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Comparative efficacy of low-concentration trisodium citrate and low-concentration heparin for locking central venous

Pattharawin Pattharanitima1, Kwansuphang Wongwatanasanti1, Pichaya Tantiyavarong1,2

  • 1Division of Nephrology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

Renal Failure
|March 12, 2026
PubMed

Insights

Low-concentration trisodium citrate (TSC) and unfractionated heparin (UFH) are effective catheter-locking anticoagulants for hemodialysis central venous catheters (CVCs). Both agents showed comparable safety and efficacy, with a potential reduction in infections for TSC in specific catheter types.

Area of Science:

  • Nephrology and Urology
  • Infectious Diseases
  • Pharmacology

Background:

  • Central venous catheters (CVCs) are crucial for hemodialysis when fistulas or grafts are not viable.
  • Catheter-locking anticoagulants (CLAs), including trisodium citrate (TSC) and unfractionated heparin (UFH), prevent dysfunction but comparative low-concentration data are limited.

Purpose of the Study:

  • To evaluate the efficacy and safety of low-concentration 5% TSC versus 1000 U/mL UFH as CLAs in hemodialysis CVCs.
  • To compare rates of catheter dysfunction (CD), bloodstream infections (CRBSI), exit site infections (ESI), bleeding, and mortality.

Main Methods:

  • Randomized controlled trial involving 204 hemodialysis patients randomized to receive either 5% TSC or 1000 U/mL UFH as CLAs.
  • Primary outcome: Catheter dysfunction (CD) rate at 180 days.
  • Secondary outcomes: CRBSI, ESI, bleeding events, and mortality.

Main Results:

  • No significant difference in CD rates between TSC (1.11/1000 catheter-days) and UFH (1.73/1000 catheter-days) (IRR 1.55, p=0.23).
  • Comparable rates of CRBSI, ESI, bleeding, and mortality were observed between the two groups.
  • In tunneled cuffed catheters (TCC), ESI rates were higher with UFH, though CD rates remained similar.

Conclusions:

  • Both 5% TSC and 1000 U/mL UFH are effective and safe CLAs for hemodialysis CVCs.
  • A potential benefit of reduced infectious complications with 5% TSC was noted in the TCC subgroup.

Keywords:
Catheter locking anti-coagulantscentral venous cathetershemodialysistrisodium citrate (TSC)unfractionated heparin (UFH)

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