Citrate lock versus heparin lock for the prevention of catheter related infections in hemodialysis patients with tunneled catheters: a Meta-analysis of randomized controlled trials

ObjectiveTo study whether citrate lock is superior to heparin lock in the prevention of catheter related infections, bleeding complications and catheter malfunctions among hemodialysis patients with tunneled catheters. MethodsBy searching in Pubmed, the Cochrane Library, EMBASE, Ovid, WanFang, VIP, CNKI and CBM databases as well as related journals, qualified randomized controlled trials were included in a Meta - analysis using Revman 5.0 and STATA 10.0 software. The endpoints included catheter related infection, bleeding complication, thrombolytic treatment, catheter removal for malfunction, catheter thrombosis and all - cause death. ResultsFifteen randomized controlled trials were included with 1621 patients involved. Eight studies compared citrate alone with heparin lock, while 7 trials focused on citrate in combination with other antimicrobials. Pooled analysis demonstrated that incidence of catheter related infections in patients receiving citrate lock decreased by 47% compared with those on heparin (RR=0.53, 95%CI 0.36-0.77, P＜0.01). Subgroup analysis by types of citrate lock indicated that all combined lock solutions of citrate and other antimicrobials (citrate + gentamicin, citrate + taurolidine, citrate + methylene blue + methylparaben + propylparaben) were superior to heparin lock in preventing catheter-related infections (P＝0.01, 0.04, 0.01, respectively); citrate alone seemed to reduce catheter-related infection risk (RR＝0.68), but no statistically significant difference was observed (95%CI 0.38-1.21, P＝0.19). There were fewer patients with bleeding complications in citrate group (RR＝0.53, 95%CI 0.34-0.84, P＜0.01), while citrate showed no advantage over heparin lock in terms of thrombolytic treatment (P＝0.93), catheter removal for malfunction (P＝0.35), catheter thrombosis (P＝0.64) and all - cause death (P＝0.35). ConclusionsFor hemodialysis patients with tunneled catheters, combined lock solutions of citrate and other antimicrobials, rather than citrate alone, are superior to heparin in preventing catheter related infections. Citrate locks are associated with less bleeding complications, and are comparable to heparin in the maintenance of catheter patency.