title: Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial.
abstract: Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin concentrations to maintain catheter patency has been previously reported in retrospective studies. We conducted a prospective, randomised, controlled study of 1000 U/mL heparin (low dose) versus 5000 U/mL heparin (high dose) locking solution to maintain patency of tunnelled catheters. Methods One hundred patients receiving chronic, unit-based hemodialysis with newly placed tunnelled hemodialysis catheters (less than 1 week) were randomly assigned to either a low dose (n = 48) or high dose heparin (n=52). The primary intention-to-treat analysis examined time to malfunction in both groups over a 90 day period. A secondary analysis compared baseline patient characteristics in relation to catheter malfunction. Findings Overall rate of catheter patency loss was 32% of catheters by 90 days. There was no significant difference in time to malfunction of catheters locked with low dose or high dose heparin (P = 0.5770). Time to catheter malfunction was not associated with diabetic, hypertensive or smoking status. There was no difference in mean delivered blood flow rate, venous and arterial pressure, and dialysis adequacy between low dose and high dose groups. No patient suffered a hemorrhagic complication requiring hospitalisation during the study period. Discussion Low dose heparin is adequate to maintain tunnelled hemodialysis catheter patency when compared with high dose heparin. The study also suggests that there is no relationship between catheter malfunction and diabetic, hypertensive or smoking status.
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.|School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors.forename: Ginger
authors.initials: G
authors.lastname: Chu
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.
authors.forename: Gemma M
authors.initials: GM
authors.lastname: Fogarty
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.
authors.forename: Leanne F
authors.initials: LF
authors.lastname: Avis
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.
authors.forename: Shauna
authors.initials: S
authors.lastname: Bergin
authors.affiliation: School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.|School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
authors.forename: Alastair H
authors.initials: AH
authors.lastname: Gillies
authors.affiliation: Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, Charlestown, NSW 2290, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Heparin lock; catheter lock; catheter patency; hemodialysis; tunnelled catheter