Table 1.
Pooled outcomes from trials of catheter lock solutions that can be used selectively for catheter dysfunction prophylaxis.
| Agents Studied, Reference | Patients (n) | Incidence Rate Ratio (IRR) (95% CI) | P value | Anticipated Incidence of Catheter Dysfunction (95% CI) |
Tunneled catheters, % | Follow-up period | |
|---|---|---|---|---|---|---|---|
| Intervention Group | Control Group | ||||||
| Low concentration heparin [5,6,11,14,15] (3 RCTs + 2 CCTs) | 676 | 0.89 (0.61–1.31) | 0.63 | Heparin (1000–2500 U/ml): 18.35% | Heparin (5000–10000 U/ml): 20.11% | Tunneled catheters, 72.93% | 2–3 months or until catheter removal |
| Tinzaparin [27] (1 RCT) | 42 | 0.32 (0.01–8.26) | >0.99 | Tinzaparin (2000 U): 1.37/1000 HD sessions | Heparin (5000 U/ml): 3.68/1000 HD sessions | Internal jugular vein, 97.6% | 14 weeks |
| Citrate 4% [33–36] (1 RCT + 3 CCTs) | 736 | 0.74 (0.55–0.98) | 0.04 | Citrate 4%: 30.37% | Heparin (5000 U/ml): 37.23% | Tunneled catheters, 100% | 6–12months or until catheter removal |
| Citrate 30% [40] (1 RCT) | 291 | 0.88 (0.49–1.57) | 0.66 | Citrate 30%: 18.24% | Heparin (5000 U/ml): 20.28% | Tunneled catheters, 34% | until catheter removal |
| Citrate 46.7% [41,42] (1 RCT + 1CCT) | 297 | 1.82 (0.55–6.05) | 0.40 | Citrate 46.7%: 5.42% | Heparin (500–1500 U/ml): 3.05% | Tunneled catheters, 100% | 6 months or until catheter removal |
| EDTA/Ethanol-Ca-EDTA [51,52] (2 RCTs) | 387 | 1.47 (0.85–2.53) | 0.16 | EDTA/Ethanol-Ca-EDTA: 19.10% | Heparin (5000 U/ml): 13.83% | Tunneled catheters, 93.8% | 3–8 months or until catheter removal |
| Weekly rt-PA [57] (1 RCT) | 225 | 0.47 (0.26–0.85) | 0.013 | rt-PA once weekly: 20.00% | Heparin (5000 U/ml): 34.78% | Tunneled catheters, 100% | 6 months |
| TaurolockTM [102–104] (3 RCTs) | 287 | 1.16 (0.55–2.30) | 0.69 | 1.35% Taurolidine + 4% citrate: 10.65% | Heparin (5000 U/ml)+/Gent 40 mg/ml: 9.36% | Tunneled catheters, 79.4% | 3 months or until catheter removal |
| TauroLock™-HEP500 [92,105] (2 CCTs) | 301 | 0.29 (0.16–0.55) | <0.0001 | 1.35%Taurolidine + 4% citrate + Heparin (500 U⁄ml): 10.12% | TauroLock™/antibiotic + Heparin/Heparin: 27.82% | Tunneled catheters, 100% | 6 months |
| TauroLock™-U25,000 [107–109] (3 RCTs) | 351 | 0.47 (0.25–0.87) | 0.016 | 1.35% Taurolidine+ 4% citrate + urokinase (25000 U) once weekly: 9.88% | TaurolockHEP/4% citrate: 18.99% | Tunneled catheters, 100% | 6 months or until catheter removal |
| Ethanol/+Heparin [111–114] (4 RCTs) | 568 | 3.40 (1.83–6.49) | <0.0001 | Ethanol + Heparin: 12.69% | Placebo/Heparin: 4.10% | Tunneled catheters, 81.9% | 6 months or until catheter removal |
| Hypertonic saline + heparin [115] (1 RCT) | 56 | 1.64 (0.40–6.98) | 0.69 | 26% NaCl + Heparin: 15.38% | Standard heparin: 10.00% | Tunneled catheters, 100% | until catheter removal |
| 7.5% NaHCO3 [118,119] (2 RCTs) | 278 | 6.03 (2.40–14.57) | <0.0001 | 7.5% NaHCO3: 9.79% | Heparin (2500 U/ml): 1.77% | Tunneled catheters, 42.4% | 6 weeks or until catheter removal |