Weijmer MC et al. (2005) Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol 16: 2769–2777

Catheter use in hemodialysis can lead to infection and reduced blood flow caused by coagulation; heparin has traditionally been used to maintain catheter patency but can cause systemic anticoagulation and persistent bleeding. Weijmer and colleagues compared heparin with trisodium citrate (TSC), a local anticoagulant with antimicrobial properties, for use in catheter locking. Their multicenter, double-blind, randomized, controlled trial has demonstrated that using TSC rather than heparin to lock catheters during hemodialysis for end-stage renal disease leads to a reduction in catheter-related bacteremia (CRB) and other complications.

Patients were randomized to either 5,000 U/ml unfractionated heparin or a 30% solution of TSC. Catheter type was determined by the treating physician. Tunneled cuffed catheters—recommended when catheterization is expected to last longer than 4–6 weeks—were used in 98 patients; untunneled catheters were used in 193. Results showed a reduction in CRB (P = 0.01), catheter removal due to complications (P = 0.005), and major bleeding episodes (P = 0.01) in the TSC group compared with the heparin group. Neither agent was superior in terms of flow maintenance, and premature removal as a result of flow problems was independently predicted only by use of an untunneled catheter. The study was halted early because of the significant difference in CRB between the groups.

The authors conclude that TSC is effective and safe, resulting in only minor, short-lived adverse effects immediately after locking, and reducing the impact of infection and premature catheter removal on patients.