title: Anticoagulant therapies versus heparin for the prevention of hemodialysis catheter-related complications: systematic review and meta-analysis of prospective randomized controlled trials.
abstract: Locking of central venous catheters with heparin is an accepted practice to maintain catheter patency between dialysis sessions. However, this practice may cause other adverse reactions. Although many studies suggest benefits of other catheter lock solutions over heparin on these grounds, no consensus has been reached for clinical practice. A systematic review and meta-analysis was performed of randomized controlled trials (RCT) that compared antimicrobial-containing or citrate-alone catheter lock solutions with heparin alone in patients undergoing hemodialysis with central venous catheters. Medline, Cochrane Central Register of Controlled Trials from EMBASE, and PubMed were searched for articles published through June 2014. The primary outcomes were catheter-related bacteremia (CRB) and catheter malfunction (CM). The secondary outcomes were bleeding, exit-site infection (ESI), clinical sepsis, and all-cause mortality. Seventeen RCTs met the inclusion criteria. The meta-analysis showed that antimicrobial-containing and citrate-alone lock solutions were superior to heparin for preventing CRB (both P < 0.01). Although antimicrobial-containing lock solutions significantly affected clinical sepsis (P < 0.01), they did not affect ESI, bleeding, or all-cause mortality. Incidence of CM episodes was lower in patients receiving antibiotics + heparin and gentamicin + citrate (both P < 0.05), while other antimicrobial-containing and citrate-alone lock solutions showed no difference. Only citrate-alone lock solutions significantly decreased bleeding and ESI episodes (both P < 0.05). Compared with heparin, antimicrobial-containing lock solutions more effectively prevent CRB and clinical sepsis. Antibiotics + heparin and gentamicin + citrate solutions showing better prevention of CM. Citrate-alone lock solutions result in fewer CRB, bleeding and ESI episodes.
authors.affiliation: Department of Renal Transplantation and Nephropathy, The Seventh People's Hospital of Zhengzhou City China.
authors.forename: Jinrui
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Renal Transplantation and Nephropathy, The Seventh People's Hospital of Zhengzhou City China.
authors.forename: Chang'an
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Blood Transfusion, The Seventh People's Hospital of Zhengzhou City China.
authors.forename: Hongfei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Renal Transplantation and Nephropathy, The Seventh People's Hospital of Zhengzhou City China.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Nephropathy, The Second Hospital of Jilin University China.
authors.forename: Jie
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Pediatrics, The Second Part of the First Hospital, Jilin University China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Department of Nephropathy, The Second Hospital of Jilin University China.
authors.forename: Hongbin
authors.initials: H
authors.lastname: Zou
keywords: Catheter lock solutions; hemodialysis; heparin; meta-analysis