Abstract | INTRODUCTION:
Central venous catheters (CVC) are a major contributor to infections in hemodialysis (HD) patients, leading to high morbidity and mortality. Gentamicin- citrate (GC) lock is used as standard of care at centers belonging to a mid-size dialysis organization. Four outpatient HD centers acquired by the organization continued to use heparin for catheter locks for a period of time before converting to the provider's standard of using GC lock. METHODS: In this retrospective observational study, we included patients receiving HD by CVC at these four centers. We report rates of CVC-related bloodstream infections (CVC-BSI) during the heparin lock and the GC lock periods; crude rate ratios and adjusted rate ratios using Cox survival analyses adjusting for potential confounders; microbiology patterns; safety signals ( gentamicin resistance, hospitalizations and deaths); and financial impact on payer. FINDINGS: A total of 220 and 281 patients used tunneled CVCs, accounting for 25,245 and 44,550 catheter days in the heparin and the GC lock periods, respectively. CVC-BSI event rates were 66% lower in the GC lock period (CVC-BSI event rate: 0.20 per 1000 catheter-days) than the heparin lock period (rate: 0.59 per 1000 catheter days); rate ratio 0.34 (95% confidence interval (CI) 0.15-0.78, P = 0.01). In the fully adjusted multivariable Cox model, use of GC lock was associated with 70% reduction in CVC-BSI events (HR 0.30, 95% CI 0.12-0.72, P = 0.01). No increased risk of gentamicin resistance, hospitalizations, or death associated with use of GC lock were observed. Use of GC lock was associated with an estimated saving of $1533 (95% CI: $259-$4882) per patient per year. DISCUSSION: Use of GC lock led to significant reductions in CVC-BSIs with no signal for harm, and is associated with significant cost savings in dialysis care.
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Authors | Wael F Hussein, Norma Gomez, Sumi J Sun, Junhua Yu, Fang Yang, Michael Ajuria, Graham E Abra, Brigitte Schiller |
Journal | Hemodialysis international. International Symposium on Home Hemodialysis
(Hemodial Int)
Vol. 25
Issue 1
Pg. 20-28
(01 2021)
ISSN: 1542-4758 [Electronic] Canada |
PMID | 33006269
(Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
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Copyright | © 2020 International Society for Hemodialysis. |
Chemical References |
- Citrates
- Gentamicins
- Citric Acid
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Topics |
- Catheter-Related Infections
(prevention & control)
- Catheterization, Central Venous
- Central Venous Catheters
(adverse effects)
- Citrates
- Citric Acid
- Gentamicins
(therapeutic use)
- Humans
- Renal Dialysis
- Sepsis
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