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Trisodium citrate is a small-molecule salt used primarily as a non-antibiotic catheter lock solution in patients undergoing hemodialysis, particularly those with chronic kidney disease. It functions as an anticoagulant by chelating calcium ions, which are essential cofactors in the blood coagulation cascade, thereby preventing thrombus formation and maintaining catheter patency. Additionally, trisodium citrate exhibits antimicrobial properties by disrupting bacterial cell wall integrity and interfering with biofilm formation, which helps prevent catheter-related bloodstream infections (CRBSI). It is often utilized as an alternative to heparin to avoid the risks of systemic anticoagulation and heparin-induced thrombocytopenia. In clinical research, such as the CLOCK trial sponsored by the University of São Paulo, it is evaluated for its comparative effectiveness against other lock solutions like minocycline-EDTA and heparin.
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