Citrate versus heparin lock in hemodialysis catheter’s complications; a randomized clinical trial

Abstract

Introduction: Permanent central venous catheters (CVCs) are utilized in patients undergoing chronic hemodialysis who lack alternative vascular access or are awaiting kidney transplantation or the development of a long-term vascular access. The primary complications associated with CVCs include catheter-related infections (CRIs) and catheter lumen thrombosis, collectively contributing to catheter dysfunction. Objectives: This study aimed to compare the efficacy of 4% sodium citrate and heparin lock solutions in maintaining hemodialysis catheters, focusing on catheter dysfunction and infection, coagulation parameters, and serum calcium levels. Patients and Methods: This randomized clinical trial included 58 patients undergoing chronic hemodialysis, who were randomly assigned into two parallel groups. The intervention group (Citra-Lock; n = 29) received a lock solution containing 4% sodium citrate, while the control group (Heparin-Lock; n = 29) was administered a heparin 5000 IU lock. Data regarding hemorrhagic or coagulation events (e.g., prolonged partial thromboplastin time [PTT]), infections, catheter-related obstructions, and bleeding at the catheter site were prospectively collected and analyzed in both groups. Data were analyzed using SPSS software version 27, with a P value < 0.05 considered statistically significant. Results: The male-to-female ratio in the study population was 1.52. A significant difference was observed in PTT changes between Citra-Lock and heparin-lock groups (P < 0.001). However, no significant differences were found in platelet counts or international normalized ratio (INR) levels (186750±9580 versus 175586±10424 and 1.00 versus 1.00; P = 0.247, P = 0.326 respectively). Besides, there were no statistically significant differences in catheter related complications (P = 0.669). Conclusion: In patients with durable hemodialysis catheters, the administration of a 4% sodium citrate lock solution was associated with fewer changes in PTT compared to heparin locks, without increasing the risk of infections or other catheter-related complications. Trial registration: The trial was approved by the Iranian registry of clinical trial (identifier: IRCT20231018059761N1; https://irct.behdasht.gov.ir/trial/75555, ethical code; IR.IUMS.FMD. REC.1402.459).