efficacy study to evaluate b-lock™ as an antimicrobial lock solution in dialysis patients with a cvc

Conditions: Dialysis Catheter Infections

Summary: hypothesis: b-lock is a safe and effective catheter lock solution that will maintain catheter patency and reduce central line associated blood stream infections (clabsi) in dialysis patients using a central venous catheter (cvc) for vascular access. the study is a prospective, randomized, site unblinded/sponsor blinded, clinical study of a minimum of 300 dialysis patients using a central venous catheter (cvc) for vascular access. patients will be randomized 1:1 to receive either the investigational medical device (b-lock or imd) or active control heparin (5000 u/ml) (ach) and observed for a minimum of 45 days or a maximum of 273 (expected average 160 days). imd or ach will be instilled into the catheter lumens (dual lumen catheters) at the end of each dialysis session and removed prior to the initiation of the next dialysis session. the primary objectives of this study are: * to demonstrate the safety of b-lock in dialysis patients * to demonstrate the non-inferiority or, if proven to be non-inferior, superiority of b-lock relative to ach with respect to maintaining catheter patency as defined by the use of recombinant tissue plasminogen activator for maintaining adequate blood flow through the dialysis catheter * to demonstrate the superiority of b-lock relative to ach with respect to the incidence of clabsi


Eligibility criteria:
inclusion criteria: * male or female patients age 18 to 80 years, inclusive. patients, age 81 to 85 years, inclusive, may be included on a case-by-case basis if their health status is determined to be stable after consultation with the medical monitor. * patients with end-stage renal disease receiving hemodialysis via cvc. * patients must be expected to receive hemodialysis through a direct or cuffed, tunneled dual lumen catheter or 2 cuffed, tunneled single lumen catheters for a minimum of 45 catheter-days after day 1. * patients must have been receiving dialysis for a minimum of 6 dialysis sessions at the study center dialysis clinic prior to the signing of the informed consent form (icf). * patients must have received dialysis at their prescribed blood flow rate (+/- 10%) for at least 2 consecutive dialysis sessions prior to signing the icf. * patients must have 2 screening pre-pump arterial pressure measurements (collected during the first 20 minutes of dialysis) that differ by less than or equal to (≤) 20 mmhg at 2 consecutive dialysis sessions when receiving dialysis at their prescribed blood flow rate (+/- 10%) prior to randomization. exclusion criteria: * clinical signs and/or symptoms of a local or systemic infection within 14 days prior to day 1. * evidence of infection of the catheter exit site/tunnel within 14 days prior to day 1. * patients who have received systemic antibiotics within 14 days prior to day 1. * history of fever (t \> 37.5°c) or chills within 14 days prior to day 1. * an occluded catheter (blood flow inadequate for dialysis) or a catheter that required thrombolytic treatment within 14 days prior to day 1. * a catheter coated or impregnated with an antithrombotic, antimicrobial or antiseptic agent, including heparin. * a catheter coated or impregnated with an antithrombotic, antimicrobial or antiseptic agent, including heparin. * catheters that are deemed by their manufacturers to be incompatible with alcohol-containing solutions. these include, but are not limited to: 1. angiodynamics - lifejet® vp vascpak catheter. 2. angiodynamics - schon™ chronic hemodialysis catheter. 3. angiotech - hemostream™ chronic dialysis catheter. 4. bard - all bard catheters. * the use of tego® or tego-like catheter caps. patients may be switched to standard catheter caps in order to participate in this study. * patients with a known or documented allergy to tmp or tmp-containing drugs, ethanol, ethylene diamine tetraacetic acid (edta), propylene glycol and/or glycerin. * patients with a history of heparin-induced thrombocytopenia or in whom the use of heparin is contraindicated. (note: if the use of heparin is restricted for only a specified period of time, the patient may be enrolled at a later date when the use of heparin is no longer contraindicated.) * evidence of acute/ongoing hepatic injury (alanine aminotransferase \[alt\] \> 300 iu/l) or chronic hepatic insufficiency (total bilirubin \> 2.0 mg/dl and/or albumin \< 3.0 g/dl during screening or within 30 days prior to screening). note: a patient whose albumin level is low solely due to nephrotic syndrome may be enrolled (with medical monitor approval) if the albumin level has been stable for at least 3 months prior to icf signature. * patients who the investigator believes have a prognosis for survival of less than 3 months.

Keywords: kidney dialysis hemodialysis locking solution antimicrobial thrombolytic