HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by MacRae, J. M. Articles by Kiaii, M. PubMed PubMed Citation Articles by MacRae, J. M. Articles by Kiaii, M.

Citrate 4% versus Heparin and the Reduction of Thrombosis Study (CHARTS)

Jennifer M. MacRae^*, Ivana Dojcinovic, Ognjenka Djurdjev, Beverly Jung, Steven Shalansky, Adeera Levin, and Mercedeh Kiaii

^* Division of Nephrology, University of Calgary, Calgary, Alberta, and Division of Nephrology, Department of Pharmacy, and Centre for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital, University of British Columbia, Canada

Correspondence: Dr. Jennifer M. MacRae, Division of Nephrology, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9. Phone: 403-944-8168; Fax: 403-944-2876; E-mail: jmmacrae{at}hotmail.com

Background and objectives: Citrate 4% has antithrombotic and antibacterial properties, which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent.

Design, setting, participants, and measurements: Sixty-one prevalent hemodialysis (HD) patients dialyzing with a tunneled cuffed HD catheter were randomized in a pilot study to receive either heparin 5000 U/ml or citrate 4% as a locking agent after HD. The primary outcomes were the development of catheter dysfunction (defined as a blood pump speed <250 ml/min or the use of tissue plasminogen activator) and catheter-associated bacteremia. The secondary outcomes were the development of an exit-site infection or bleeding complications (either local or systemic).

Results: Citrate had comparable catheter dysfunction episodes to heparin (13/32 [41%] cases versus 12/29 [41%] cases, respectively). There were no differences in the development of catheter-associated bacteremia (2.2/1000 catheter days citrate versus 3.3/1000 catheter days heparin group; P = 0.607) or exit-site infection (2.2/1000 catheter days for both groups).

Conclusions: The preliminary findings from our pilot study demonstrate that 4% citrate is effective in maintaining catheter patency and does not appear to have any increased incidence of infections. Because citrate is significantly cheaper and has a more favorable side effect profile than heparin, it can be considered a potentially better locking agent in HD catheters.