title: Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS).
abstract: OBJECTIVE
  Citrate 4% has antithrombotic and antibacterial properties, which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent.
  
  
  METHODS
  Sixty-one prevalent hemodialysis (HD) patients dialyzing with a tunneled cuffed HD catheter were randomized in a pilot study to receive either heparin 5000 U/ml or citrate 4% as a locking agent after HD. The primary outcomes were the development of catheter dysfunction (defined as a blood pump speed <250 ml/min or the use of tissue plasminogen activator) and catheter-associated bacteremia. The secondary outcomes were the development of an exit-site infection or bleeding complications (either local or systemic).
  
  
  RESULTS
  Citrate had comparable catheter dysfunction episodes to heparin (13/32 [41%] cases versus 12/29 [41%] cases, respectively). There were no differences in the development of catheter-associated bacteremia (2.2/1000 catheter days citrate versus 3.3/1000 catheter days heparin group; P = 0.607) or exit-site infection (2.2/1000 catheter days for both groups).
  
  
  CONCLUSIONS
  The preliminary findings from our pilot study demonstrate that 4% citrate is effective in maintaining catheter patency and does not appear to have any increased incidence of infections. Because citrate is significantly cheaper and has a more favorable side effect profile than heparin, it can be considered a potentially better locking agent in HD catheters.
authors.affiliation: Division of Nephrology, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9. jmmacrae@hotmail.com
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Macrae
authors.forename: Ivana
authors.initials: I
authors.lastname: Dojcinovic
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: Beverly
authors.initials: B
authors.lastname: Jung
authors.forename: Steven
authors.initials: S
authors.lastname: Shalansky
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002404:Catheterization / Q000009:adverse effects*; D019343:Citric Acid / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D019343:Citric Acid; D006493:Heparin