title: Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial.
abstract: OBJECTIVE
  Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock in chronic hemodialysis patients suggest it may be efficacious in preventing infection and thrombotic complications. We compared sodium citrate with saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adult patients. Primary endpoint was catheter life span without complication.
  
  
  METHODS
  This was a randomized, controlled, open-label trial involving intensive care patients with acute renal failure requiring hemodialysis. Events were defined as catheter-related bloodstream infection and catheter malfunction.
  
  
  RESULTS
  Seventy-eight patients were included. Median catheter life span without complication was 6 days (saline group) versus 12 days (citrate group) [hazard ratio (HR) 2.12 (95% CI 1.32-3.4), p = 0.0019]. There was a significantly higher rate of catheter malfunction in the saline group compared with in the citrate group (127 catheter events/1,000 catheter-days, saline group vs. 26 events/1,000 catheter-days, citrate group, p < 0.00001). There was no significant difference in incidence of infections between groups. We observed a significantly longer time to occurrence of infection in the citrate group (20 days vs. 14 days, HR 2.8, 95% CI 1.04-7.6, p = 0.04). By multivariate analysis, age and citrate group were the only independent factors that influenced catheter life span.
  
  
  CONCLUSIONS
  This study shows for the first time that citrate lock reduced catheter complications and increased catheter life span as compared to saline lock in critically ill adults requiring hemodialysis.
authors: CHU de Dijon, Hôpital du Bocage, Réanimation Traumatologique et Neurochirurgicale, Université de Bourgogne, Dijon, France.
authors: Laure
authors: L
authors: Hermite
authors: Jean-Pierre
authors: JP
authors: Quenot
authors: Abdelouaid
authors: A
authors: Nadji
authors: Saber David
authors: SD
authors: Barbar
authors: Pierre-Emmanuel
authors: PE
authors: Charles
authors: Maël
authors: M
authors: Hamet
authors: Nicolas
authors: N
authors: Jacquiot
authors: François
authors: F
authors: Ghiringhelli
authors: Marc
authors: M
authors: Freysz
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002951:Citrates / Q000008:administration & dosage*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012965:Sodium Chloride / Q000008:administration & dosage*; D000077559:Sodium Citrate
chemical_list: D002951:Citrates; D000077559:Sodium Citrate; D012965:Sodium Chloride