Efficacy of preventing hemodialysis catheter infections with citrate lock

Abstract

Abstract Prevalent use of tunneled dialysis catheters can reach 30%. Infection remains the most serious catheter‐related problem. Catheter locks are increasingly used for prevention, but are not yet recommended either by the F ood and D rug A ssociation or European Medicines Agency, on the basis of increasing bacterial resistance or lock toxicity. The aim was to test safety and effectiveness of citrate. A prospective, interventional study was conducted to assess the safety and efficacy of a 30% citrate lock in preventing catheter‐related bacteremia ( CRB ). A total of 157 prevalent tunneled catheters were locked with citrate and prospectively followed during a 1‐year period. The primary endpoint was first CRB diagnosed according to two of the diagnostic criteria for C atheter I nfection of C enters for D isease C ontrol and P revention ( CDC ), namely definite and probable infection. The CDC criterion of possible but not proved infection was not considered. This citrate lock cohort (n = 157) had 10 episodes of CRB . We observed 0.49 CRB episodes/1000 patient‐days and the mean infection‐free catheter day was 130.6 ± 100.9. No clinically relevant adverse events were observed. No proved tunnel or exit site infection was observed and no patients died because of CRB . Catheter obstruction episodes were reported on 69 occasions out of 14 catheters. These results were compared with an historical cohort from a previous study of catheter locking with low‐dose gentamicin and did not show significant difference in efficacy. Citrate lock is effective in preventing CRB . No toxicity was observed. The use of citrate lock may have advantages over antibiotic locks: No reported bacterial resistance, lower industrial cost, and less manipulation.