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. 2025 Apr;40(4):1081-1091.
doi: 10.1007/s00467-024-06601-4. Epub 2024 Nov 22.

Use of 4% tetrasodium EDTA (KiteLock™) to prevent central venous catheter-related bloodstream infections in pediatric hemodialysis patients

Cal H Robinson  1   2   3   4 , Elizabeth Harvey  5   6 , Rose Nemec  5 , Katherine Karkut  5 , Lor Tecson  5 , Ashlene M McKay  5   6
Affiliations

Use of 4% tetrasodium EDTA (KiteLock™) to prevent central venous catheter-related bloodstream infections in pediatric hemodialysis patients

Cal H Robinson et al. Pediatr Nephrol. 2025 Apr.

Abstract

Background: Central venous catheter (CVC)-related bloodstream infections (CRBSI) are common in children receiving hemodialysis and cause significant morbidity and healthcare costs. Unlike standard locking solutions, 4% tetrasodium EDTA (KiteLock™) has antimicrobial and antibiofilm properties. We aimed to study the safety and efficacy of 4% tetrasodium EDTA CVC locking in pediatric hemodialysis.

Methods: Single-center, before-and-after quality improvement study. We included all chronic hemodialysis patients (6 months-18 years) from 2016-2022 (before) to 2022-2024 (after). The standard CVC locking solution was changed from heparin (1000 units/mL) to 4% tetrasodium EDTA. We compared unit-level incidence of CRBSI, CVC replacement procedures (exchange or removal and reinsertion), laboratory results, alteplase use, and adverse events before and after 4% tetrasodium EDTA implementation.

Results: We included 22 pediatric chronic hemodialysis patients (median age 13.5 years, 50% female). CRBSI incidence was 0.89 infections per 1000 catheter-days (25,769 total catheter-days) before and 0.18 per 1000 catheter-days (5426 total catheter-days) after 4% tetrasodium EDTA (IRR 0.21, 95%CI 0.03-1.52). CVC replacement procedure incidence was 1.99 procedures per 1000 catheter-days (4027 total catheter-days) before and 1.29 per 1000 catheter-days (5426 total catheter-days) after 4% tetrasodium EDTA (IRR 0.65, 95%CI 0.24-1.79). There were no significant differences in hemodialysis treatment parameters, alteplase use (12% of treatments before vs. 18% after), or access complications (12% of treatments before vs. 15% after).

Conclusions: CVC locking with 4% tetrasodium EDTA was associated with sustained reductions in CRBSI and CVC replacement procedure incidence. Incorporation of 4% tetrasodium EDTA locking into standardized CVC care bundles may prolong vascular access survival.

Keywords: 4% tetrasodium EDTA; CRBSI; Catheter-related bloodstream infection; Central venous catheters; Hemodialysis catheter; Kitelock.

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Conflict of interest statement

Declarations. Conflict of interest: C.H.R. received travel support from SterileCare Inc. (Markham, Canada) to present this research at the 2024 World Congress of Nephrology. All other authors declare no real or perceived conflicts of interest that could affect the study design, data collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. SterileCare Inc. was not involved in the study design, data collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication.

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References

    1. Borzych-Duzalka D, Shroff R, Ariceta G et al (2019) Vascular access choice, complications, and outcomes in children on maintenance hemodialysis: findings from the International Pediatric Hemodialysis Network (IPHN) Registry. Am J Kidney Dis 74:193–202. https://doi.org/10.1053/j.ajkd.2019.02.014 - DOI - PubMed
    1. Shroff R, Calder F, Bakkaloğlu S et al (2019) Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transplant 34:1746–1765. https://doi.org/10.1093/ndt/gfz011 - DOI - PubMed
    1. Raina R, Joshi H, Chakraborty R, Sethi SK (2021) Challenges of long-term vascular access in pediatric hemodialysis: recommendations for practitioners. Hemodial Int 25:3–11. https://doi.org/10.1111/hdi.12868 - DOI - PubMed
    1. Chand DH, Valentini RP, Kamil ES (2009) Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners. Pediatr Nephrol 24:1121–1128. https://doi.org/10.1007/s00467-008-0812-3 - DOI - PubMed - PMC
    1. Onder AM, Somers MJG (2021) Infectious complications of hemodialysis in children. In: Warady BA, Alexander SR, Schaefer F (eds) Pediatric dialysis. Springer International Publishing, Cham, pp 401–436 - DOI

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