PLoS ONE (Jan 2021)

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

DOI
https://doi.org/10.1371/journal.pone.0251793
Journal volume & issue
Vol. 16, no. 5
p. e0251793

Abstract

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BackgroundThe 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.MethodsPrevalent 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.Results68 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.ConclusionsProphylactic 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 registrationClinicalTrials.gov Identifier: NCT02036255.