Citrate Versus Heparin Lock for Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

“…This observation is consistent with the anticoagulant and antibacterial (31,34,35) activity across a broad spectrum of microbes. Of note, thrombosis and bacterial growth within biofilm are closely related in the physiopathology of catheter-related infections (36).…”

“…This study represented the third cohort (5,8) and largest comparison employing individual data to investigate the risk of dialysis catheter infection when using citrate locking in the ICU; thus, this cohort is unique. The findings are biologically plausible and supported by in vitro (22,28,37) and in vivo (31,35) studies. The effects of citrate on catheter-tip colonization, including the propensity-score-matched subcohort, which mimics "post hoc" randomization by balancing the recorded risk factors between groups, were consistent in our analyses.…”

“…Importantly, several lock solutions, such as ethanol, have been associated with adverse reactions (29) or can adversely affect catheter integrity (30). Different antimicrobial agents, such as those used for skin antisepsis (12), may have synergistic antimicrobial activity (31). The combining of several compounds is, therefore, a focus of research that has yielded promising results (32,33).…”

Cathasept Line Lock and Microbial Colonization of Tunneled Hemodialysis Catheters: A Multicenter Randomized Controlled Trial

“…Several meta-analyses of randomized controlled studies (RCTs) have demonstrated significant reduction in CRBSI rates when various antimicrobial lock solutions were used to prevent CRBSI in HD patients, but there was a significant heterogeneity between the studies [28][29][30][31][32][33][34] . Concerns remain over the risk of bacterial resistance developing when antibiotic solutions are used and the potential side effects of some antibiotics 35 .…”

Reducing Catheter-Related Infections in Hemodialysis Patients

“…Several authors have evaluated citrate, but in some studies higher doses (47%) have failed to outperform heparin and have also raised concerns about the possibility of fatal arrhythmias induced by hypocalcemia or systemic emboli from catheter leakage (25,26). However, a recent meta-analysis by Zhao et al indicated that low-to-moderate concentrations of citrate (1.04%-7%) appear to be of benefit in decreasing the risk for CRBSI (27). The combination of citrate with other novel antimicrobials, such as taurolidine (28)(29)(30)(31) and methylene blue-methylparaben-propylparaben, has shown efficacy in reducing CRBSI, but issues with catheter thrombosis have limited their use (18).…”