COMPARATIVE STUDY OF UROKINASE VS TRISODIUM CITRATE IN PREVENTION OF LUMINAL THROMBOSIS IN TUNNELED DIALYSIS CATHETERS

Abstract

Background: Tunneled dialysis catheters (TDCs) are vital for vascular access in hemodialysis patients but are frequently complicated by luminal thrombosis, leading to catheter dysfunction, reduced dialysis efficiency, and increased morbidity. Effective catheter lock solutions are essential to prevent thrombotic events and maintain long-term catheter patency. While urokinase is widely used for its thrombolytic properties, trisodium citrate has gained attention due to its anticoagulant action and potentially superior safety profile.

Objective: To compare the efficacy and safety of trisodium citrate and urokinase in preventing luminal thrombosis in tunneled dialysis catheters.

Methods: This nonrandomized controlled trial was conducted over 12 months at a tertiary care center. A total of 120 adult hemodialysis patients requiring tunneled dialysis catheter use were enrolled and assigned equally into two groups: Group 1 (n=60) received urokinase 5000 IU, and Group 2 (n=60) received trisodium citrate 4% as lock solutions following each dialysis session. The primary outcome was incidence of luminal thrombosis, clinically suspected and confirmed by ultrasound. Secondary outcomes included catheter survival time without thrombosis, catheter-related infections, mechanical complications, and adverse events. Data analysis was performed using SPSS version 23. Chi-square test and Kaplan-Meier survival analysis were employed where appropriate.

Results: Trisodium citrate group exhibited a significantly lower thrombosis rate of 15% compared to 28% in the urokinase group (p=0.03). Median time to first thrombosis was 9 months in the citrate group versus 6 months in the urokinase group (p=0.02). Catheter survival without thrombosis was higher in the citrate group (85%) than urokinase (72%) (p=0.04). No significant differences were observed in infection (p=0.68) or mechanical complication rates (p=0.99). Local irritation occurred equally in 3.3% of patients in both groups.

Conclusion: Trisodium citrate is more effective than urokinase in preventing luminal thrombosis in TDCs and supports better catheter survival with a comparable safety profile, making it a practical option for routine clinical use.