotic dysfunction of tunnelled cuffed hemodialysis catheters (TCC) remains controversial. The aim of the present study was to compare the incidence rate of thrombotic dysfunction and loss of TCC treated with citrate- or taurolidine-based locking solutions. Methods: Retrospective cohort analysis of incidence and treatment of thrombotic TCC dysfunction in adult hemodialysis patients. Data were prospectively collected since 01/ 05/2010. From 01/05/2010 until 31/07/2012 Citra-Lock™ 30% (Citra-L) was used as a locking solution and replaced since 01/08/2012 with TauroLock™-Hep500 (Tauro-L). The observation period ended on 31/10/2014. Thrombotic dysfunction was retrospectively defined as the use of Urokinase (Actosolv®) instillation. Catheter loss due to thrombosis was defined as thrombotic dysfunction unresponsive to thrombolytic therapy and requiring catheter replacement. Results: A total of 251 patients received hemodialysis using a total of 346 TCC. 236 (68.2%) TCC experienced 764 episodes of thrombotic dysfunction during the study period. Under Citra-L (70325 days at risk), 252 episodes of thrombotic dysfunction occurred (3.58/1000 catheter days; 95% CI 3.17-4.05), whereas under Tauro-L (67140 days at risk), 512 episodes occurred (7.63/1000 catheter days; 95% CI 6.99-8.31). The rate ratio was 0.47 (95% CI 0.40-0.55; P<0.0001), corresponding to an incidence rate reduction of thrombotic dysfunctions by 53% with Citra-L. The rate of catheter loss due to thrombotic dysfunction was 0.15/1000 catheter days (95% CI 0.08-0.27) under Citra-L and 0.28/1000 catheter days (95% CI 0.18-0.43) under Tauro-L (rate ratio of 1.84 (0.89 to 3.81; P=0.1). The rate of catheter-related bacteremia was 0.29/1000 catheter days with both locks (P=0.99). Conclusions: The use of Citra-Lock™ 30% is associated with a 53% reduction in the incidence rate of thrombotic dysfunction of tunneled hemodialysis catheters as compared to TauroLock™-Hep500. There were no significant differences in the incidence rates of catheter loss and catheter related bacteremia.