Comparative efficacy of low-concentration trisodium citrate and low-concentration heparin for locking central venous hemodialysis catheters: a randomized controlled study

Central venous catheters (CVCs) are used in hemodialysis patients when arteriovenous fistulas (AVFs) or grafts (AVGs) are not feasible. Catheter-locking anticoagulants (CLAs), such as low-concentration trisodium citrate (TSC) and unfractionated heparin (UFH), are used to prevent catheter dysfunction (CD), but comparative data on their safety and efficacy–especially at low concentration remain limited. This study evaluates the efficacy of low-concentration TSC versus low-concentration UFH as CLAs in hemodialysis CVCs. Patients undergoing hemodialysis were randomly allocated to receiving either 5% TSC or UFH 1000 U/mL as CLAs. The primary outcome was the CD rate. Secondary outcomes encompass catheter-related bloodstream infection (CRBSI), exit site infection (ESI), bleeding events, and mortality at 180 days. A total of 204 hemodialysis patients were randomized to receive either 5% trisodium citrate or 1,000 U/mL unfractionated heparin as catheter-locking anticoagulants. The CD rates at 180 days were 1.11 and 1.73 per 1,000 catheters-days for TSC and UFH, respectively, yielding an incidence rate ratio of 1.55 (95% CI: 0.72–3.45), p = 0.23. CRBSI and ESI were comparable in both groups. Bleeding and mortality were also not significantly different between the groups. In the sensitivity analysis of tunnel cuffed catheters (TCC), the rate of CD remained not significantly different between the groups; however, the rate of ESI was higher in the UFH group. Both 5% TSC and 1,000 U/mL UFH demonstrated comparable overall efficacy and safety as CLAs. A possible reduction in infectious complications with 5% TSC was observed only in the tunneled cuffed catheter subgroup.