ArticleFrontiers in pharmacology2026
Sodium bicarbonate combined with urokinase for the prevention and management of hemodialysis central venous catheter dysfunction.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Central venous catheter (CVC) dysfunction remains a common problem in maintenance hemodialysis and may impair prescribed blood flow and dialysis adequacy. This study aimed to evaluate whether a sodium bicarbonate-urokinase lock within a standardized dwell-and-aspiration protocol was associated with improved catheter patency and safety outcomes compared with a saline-urokinase lock. Methods: This retrospective study included 220 clinically stable adults undergoing maintenance hemodialysis with an indwelling CVC between December 2023 and March 2024. Patients were grouped according to the predefined catheter-locking schedule used in routine practice: sodium bicarbonate plus urokinase group (n = 115) and 0.9% sodium chloride plus urokinase group (n = 105). Urokinase was prepared at 10,000 U/mL, instilled at 1.1-1.2 times the catheter lumen volume, dwelled for 30 min, and followed by standardized negative-pressure aspiration. Outcomes included catheter dysfunction, event rates, dialysis performance, procedural response, recurrence, catheter exchange, and safety events. Multivariable logistic regression was used to adjust for clinically relevant covariates. Results: Catheter dysfunction occurred in 20.9% of patients in the sodium bicarbonate-urokinase group and 34.3% in the saline-urokinase group (P = 0.026). Dysfunction event rates were 4.35 versus 8.30 per 1,000 catheter-days, respectively (incidence rate ratio = 0.52, P = 0.002). After covariate adjustment, the sodium bicarbonate-urokinase regimen was associated with lower odds of dysfunction (adjusted odds ratio = 0.49, 95% confidence interval: 0.26-0.90; P = 0.024). Single-procedure patency restoration was more frequent (85.7% vs. 65.6%; P = 0.033), while repeat intervention and catheter exchange/reinsertion were less frequent. Bleeding events and laboratory safety indicators were comparable. Catheter-related bloodstream infection was infrequent but observed less often in the sodium bicarbonate-urokinase group (0.9% vs. 6.7%; P = 0.029). Conclusion: Sodium bicarbonate combined with urokinase within a standardized dwell-and-aspiration protocol may be associated with lower observed rates of CVC dysfunction, fewer dysfunction-related events, a higher observed rate of single-procedure patency restoration, and a comparable safety profile. Infection-related findings should be interpreted cautiously because of the small number of events and should be considered hypothesis-generating.
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