title: Comparative effectiveness of 30 % trisodium citrate and heparin lock solution in preventing infection and dysfunction of hemodialysis catheters: a randomized controlled trial (CITRIM trial).
abstract: BACKGROUND
  Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients.
  
  
  METHODS
  Randomized, double-blind controlled trial comparing the event-free survival of non-tunneled CVC locked with heparin or TSC30 % in adult hemodialysis patients.
  
  
  RESULTS
  The study included 464 catheters, 233 in heparin group, and 231 in TSC30 % group. The CRBSI-free survival of TSC30 % group was significantly shorter than that of heparin group. When stratified by insertion site, heparin was better than TSC30 % only in subclavian CVC. The dysfunction-free survival was not different between groups in the main analysis, but there is also a shorter survival among subclavian CVC locked with TSC30 % in stratified analysis.
  
  
  CONCLUSIONS
  There was no difference on CRBSI-free or dysfunction-free survival between jugular vein CVC locked with heparin or 30 % citrate. However, subclavian CVC locked with 30 % citrate presented shorter event-free survival. This difference may be related to anatomical and positional effects, CVC design, and hydraulic aspects of the lock solution. CLINICALTRIALS.
  NCT02563041.
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Franklin
authors: F
authors: Correa Barcellos
authors: Department of Nursing, Federal University of Pelotas, Pelotas, Brazil.
authors: Bruno
authors: B
authors: Pereira Nunes
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Luciana
authors: L
authors: Jorge Valle
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Thiago
authors: T
authors: Lopes
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Bianca
authors: B
authors: Orlando
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Cintia
authors: C
authors: Scherer
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Marcia
authors: M
authors: Nunes
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil.
authors: Gabriela
authors: G
authors: Araújo Duarte
authors: Unidade de Diálise e Transplante Renal do Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas, Pelotas, Brazil. mbohlke.sul@gmail.com.
authors: Maristela
authors: M
authors: Böhlke
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D002951:Citrates / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D002951:Citrates; C514290:trisodium citrate; D006493:Heparin
keywords: Catheter-related bloodstream infection; Citrate; Hemodialysis; Lock solutions