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      Trisodium citrate 4% versus heparin as a catheter lock for non-tunneled hemodialysis catheters in critically ill patients: a multicenter, randomized clinical trial

      research-article
      1 , 2 , 3 , 4 , , 5 , 6 , 3 , 4 , 1 , 2 , 5 , 6 , 7 , 8 , 9 , 10 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 17 , 18 , 3 , 4 , 19 , 20 , for the VERROU-REA Trial Investigators and the CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis)
      Annals of Intensive Care
      Springer International Publishing
      Citra-Lock, Heparin, Catheters, Acute renal failure, Hemodialysis, Critical illness

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          Abstract

          Background

          Non-tunneled hemodialysis catheters are currently used for critically ill patients with acute kidney injury requiring extracorporeal renal replacement therapy. Strategies to prevent catheter dysfunction and infection with catheter locks remain controversial.

          Methods

          In a multicenter, randomized, controlled, double-blind trial, we compared two strategies for catheter locking of non-tunneled hemodialysis catheters, namely trisodium citrate at 4% (intervention group) versus unfractionated heparin (control group), in patients aged 18 years or older admitted to the intensive care unit and in whom a first non-tunneled hemodialysis catheter was to be inserted by the jugular or femoral vein. The primary endpoint was length of event-free survival of the first non-tunneled hemodialysis catheter. Secondary endpoints were: rate of fibrinolysis, incidence of catheter dysfunction and incidence of catheter-related bloodstream infection (CRBSI), all per 1000 catheter-days; number of hemorrhagic events requiring transfusion, length of stay in intensive care and in hospital; 28-day mortality.

          Results

          Overall, 396 randomized patients completed the trial: 199 in the citrate group and 197 in the heparin group. There was no significant difference in baseline characteristics between groups. The duration of event-free survival of the first non-tunneled hemodialysis catheter was not significantly different between groups: 7 days (IQR 3–10) in the citrate group and 5 days (IQR 3–11) in the heparin group ( p = 0.51). Rates of catheter thrombosis, CRBSI, and adverse events were not statistically different between groups.

          Conclusions

          In critically ill patients, there was no significant difference in the duration of event-free survival of the first non-tunneled hemodialysis catheter between trisodium citrate 4% and heparin as a locking solution. Catheter thrombosis, catheter-related infection, and adverse events were not statistically different between the two groups.

          Trial registration Registered with Clinicaltrials.gov under the number NCT01962116. Registered 14 October 2013.

          Electronic supplementary material

          The online version of this article (10.1186/s13613-019-0553-4) contains supplementary material, which is available to authorized users.

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          Most cited references27

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          A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.

          To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method to convert the score to a probability of hospital mortality. The SAPS II and the probability of hospital mortality were developed and validated using data from consecutive admissions to 137 adult medical and/or surgical intensive care units in 12 countries. The 13,152 patients were randomly divided into developmental (65%) and validation (35%) samples. Patients younger than 18 years, burn patients, coronary care patients, and cardiac surgery patients were excluded. Vital status at hospital discharge. The SAPS II includes only 17 variables: 12 physiology variables, age, type of admission (scheduled surgical, unscheduled surgical, or medical), and three underlying disease variables (acquired immunodeficiency syndrome, metastatic cancer, and hematologic malignancy). Goodness-of-fit tests indicated that the model performed well in the developmental sample and validated well in an independent sample of patients (P = .883 and P = .104 in the developmental and validation samples, respectively). The area under the receiver operating characteristic curve was 0.88 in the developmental sample and 0.86 in the validation sample. The SAPS II, based on a large international sample of patients, provides an estimate of the risk of death without having to specify a primary diagnosis. This is a starting point for future evaluation of the efficiency of intensive care units.
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            Preventing complications of central venous catheterization.

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                Author and article information

                Contributors
                +33 380 293 751 , jean-pierre.quenot@chu-dijon.fr
                julie.helms@libertysurf.fr
                abderrahmane.bourredjem@u-bourgogne.fr
                auguste.dargent@chu-dijon.fr
                ferhat.meziani@chru-strasbourg.fr
                jbadie@chbm.fr
                gblasco@chu-besancon.fr
                gpiton@chu-besancon.fr
                gilles.capellier@univ-fcomte.fr
                cmezher@chbm.fr
                jean-michel.rebibou@chu-dijon.fr
                abdelouaid.nadji@chu-dijon.fr
                tcrepin@chu-besancon.fr
                saber.barbar@chu-nimes.fr
                camille.fleck@chu-dijon.fr
                amelie.cransac@chu-dijon.fr
                mathieu.boulin@chu-dijon.fr
                christine.binquet@u-bourgogne.fr
                agnes.soudry@chu-dijon.fr
                rbruyere@ch-bourg01.fr
                Journal
                Ann Intensive Care
                Ann Intensive Care
                Annals of Intensive Care
                Springer International Publishing (Cham )
                2110-5820
                1 July 2019
                1 July 2019
                2019
                : 9
                : 75
                Affiliations
                [1 ]Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Dijon Bourgogne, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
                [2 ]ISNI 0000 0004 4910 6615, GRID grid.493090.7, Université Bourgogne Franche-Comté, Lipness Team UMR 1231 et LabExLipSTIC, ; 21000 Dijon, France
                [3 ]ISNI 0000000121866389, GRID grid.7429.8, INSERM, CIC 1432, module Epidémiologie Clinique, ; 21000 Dijon, France
                [4 ]GRID grid.31151.37, CHU de Dijon, Centre d’Investigation Clinique, module Epidémiologie Clinique/Essais cliniques, ; 21000 Dijon, France
                [5 ]ISNI 0000 0000 8928 6711, GRID grid.413866.e, CHRU de Strasbourg, Nouvel Hôpital Civil, Service de Réanimation Médicale, ; 67000 Strasbourg, France
                [6 ]GRID grid.503388.5, Université de Strasbourg, UMR 1260, régénérative nanomédicine, FMTS, ; 67 000 Strasbourg, France
                [7 ]CH de Belfort-Montbéliard, Service de Réanimation Polyvalente, 90000 Belfort, France
                [8 ]ISNI 0000 0004 0638 9213, GRID grid.411158.8, CHU de Besançon, Service de Réanimation Chirurgicale, ; 25000 Besançon, France
                [9 ]ISNI 0000 0004 0638 9213, GRID grid.411158.8, CHU de Besançon, Service de Réanimation Médicale, ; 25000 Besançon, France
                [10 ]ISNI 0000 0001 2188 3779, GRID grid.7459.f, Université de Franche-Comté, ; EA 3920, 25000 Besançon, France
                [11 ]CH Belfort-Montbéliard, Service de Réanimation Polyvalente, 25200 Montbéliard, France
                [12 ]GRID grid.31151.37, CHU Dijon Bourgogne, Service de Néphrologie, ; 21000 Dijon, France
                [13 ]GRID grid.31151.37, CHU Dijon Bourgogne, Service de Réanimation Neuro-Traumatologique, ; 21000 Dijon, France
                [14 ]ISNI 0000 0004 0638 9213, GRID grid.411158.8, CHU de Besançon, Service de Soins intensifs Néphrologie, ; 25000 Besançon, France
                [15 ]ISNI 0000 0004 0593 8241, GRID grid.411165.6, CHU de Nîmes, Service de Réanimation Médicale, ; 30 000 Nîmes, France
                [16 ]GRID grid.31151.37, CHU Dijon Bourgogne, Délégation à la Recherche Clinique et à l’Innovation (DRCI), ; 21000 Dijon, France
                [17 ]GRID grid.31151.37, Département de Pharmacie, , CHU Dijon Bourgogne, ; 21000 Dijon, France
                [18 ]ISNI 0000 0001 2298 9313, GRID grid.5613.1, Université de Bourgogne Franche-Comté, LNC-UMR 1231, ; 21000 Dijon, France
                [19 ]GRID grid.31151.37, CHU Dijon Bourgogne, Unité de Soutien Méthodologique à la Recherche (USMR), ; 21000 Dijon, France
                [20 ]CH de Bourg en Bresse, Service de Réanimation polyvalente, 01000 Bourg en Bresse, France
                Author information
                http://orcid.org/0000-0003-2351-682X
                Article
                553
                10.1186/s13613-019-0553-4
                6603108
                31264073
                8cacd3fc-3eb1-4b5d-b4fb-7c14e3a1e01f
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 31 March 2019
                : 24 June 2019
                Funding
                Funded by: Centre Hospitalier Universitaire de Dijon
                Award ID: AAP 2012
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Emergency medicine & Trauma
                citra-lock,heparin,catheters,acute renal failure,hemodialysis,critical illness

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