CITRATE VERSUS HEPARIN LOCK IN HEMODIALYSIS CATHETER'S COMPLICATIONS; A PILOT UNICENTER STUDY

Citrate lock and heparin lock are the two principal intraluminal agents used to maintain central venous catheter (CVC) patency and reduce complications in hemodialysis patients. Heparin, traditionally, acts as an anticoagulant to prevent catheter thrombosis but carries a risk of systemic anticoagulation and bleeding if inadvertently flushed into the circulation. Citrate, provides local anticoagulation by chelating calcium and also exhibits antimicrobial properties, with minimal systemic effects. Importantly, citrate locks are associated with a lower risk of bleeding episodes compared to heparin. In addition, citrate reduces the incidence of catheter-related bloodstream infections (CRBSI) compared to heparin.

A pilot study was conducted in 58 patients, who were randomly assigned to groups. The experimental group (Citralock n=35) received sodium citrate, while the control group (Heparin n=23) received heparin as the locking solution. Data on bleeding or clotting events, infections, catheter-related obstructions, and insertion-site bleeding were prospectively collected and analyzed in both groups. The outcome was to compare the efficacy of citrate and heparin lock solutions in the maintenance of hemodialysis catheters, focusing on catheter dysfunction and infection, coagulation parameters, and serum calcium levels in patients undergoing chronic hemodialysis.

In a group of 58 patients, the use of Citralock vs. Heparin was compared in nine laboratory parameters evaluated at one, two and three months, finding that the Citralock group presented a higher platelet count in all measurements, with statistically significant differences at the first month (218.8 ± 15.95 vs. 170.78 ± 11.07; p = 0.0242) and at the third month (200.86 ± 11.87 vs. 158.74 ± 9.18; p = 0.0097), suggesting better platelet preservation in this group. Regarding the INR, values ​​were consistently lower with Citralock compared to heparin at all three measurement times, with highly significant differences (p < 0.001), indicating that Citralock maintains this parameter within physiological ranges, while heparin induces a sustained and clinically relevant increase. Regarding the TPP, a shorter prolongation was observed in the Citralock group, with significant differences at the first month (p = 0.048) and especially at the third month (p = 0.0001). Regarding associated complications, the Citralock group had significantly fewer adverse events compared to the heparin group (5 vs. 19 total events). Catheter obstructions were significantly more frequent in the heparin group, with 6 cases versus none in the Citralock group, while catheter replacements were also more common with heparin (6 vs. 2 cases). Regarding catheter-site bleeding, 3 cases were identified in the heparin group and none in the Citralock group, suggesting that the anticoagulant profile of heparin may contribute to this type of complication. Catheter infection occurred in both groups at a similar frequency (3 vs. 4 cases), indicating that this event does not appear to be directly influenced by the solution used for maintenance. The number of patients with at least one complication was similar between both groups (5 in Citralock vs. 6 in Heparin); However, the total burden of complications was significantly higher in the heparin group because some patients experienced more than one event.

In a study of 58 patients, Citralock showed better platelet preservation and stability in coagulation tests compared to heparin, which was associated with decreased platelet counts and a higher risk of bleeding disorders. Furthermore, Citralock had fewer overall complications, with no cases of catheter obstructions or bleeding, while heparin had more replacements and patency problems. These results suggest that Citralock offers a safer profile and reduces the need for interventions in patients with vascular catheters.