柠檬酸与肝素固定用于血液透析导管的比较:系统综述与对随机对照试验的meta分析

Citrate versus heparin lock for hemodialysis catheters: A systematic review and meta-analysis of randomized controlled trials
作者:Zhao, Y. | Li, Z. | Zhang, L. | Yang, J. | Yang, Y. | Tang, Y. | Fu, P.
机构: 四川大学华西医院肾内科
期刊: AM J KIDNEY DIS2014年3月3期63卷

Abstract

BACKGROUND:

Citrate solution has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a citrate lock is superior to a heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive.

STUDY DESIGN:

systematic review and meta-analysis was performed by searching in PubMed, EMBASE, Ovid, the Cochrane Library, and Web of Science databases and major nephrology journals.

SETTING & POPULATION:

Patients receiving hemodialysis with central venous catheters.

SELECTION CRITERIA FOR STUDIES:

Randomized controlled trials comparing citrate locks with heparin locks in hemodialysis patients with central venous catheters.

INTERVENTION:

Locking central venous catheters with citrate locks.

OUTCOMES:

Primary outcomes include catheter-related bloodstream infection (CRBSI), exit-site infection, catheter removal for poor flow, and thrombolytic treatment.

RESULTS:

13 randomized controlled trials (1,770 patients, 221,064 catheter-days) met the inclusion criteria. Pooled analyses found that citrate locks could significantly reduce the incidence of CRBSI (risk ratio [RR], 0.39; 95% CI, 0.27-0.56; P < 0.001). Subgroup analysis showed that antimicrobial-containing citrate locks (citrate + gentamicin, citrate + taurolidine, and citrate + methylene blue + methylparaben + propylparaben) were superior toheparin locks in the prevention of CRBSI (P < 0.001, P = 0.003, and P = 0.008, respectively), whereas citrate alone failed to show a similar advantage (P = 0.2). Low- (1.04%-4%) to moderate-concentration (4.6%-7%) citrate locks were associated with decreased CRBSI incidence (P < 0.001 and P = 0.003, respectively), but patients receiving high-concentration (30%-46.7%) citrate and heparin locks had similar incidences (P = 0.3). The incidence of bleeding episodes (RR, 0.48; 95% CI, 0.30-0.76; P = 0.002) was significantly lower in patients receiving citrate locks, whereas both groups were similar in terms of exit-site infection (P = 0.2), catheter removal for poor flow (P = 0.9), thrombolytic treatment (P = 0.8), all-cause death (P = 0.3), catheter thrombosis (P = 0.9), mean catheter duration (P = 0.2), CRBSI-free catheter survival (P = 0.2), and catheter-related readmission (P = 0.5).

LIMITATIONS:

All studies used in the meta-analysis were performed in Western countries. The applicability of our findings to other regions remains to be clarified.

CONCLUSIONS:

An antimicrobial-containing citrate lock is better than a heparin lock in the prevention of catheter-related infection, while citrate alone fails to show a similar advantage. Citrate locks of low to moderate concentrations, rather than high concentration, were superior to heparin locks in preventing CRBSI. Citrate locks also might decrease bleeding episodes. No difference has been identified in the efficacy to prevent exit-site infection or preserve catheter patency between citrate and heparin locks.

Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Hemodialysis, antimicrobial solution, catheter lock, catheter-related bacteremia, citrate, exit-site infection, heparinlock solution, renal replacement therapy, vascular access

通讯作者:Division of Nephrology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
学科代码:肾脏病学 泌尿外科学   关键词:柠檬酸
来源: Scopus
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