SP625IS 4% CITRATE AN EFFECTIVE TOOL AS A CATHETER LOCKING SOLUTION?

Abstract

Introduction and Aims: Currently there are several catheter locking solutions, from heparin to various concentrations of citrate. Could the entrance of a new product change our usage habits? Assess patient outcomes with the use of 4% citrate. Compare with the previous catheter lock solution used in the same population. Methods: The methodology used was observational and retrospective. In 36 haemodialysis centres, from a total of 372 patients using 4% citrate as a catheter lock solution, we selected 56 patients with at least 4 months using 4% citrate and also, at least, with 4 months of previous use of another catheter lock. For the comparison, individual analyses were performed, per patient and per treatment in a total of 5819 events. Results: Average age was 75 years. Access longevity median was 37 months. 61% were Female. 50% had at least one comorbidity (cardiovascular or rheological), 45% were diabetic. Catheter insertion site was 95% jugular vein. 66% moved from 30% citrate to 4% citrate, the remaining from heparin. There were non-significant changes in the treatments outcomes: Qb from 326ml/min to 323ml/min (p=0.16); Kt/V (Online Clearance Monitor) from 1.76 to 1.75 (p=0.36). Substitution volume from 19.6L to 19.9L (p=0.09). The HCT changed from 34.9% to 34.3% ( p=0.07), and the Hb from 11.4g/dL to 11.3g/ dL ( p=0.08). The average dose of ESA administered 1.1μg/Kg/month ( p=0.29) didn't change from the first period to the second and the Iron doses varied from 119mg/Kg/ month to 139mg/Kg/month (p<0.05) in the same periods. There were also non-significant changes in the infection and inflammation direct or indirect indicators: CRP from 1.07mg/L to 1.05mg/L (P=0.27). Albumin remained 3.9g/dL (p=0.19). Leukocytes 6264 to 6283 ( p=0.47). Eosinophiles 3.3% to 3.2% (p=0.23). Use of Antibiotics, Fibrinolysis and catheter related Hospitalization was very low and with non-significant changes in both periods. Conclusions: Our study showed that with accurate catheter volume prescription, strict medical/nursing protocols and good nursing practices, 4% citrate has demonstrated to be at least not inferior, when compared to heparin and 30% citrate, as a catheter locking solution.