Comparison of Catheter Related Blood Stream Infections in Hemodialysis Patients Treated With Trisodium Citrate as Catheter Locking Solution vs Heparin as Conventional Locking Method

Objective: To compare the frequency of temporary catheter related blood stream infections using sodium citrate as catheter locking solution with heparin as standard in hemodialysis patients. Methods: A comparative randomized control trial was conducted at hemodialysis unit of nephrology department, Pakistan Institute of Medical Sciences (PIMS) Islamabad between August 2022 and February 2023. Total 110 patients included consecutively with end stage renal disease, aged above 18 years undergone hemodialysis using temporary central venous catheter as vascular access irrespective of etiology of renal failure. Patients were divided into two groups: Group-I (Trisodium citrate) was administrated with lock solution of trisodium citrate 46.7%, whereas Group-II (Heparin) was administrated with lock solution of heparin 2000 U/ml (as control). The primary endpoint of this study is catheter-related bloodstream infection (CRBSI), measured as the number of observed episodes per 1000 catheter days between the two groups. Secondary endpoints were the number of catheters with thrombosis, catheter infection, and bleeding episodes. Results: The average age of patients in both groups was 51.98±13.57 years. The average duration of dialysis in both groups was 4.01±3.1 months and mean catheter time in group-I was 13.65±8.29 days and in group-II was 13.40±8.33 days with statistically insignificant (p ≥ 0.05). The rate of CRBSI per 1000 catheter days was 3.12 days for group I and 5.14 days for group II (p = 0.001). The cumulative mean infection-free catheter survival in the trisodium citrate group was lower than the heparin group (log rank = 2.31, p = 0.128). Cox regression survival analysis between two groups; the difference in group I & II was insignificant (HR = 1.6, CI = 0.49–1.17, p = 0.201). Practical implication: is that the determination of catheter related blood stream infections and comparing two methods i.e., trisodium citrate and heparin in hemodialysis patients. Conclusion: There is insignificant difference between trisodium citrate 46.7% and heparin as a catheter lock solution in the survival rate of tunneled hemodialysis catheters in end-stage renal disease