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      Sodium bicarbonate catheter lock solution reduces hemodialysis catheter loss due to catheter-related thrombosis and blood stream infection: an open-label clinical trial

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          Abstract

          Background

          There is no ideal lock solution that prevents hemodialysis (HD) catheter loss due to catheter-related thrombosis (CRT) and catheter-related bloodstream infection (CRBSI). Catheter loss is associated with increased hospitalization and high inpatient costs. Sodium bicarbonate (NaHCO 3) demonstrates anti-infective and anticoagulation properties with a good safety profile, making it an ideal lock solution development target.

          The objective of this study was to determine the safety and efficacy of using sodium bicarbonate catheter lock solution (SBCLS) as a means of preventing HD catheter loss due to CRT and CRBSI.

          Methods

          The study took place in a community hospital in Brooklyn, NY, USA. All admitted patients ≥18 years of age who needed HD treatment through CVC were included in the study. 451 patients included in the study were provided SBCLS or NSCLS post-dialysis. Catheter loss due to CRT or CRBSI was evaluated over a period of 546 days.

          Results

          A total of 452 patients met the criteria; 1 outlier was excluded, 226 were in the NSCLS group and 225 were in the SBCLS group. There were no significant differences between groups in comorbidities at the outset. The NSCLS group had CRT and CRBSI rates of 4.1 and 2.6/1000 catheter days (CD), respectively, compared with 0.17/1000 CD for both outcomes in the SBCLS group. SBCLS patients had a significantly reduced catheter loss rate due to CRT (P  <  0.0001) and CRBSI (P  =  0.0004). NSCLS patients had higher odds of losing their catheter due to CRT {odds ratio [OR] 26.6 [95% confidence interval (CI) 3.57–198.52]} and CRBSI [OR 15.9 (95% CI 2.09–121.61)] during the study period.

          Conclusion

          The novel approach of using SBCLS was found to be safe and was statistically superior to normal saline in preventing HD catheter loss due to CRT and CRBSI. NaHCO 3 solution is inexpensive, readily available in various settings and holds the potential to decrease hospitalization, length of stay and dialysis-related costs.

          Trial registration

          Maimonides Medical Center Investigational Review Board, Study IRB 2015-06-25-CIH. ClinicalTrials.gov identifier: NCT03627884.

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          Most cited references37

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          Sepsis: current dogma and new perspectives.

          Clifford S Deutschman, Kevin J. Tracey (2014)
          Sepsis, a clinical syndrome occurring in patients following infection or injury, is a leading cause of morbidity and mortality worldwide. Current immunological mechanisms do not explain the basis of cellular dysfunction and organ failure, the ultimate cause of death. Here we review current dogma and argue that it is time to delineate novel immunometabolic and neurophysiological mechanisms underlying the altered cellular bioenergetics and failure of epithelial and endothelial barriers that produce organ dysfunction and death. These mechanisms might hold the key to future therapeutic strategies. Copyright © 2014 Elsevier Inc. All rights reserved.
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            Type of vascular access and mortality in U.S. hemodialysis patients.

            Sean F Leavey, Rishi R. Dhingra, T Hulbert-Shearon … (2001)
            Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality. Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Study Wave 1, a random sample of 5507 patients, prevalent on hemodialysis as of December 31, 1993. The relative mortality risk during a two-year observation was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Using similar methods, cause-specific analyses also were performed for death caused by infection and cardiac causes. In diabetic mellitus (DM) patients with end-stage renal disease, the associated relative mortality risk was higher for those with arteriovenous graft (AVG; RR = 1.41, P < 0.003) and central venous catheter (CVC; RR = 1.54, P < 0.002) as compared with arteriovenous fistula (AVF). In non-DM patients, those with CVC had a higher associated mortality (RR = 1.70, P < 0.001), as did to a lesser degree those with AVG (RR = 1.08, P = 0.35) when compared with AVF. Cause-specific analyses found higher infection-related deaths for CVC (RR = 2.30, P < 0.06) and AVG (RR = 2.47, P < 0.02) compared with AVF in DM; in non-DM, risk was higher also for CVC (RR = 1.83, P < 0.04) and AVG (RR = 1.27, P < 0.33). In contrast to our hypothesis that AV shunting increases cardiac risk, deaths caused by cardiac causes were higher in CVC than AVF for both DM (RR = 1.47, P < 0.05) and non-DM (RR = 1.34, P < 0.05) patients. This case-mix adjusted analysis suggests that CVC and AVG are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.
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              Malnutrition: laboratory markers vs nutritional assessment

              Shishira Bharadwaj, Shaiva Ginoya, Parul Tandon … (2016)
              Malnutrition is an independent risk factor for patient morbidity and mortality and is associated with increased healthcare-related costs. However, a major dilemma exists due to lack of a unified definition for the term. Furthermore, there are no standard methods for screening and diagnosing patients with malnutrition, leading to confusion and varying practices among physicians across the world. The role of inflammation as a risk factor for malnutrition has also been recently recognized. Historically, serum proteins such as albumin and prealbumin (PAB) have been widely used by physicians to determine patient nutritional status. However, recent focus has been on an appropriate nutrition-focused physical examination (NFPE) for diagnosing malnutrition. The current consensus is that laboratory markers are not reliable by themselves but could be used as a complement to a thorough physical examination. Future studies are needed to identify serum biomarkers in order to diagnose malnutrition unaffected by inflammatory states and have the advantage of being noninvasive and relatively cost-effective. However, a thorough NFPE has an unprecedented role in diagnosing malnutrition.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nephrol Dial Transplant
                Journal ID (iso-abbrev): Nephrol. Dial. Transplant
                Journal ID (publisher-id): ndt
                Title: Nephrology Dialysis Transplantation
                Publisher: Oxford University Press
                ISSN (Print): 0931-0509
                ISSN (Electronic): 1460-2385
                Publication date (Print): October 2019
                Publication date (Electronic): 21 January 2019
                Publication date PMC-release: 21 January 2019
                Volume: 34
                Issue: 10
                Pages: 1739-1745
                Affiliations
                [1 ] Department of Nephrology, NYC Health + Hospitals/Coney Island , Brooklyn, NY, USA
                [2 ] Department of Medicine, NYC Health + Hospitals/Coney Island , Brooklyn, NY, USA
                Author notes
                Correspondence and offprint requests to: Adel S. El-Hennawy; E-mail: adel7@ 123456yahoo.com ; Twitter handle: @Adelhennawy
                Article
                Publisher ID: gfy388
                DOI: 10.1093/ndt/gfy388
                PMC ID: 6775472
                PubMed ID: 30668833
                SO-VID: 3b64b831-ba86-4aed-860e-93ec8ea9ce0c
                Copyright © © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 01 August 2018
                Date accepted : 19 November 2018
                Related
                Page count
                Pages: 7
                Categories
                Subject: Original Articles
                Subject: Dialysis

                ScienceOpen disciplines: Nephrology
                Keywords: catheter lock,catheter-related blood stream infection,catheter-related thrombosis,esrd,sodium bicarbonate
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: catheter lock, catheter-related blood stream infection, catheter-related thrombosis, esrd, sodium bicarbonate

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