Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS).

Background And Objectives: Citrate 4% has antithrombotic and antibacterial properties, which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent.

Design, Setting, Participants, And Measurements: Sixty-one prevalent hemodialysis (HD) patients dialyzing with a tunneled cuffed HD catheter were randomized in a pilot study to receive either heparin 5000 U/ml or citrate 4% as a locking agent after HD. The primary outcomes were the development of catheter dysfunction (defined as a blood pump speed <250 ml/min or the use of tissue plasminogen activator) and catheter-associated bacteremia.

Short and long alteplase dwells in dysfunctional hemodialysis catheters.

Background: Hemodialysis catheter dysfunction (CD) is the inability to attain adequate blood pump speeds (BPS) and is attributed to thrombus or catheter malposition; alteplase (TPA) is often given in a variety of dwell times to treat CD. The purpose of this study was to determine if TPA dwell time affects short- or long-term catheter patency rates.

Methods: Sixty hemodialysis (HD) patients with CD, as defined by BPS of < 250 mL/min, were randomized to receive either 1- or > 48-hr (to subsequent HD run) TPA dwell.