A new study points to the effectiveness of a different product in the category of “line-locking solutions” than what’s typically used to minimize hemodialysis catheter blockages, which could also result in cost savings for the health-care system. The results, published in the
Canadian Journal of Hospital Pharmacy, show that ethylenediaminetetraacetic acid 4% (EDTA 4%), can reduce the rate of catheter blockages for hemodialysis patients compared to sodium citrate 4% (SC 4%).
Hemodialysis involves withdrawing blood from a person using an access (fistula, graft or catheter) and filtering it through a machine before returning it to the body. In the case of a catheter access, which includes a tube, tissue can sometimes build up and block the catheter. To reduce the chances of this happening, a line-locking solution is instilled in the catheter.
SC 4% is a commonly used line-locking solution. If a blockage forms despite SC 4% use, care providers must administer alteplase, an agent that breaks down the clot (similar to how Draino™ is used to unclog sinks). However, alteplase is expensive.
As an alternative line-locking solution, EDTA is showing promise in the clinic, gaining the interest of kidney care providers in British Columbia.
“As EDTA became available, we wanted to see if it was able to reduce the need for alteplase, so we could put those funds towards other things for health care and kidney patients,” explains Brittany Gage, a clinical pharmacist at Burnaby General Hospital.
Therefore, her team conducted a small study, whereby 37 patients receiving hemodialysis at two major hospitals in BC – who often required many alteplase treatments to address blockages – were switched from SC to EDTA for a 12-week period.
“We found there was a significant decrease in the amount of alteplase that we had to use in patients on the EDTA line-locking solution,” Gage says.
The total number of days in which alteplase was required across all 37 patients declined significantly, from 313 days with SC 4% to 94 days with EDTA 4%. What’s more, the researchers conducted a cost analysis of this decrease in alteplase use, and found it resulted in an overall cost reduction of more than $13,100.
Gage notes an added benefit and surprising finding is that the patients who had had EDTA during the 12-week trial needed less alteplase even after EDTA was stopped. “This brought up the question that maybe we could schedule EDTA for a bit, do a break, and go back to sodium citrate for a while, and potentially reduce the costs even more,” she says.
Gates adds that because this was a small study, the next step would be a bigger one to explore these findings on a larger scale.
