Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2008 Mar;3(2):369-74.
doi: 10.2215/CJN.01760407.

Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS)

Jennifer M Macrae  1 , Ivana Dojcinovic, Ognjenka Djurdjev, Beverly Jung, Steven Shalansky, Adeera Levin, Mercedeh Kiaii
Affiliations
Randomized Controlled Trial

Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS)

Jennifer M Macrae et al. Clin J Am Soc Nephrol. 2008 Mar.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Kaplan-Meier survival curve for time to catheter dysfunction.
Figure 2.
Figure 2.
Patient flow chart. AVF, arteriovenous fistula; PD, peritoneal dialysis; pts, patients.
See this image and copyright information in PMC

References

    1. Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL: Haemodialysis vascular access problems in Canada: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Nephrol Dial Transplant 21: 721–728, 2006 - PubMed
    1. Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, Radkevich V, Murphy B: Establishment and maintenance of vascular access in incident hemodialysis patients: A prospective cost analysis. J Am Soc Nephrol 16: 201–209, 2005 - PubMed
    1. Bayes B, Bonal J, Romero R: Sodium citrate for filling haemodialysis catheters. Nephrol Dial Transplant 14: 2532–2533, 1999 - PubMed
    1. Buturovic J, Ponikvar R, Kandus A, Boh M, Klinkmann J, Ivanovich P: Filling hemodialysis catheters in the interdialytic period: Heparin versus citrate versus polygeline: A prospective randomized study. Artificial Organs 22: 945–947, 1998 - PubMed
    1. Lok CE, Appleton D, Bhola C, Khoo B, Richardson RM: Trisodium citrate 4%: an alternative to heparin capping of haemodialysis catheters. Nephrol Dial Transplant 22: 477–483, 2007 - PubMed

Publication types