M-EDTA demonstrates efficacy in prevention of CRB for hemodialysis patients

An antimicrobial lock solution containing minocycline in combination with EDTA reduces the rate of catheter-related bacteremia (CRB) in hemodialysis patients, according to the results of a study published online in the Journal of the American Society of Nephrology.

CRB represents the most serious complication of catheter use among dialysis patients, the authors noted citing several studies that link morbidity and mortality with CRB.

Based on more recent evidence that antimicrobial catheter locks significantly reduced CRB events, the authors wanted to evaluate whether M-EDTA solution would reduce episodes of catheter-related bacteremia and increase bacteremia-free catheter survival in hemodialysis patients.

They conducted a multicenter, randomized, open-label, controlled trial comparing M-EDTA with heparin as an interdialytic catheter lock. Ninety-two catheters were followed in the M-EDTA group and 95 in the heparin group for 90 days. The primary end point of the study was the occurrence of CRB within 90 days from catheter insertion.

Results demonstrated that the incidence of CRB was significantly lower in the M-EDTA group. Nineteen patients had CRB in the heparin group compared with 5 patients in the M-EDTA group, representing 4.3 per 1,000 catheter-days in the heparin group and 1.1 per 1,000 catheter-days in the M-EDTA group. The 90-day CRB-free survival was 91.3% in the M-EDTA group versus 69.3% in the heparin group. Patients with nontunneled catheters locked with M-EDTA had a lower incidence of CRB versus those locked with heparin.

“This solution reduces the rate of catheter removal because of bacteremia; consequently, it provides a more extended period for the maturation of an arteriovenous fistula without the need to place a new catheter; this was true even in patients with nontunneled catheters. It is important to point out that a reduction in episodes of CRB implies less hospitalization, less cost, less morbidity, and less mortality,” the authors noted.