Approaches to Prolong the Use of Uncuffed Hemodialysis Catheters: Results of a Randomized Trial

• Published in: American journal of nephrology Vol. 33; no. 3; pp. 260 - 268
• Main Authors: Filiopoulos, Vassilis, Hadjiyannakos, Dimitrios, Koutis, Ioannis, Trompouki, Sofia, Micha, Theodora, Lazarou, Dimitrios, Vlassopoulos, Dimosthenis
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.03.2011
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Anticoagulants - therapeutic use; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheters, Indwelling - adverse effects; Catheters, Indwelling - microbiology; Citric Acid - therapeutic use; Female; Gentamicins - therapeutic use; Heparin - therapeutic use; Humans; Kidney Failure, Chronic - drug therapy; Kidney Failure, Chronic - therapy; Male; Middle Aged; Original Report: Patient-Oriented, Translational Research; Renal Dialysis - adverse effects; Renal Dialysis - instrumentation; Taurine - analogs & derivatives; Taurine - therapeutic use; Thiadiazines - therapeutic use; Catheter-related bacteremia; Uncuffed catheters; Hemodialysis; Thrombosis; Lock solutions; Taurolidine
• ISSN: 0250-8095; 1421-9670
• DOI: 10.1159/000324685

Background: Use of uncuffed catheters (UCs) in hemodialysis patients is common practice. An antibiotic lock has been recommended to prevent catheter-related bacteremia (CRB), although insufficient data are available about the appropriate antimicrobial agent and dose with prolonged use of UCs. Methods: This open-label randomized study was conducted to compare gentamicin/heparin (group A) and taurolidine/citrate (group B), as catheter-lock solutions, in 119 chronic hemodialysis patients in whom a total of 150 UCs were placed. A well-matched historical control group (heparin) included 67 UCs in 58 patients (group C). Results: CRB episodes developed in 6 and 8 patients in groups A and B, respectively, significantly fewer than in group C (20 patients). Cumulative CRB-free catheter survival at 90 days was 82% for A and 78% for B, which is significantly higher than the 26% for C. Similar Gram-positive infection rates were found in all groups. The Gram-negative infection rate was significantly lower in B compared to C. No significant differences in thrombosis rates were observed between the groups. Conclusions: Gentamicin/heparin and taurolidine/citrate, used for locking UC, were similarly effective at preventing CRB and catheter thrombosis for up to 3 months, until a functional permanent vascular access became available. Both antimicrobial lock solutions were superior to heparin in CRB prevention with similar thrombosis rates.