{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:11:36Z","timestamp":1790611896128,"version":"4.1.0"},"reference-count":121,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["APP2005174"],"award-info":[{"award-number":["APP2005174"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>\n                    Millions of patients with kidney failure rely on hemodialysis central venous catheters (CVCs) for their life-sustaining dialysis treatments. CVC dysfunction necessitates removal of up to 20% of CVCs and is an important problem for patients with kidney failure. Thrombosis and fibrin sheath formation are the most common mechanisms of CVC dysfunction beyond the first week after insertion. Factors such as female sex, left-sided CVC placement, and prior CVC dysfunction are associated with a higher risk of dysfunction. Patient-specific factors contribute substantially to variation in the number of CVC dysfunction events. Weekly thrombolytic locks have been shown to improve CVC blood flow rates, prevent infection, and reduce dysfunction requiring removal. However, routine administration may not be cost-effective in hemodialysis units with low infection rates, and targeted use among patients with established CVC dysfunction has not been studied. Concentrated heparin lock (\n                    <jats:italic toggle=\"yes\">e.g<\/jats:italic>\n                    ., 5000 versus 1000 international unit\/ml) has been associated with lower requirements for therapeutic CVC thrombolysis but greater systemic bleeding risks and costs. Citrate 4% was noninferior to standard heparin locks to prevent thrombosis, may cause less bleeding, and is less costly in some countries. Tunneled CVCs with a symmetrical tip have been associated with a lower risk of CVC dysfunction compared with those with a step tip. Multifaceted CVC care interventions can reduce the incidence of dysfunctional CVCs by 33% compared with usual care. Future research to identify patients at high risk of CVC dysfunction will inform individualized vascular access plans, targeted use of preventive strategies, and enrollment criteria for future clinical trials.\n                  <\/jats:p>","DOI":"10.1681\/asn.0000000666","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T12:01:15Z","timestamp":1740052875000},"page":"952-966","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Strategies to Prevent Hemodialysis Catheter Dysfunction"],"prefix":"10.1681","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7936-025X","authenticated-orcid":false,"given":"Benjamin","family":"Lazarus","sequence":"first","affiliation":[{"name":"Centre for Health Services Research, University of Queensland, Woolloongabba, Queensland, Australia"},{"name":"Department of Medicine, Monash University, Clayton, Victoria, Australia"},{"name":"Department of Nephrology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmaine E.","family":"Lok","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3875-9197","authenticated-orcid":false,"given":"Louise","family":"Moist","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Schulich School of Medicine, Western University, London, Ontario, Canada"},{"name":"Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada"},{"name":"Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-002X","authenticated-orcid":false,"given":"Kevan R.","family":"Polkinghorne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Monash University, Clayton, Victoria, Australia"},{"name":"Department of Nephrology, Monash Health, Clayton, Victoria, Australia"},{"name":"School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"issue":"6","key":"B1-20260114","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/s41581-022-00542-7","article-title":"Epidemiology of haemodialysis outcomes","volume":"18","author":"Bello","year":"2022","journal-title":"Nat Rev 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