Adverse Events in Hemodialysis Patients With Venous Catheters Locked With 30% Trisodium Citrate Versus Alternative Locking Solutions

Abstract

Introduction

Catheter locking solutions—including trisodium citrate—are crucial for maintaining central venous catheter patency in end-stage renal disease patients. Despite widespread usage, discrepancies remain regarding the safety profile of trisodium citrate. This study evaluates the safety of 30% trisodium citrate relative to alternative solutions in a large, heterogenous population.

Methods

We conducted a retrospective cohort study of 83,306 catheters from 51,243 patients at Fresenius Medical Care clinics across Europe, the Middle East, Africa, and Latin America from October 15, 2011 to 31 August 31, 2021. The 30% trisodium citrate group (10,689 patients) comprised all catheters routinely locked with 30% trisodium citrate. The control group (40,554 patients) included catheters locked with various non-trisodium citrate solutions, most commonly heparin, along with saline, gentamicin, and, less frequently, alteplase, antimicrobial caps (isopropyl alcohol or chlorhexidine), or taurolidine. Mean follow-up was 116 days.

Findings

Chi-square testing identified significant differences in three of four adverse event categories between the 30% trisodium citrate and control groups. The 30% trisodium citrate showed a favorable risk profile for Catheter and Procedure Issues (RR = 0.27, 95% CI: 0.25–0.28), Systemic Reactions and Symptoms (RR = 0.10, 95% CI: 0.09–0.11), and Thrombotic or Coagulation Complications (RR = 0.60, 95% CI: 0.58–0.61). No significant difference emerged for Infection-Related Events (RR = 1.02, 95% CI: 0.98–1.07).

Discussion

These results support the relative safety of 30% trisodium citrate as a locking solution in a large, diverse patient cohort. Further research should further explore how patient-level, catheter-level, and facility-level factors influence the comparative safety of locking solutions.