Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial

Florence Bonkain, Jean-Claude Stolear, Concetta Catalano, Dominique Vandervelde, Serge Treille, Marie M Couttenye, Annemieke Dhondt, Mark Libertalis, Mandelina Allamani, Philippe Madhoun, Amaryllis H Van Craenenbroeck, Floris Vanommeslaeghe, Freya Van Hulle, Philippe Durieux, Ingrid Van Limberghen, Christian Tielemans, Karl Martin Wissing

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

BACKGROUND: The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study.

METHODS: Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function.

RESULTS: 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23-0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis.

CONCLUSIONS: Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036255.

Original languageEnglish
Article numbere0251793
Number of pages17
JournalPLOS ONE
Volume16
Issue number5
DOIs
Publication statusPublished - 20 May 2021

Keywords

  • prevention
  • tunneled cuffed catheter dysfunction
  • taurolidine urokinase lock
  • hemodialysis

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