Evidence map›Paper›PMID 25926995›Full record

ArticleCanadian journal of kidney health and disease2015

Benefits and harms of citrate locking solutions for hemodialysis catheters: a systematic review and meta-analysis.

Alexa Grudzinski, Arnav Agarwal, Neera Bhatnagar, Gihad Nesrallah

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of kidney health and disease, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04756427 (Sodium Citrate 4% Locking Solution for Children Requiring Home Parenteral Nutrition), which is not on this map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04756427 phase4terminatednot on this mapstarted 2022, after this paper: background citation

Sodium Citrate 4% Locking Solution for Children Requiring Home Parenteral Nutrition

TypeinterventionalSponsorJohns Hopkins UniversityRan2022 to 2023Enrolled1ConditionsCLABSI - Central Line Associated Bloodstream InfectionArmsSodium Citrate 4% Inj Syringe 3Ml
3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Trial
  4. Cluster-Randomized Trial of Devices to Prevent Catheter-Related Bloodstream Infection.Journal of the American Society of Nephrology : JASN · 2018
    Trial
  5. Article
  6. Article
  7. Observational
  8. Review
  9. Disinfectants in a Hemodialysis Setting: Antifungal Activity AgainstFrontiers in cellular and infection microbiology · 2021
    Article
  10. Article
  11. Article
  12. Review
  13. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Alexa GrudzinskiDepartment of Basic Medical Sciences, Faculty of Science, Western University, London, ON Canada.
Arnav AgarwalFaculty of Medicine, University of Toronto, Toronto, ON Canada.
Neera BhatnagarDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada.
Gihad NesrallahLawson Health Research Institute, Western University, 375 South Street, London, ON Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCitrate has theoretical advantages over heparin for locking hemodialysis central venous catheters (CVCs), but the comparative effectiveness of these agents is not clear.

objectives1) To compare the benefits and harms of citrate versus heparin locking solutions among patients undergoing hemodialysis through CVCs; 2) to appraise methodological quality of the supporting evidence. DATA SOURCES: CENTRAL, MEDLINE, EMBASE, CINAHL, ISI Web of Science, and nephrology conference abstracts. STUDY ELIGIBILITY PARTICIPANTS AND

interventionsWe included randomized, parallel arm clinical trials that enrolled adult patients (>18 years) receiving chronic hemodialysis through CVCs using a citrate locking solution. We excluded studies in which citrate was combined with other agents, such as antibiotics. APPRAISAL AND SYNTHESIS

methodsWe used the GRADE approach to systematic reviews and quality appraisal. Two reviewers performed data extraction independently and in duplicate. We pooled count data using generic inverse variance with random-effects models, and used fixed-effect models when only two studies were available for pooling. Subgroups included low (≤5%) vs. higher (≥30%) citrate.

resultsWe screened 600 citations. Forty-one proceeded to full-text screen; 5 met inclusion criteria. Studies included between 19 and 291 participants (Median N = 61) followed for a total of 174.6 catheter-years; 2 were multi-centred trials. Three studies assessed all-cause mortality; the pooled relative risk for death was 0.71 (95% CI = 0.42-1.24; p = 0.21; I(2) = 0%). The rate ratio for bacteremic episodes was 0.54 (95% CI = 0.23-1.29; p = 0.16; I(2) = 65%) while the rate ratio for bleeding was 0.48 (95% CI = 0.3-0.75; p = 0.001;I I(2) = 5%). Rates of catheter exchange/replacement, all-cause hospitalization and in-situ thrombolysis were not significantly different between groups in any of the pooled analyses. Risk of bias within pooled studies was low. LIMITATIONS: Outcome definitions varied across studies. Imprecision due to small sample sizes and low event rates reduce our overall confidence in the pooled effect estimates. IMPLICATIONS: Benefits and harms of citrate vs. heparin locking solutions remain unclear; larger studies and standardization of outcome measurement and reporting are warranted.

trial registrationProtocol Registration Number: CRD42013004781.

Identifiers

PMID25926995
PMCPMC4413999

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.