#4588 EFFECT OF TRISODIUM CITRATE 30% VERSUS HEPARIN AS A CATHETER LOCK SOLUTION ON INFLAMMATORY RESPONSE AND DIALYSIS ADEQUACY IN HEMODIALYSIS PATIENTS
Authors: Elsharkawy Magdy , Khedr Lina , Kamal Ahmed , Emara Ahmed 
Published: June 2023

Abstract

Background and Aims
In hemodialysis (HD) patients, the majority of bloodstream infections are caused by infection of vascular access catheters. Commonly, Central venous catheters (CVCs) are the only option when HD is needed for patients without definitive vascular access. However, in addition to infection, CVCs are associated with other complications, such as thrombosis, and dysfunction, leading to higher mortality and expenditures. In Egypt, recent data show that 6.6% of HD patients use catheters as a vascular access, of which short term catheters represent 59.6% and 40.4% with long-term catheters. Many data show that the use of HD catheter-locking solutions could contribute to reduction of catheter-related complications, especially infections. Aim; to assess the possible effect of using Trisodium citrate 30% (TSC 30%) in comparison to unfractionated heparin, as a lock solution for HD catheters, on inflammatory status, incidence of catheter related Bacteremia (CRB) and dialysis adequacy in HD patients.

Method
This was a randomized controlled clinical trial, conducted on 70 prevalent HD patients on regular dialysis using HD catheters as a vascular access, recruited from hemodialysis unit in Nasser Institute Hospital in Cairo government at the time of catheter insertion. Patients were divided into two groups: Citrate Group; 35 patients received trisodium citrate 30% as a catheter lock after HD session, Heparin Group; 35 patients received unfractionated heparin (5000i.u) as a catheter lock solution after HD session. Both groups were followed up for 3 months period and monitored for signs of CRB. Also, Urea reduction ratio (URR) were measured monthly. Highly sensitive CRP were measured at baseline and 3 months after start using the lock solutions. Blood cultures were withdrawn in patients who developed signs of CRB.

Results
In our study, the catheter-related bacteremia (CRB) episodes were significantly lower in the Citrate group when compared to Heparin group. Only 2 patients (5.7%) in Citrate group had CRB, whereas in Heparin group, 8 patients (22.9%) had CRB (P = 0.04) (Fig. 1). Also, Bacteremia-free time was longer in the Citrate group. The mean bacteremia free time in Citrate group was 10.97 ± 2.36 weeks, while in Heparin group it was 9.43 ± 3.91 weeks
(P = 0.032) (Fig. 2). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.596) and WBCs (P = 0.528). While after 3 months of using TSC 30% as a lock solution, there was a significant difference as regards levels of hsCRP (P = 0.030) (Fig. 3) and WBCs (P = 0.036), with the higher levels of inflammatory markers showed in Heparin group. There was no difference between the two studied groups regarding thrombosis events. However, dialysis adequacy and catheter performance, assessed by URR, were higher in citrate group compared to heparin group after 3 months (P = 0.005) compared to baseline (P = 0.108) (Fig. 4).

Conclusion
we may conclude that, using Trisodium citrate 30% as lock solution for HD catheters was associated with reduction in the inflammatory markers and CRB incidence compared to the standard heparin lock. Also, its use was associated with better catheter performance and dialysis adequacy. We therefore believe that TSC 30% may be a potential alternative to standard heparin as a catheter lock solution for HD patients.