ArticleAnnals of intensive care2019
Trisodium citrate 4% versus heparin as a catheter lock for non-tunneled hemodialysis catheters in critically ill patients: a multicenter, randomized clinical trial.
Article in Annals of intensive care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01962116 (Citrate Versus Heparin for the Lock of Non-tunneled Hemodialysis Catheters in Patients Hospitalised in ICU = Multicentre, Controlled, Randomised Superiority Trial), which is not on this map. Cited by 19 papers, 3 of them syntheses that pooled 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.
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.
Citrate Versus Heparin for the Lock of Non-tunneled Hemodialysis Catheters in Patients Hospitalised in ICU = Multicentre, Controlled, Randomised Superiority Trial
Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Citrate as a safe and effective alternative to heparin for catheter locking: a systematic review and meta-analysis of randomized controlled trials.Frontiers in medicine · 2025Pooled it
- Pooled it
- Systematic review of locking solutions for non-tunneled hemodialysis catheters.Hemodialysis international. International Symposium on Home Hemodialysis · 2023Pooled it
- Sodium bicarbonate is a potential alternative to classic heparin as a lock solution for non-tunneled dialysis catheters: a result from the prospective randomized BicarbLock trial.International urology and nephrology · 2024Trial
- Trial
- Clinical practice guideline for renal replacement therapy in critically ill patients with acute kidney injury (2026 edition).Journal of intensive medicine · 2026Article
- Renal replacement therapy in intensive care unit: a narrative review.Annals of intensive care · 2026Review
- Comparable rates of catheter-related bloodstream infections between non-tunneled and tunneled hemodialysis catheters: a retrospective single-center study.Clinical kidney journal · 2026Article
- Renal replacement therapy in an intensive care unit: guidelines from the SRLF-GFRUP consensus conference.Annals of intensive care · 2025Review
- Strategies to Prevent Hemodialysis Catheter Dysfunction.Journal of the American Society of Nephrology : JASN · 2025Review
- Simulation and Modeling Thrombotic Occlusion in Peripherally Inserted Central Catheters.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2025Article
- Complications of tunneled central venous catheter placement: a narrative review of risks, prevention, and management strategies.Frontiers in radiology · 2025Review
- Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens.Pathogens (Basel, Switzerland) · 2024Review
- Article
- Management of renal replacement therapy among adults in French intensive care units: A bedside practice evaluation.Journal of intensive medicine · 2023Article
- Article
- The landscape of renal replacement therapy in Veterans Affairs Medical Center intensive care units.Renal failure · 2021Article
- Role of miR-92a-3p, oxidative stress, and p38MAPK/NF-κB pathway in rats with central venous catheter related thrombosis.BMC cardiovascular disorders · 2020Article
- What should be the best dialysis catheter lock in critically ill patients?Critical care (London, England) · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
21 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundNon-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.
methodsIn 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.
resultsOverall, 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.
conclusionsIn 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.
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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.