A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis

Abstract

Background: Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports. Objective: To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients. Design: A multicenter, randomized, open-label study Setting: In a developing country, Thailand Patients: Chronic HD patients with tunneled central venous catheter Measurements: Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infection Methods: The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI). Results: The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA). Limitations: Short follow-up period. Conclusions: In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis. Trial registration: The study was registered with the Thai Clinical Trials Registry TCTR 20200610003

Sodium Bicarbonate Locks May Be a Safe and Effective Alternative in Pediatric Intestinal Failure: A Pilot Study

“…None of the patients had any reported adverse events on SBLT. This is noteworthy, as a recent randomized controlled trial in adults on hemodialysis treated with SBLT was stopped early due to concern for CRT (20). However, the investigators in this study comment that the use of 7.5% SBLT (rather than 8.4%) and a higher proportion of patients with diabetes in the intervention arm explained the increased CRT rate.…”

Reevaluation of lock solutions for Central venous catheters in hemodialysis: a narrative review

“…An RCT showed that the incidence of catheter removal due to thrombosis (CRT) in the sodium bicarbonate group was higher than that in the heparin group, whereas the incidence of CRBSI and ESI was lower in the sodium bicarbonate group. Sodium bicarbonate is considered an alternative catheter lock used in every HD session with rt-PA every 3 weeks, especially when heparin is prohibited [ 118 ].…”