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


  • Jais Kumar Karmani Associate Professor (Nephrology), Akbar Niazi Teaching Hospital/IMDC, Islamabad
  • Saima Mir Senior Registrar (Nephrology), DHQ Teaching Hospital, Rawalpindi Pakistan
  • Syed Mohsin Naveed HOD and Professor of Nephrology, PIMS, Islamabad
  • Syed Asim Ali Shah 7. Associate Professor (Medicine), POF Hospital, Wah Medical College, NUMS, Wah Cantt Pakistan
  • Muhammad Khalid Javaid Assistant Professor/Consultant Pathologist (Pathology), Akbar Niazi Teaching Hospital/IMDC, Islamabad Pakistan
  • Fareena Asim Lecturer/Clinical Pathologist (Pathology), Wah Medical College, NUMS, Wah Cantt Pakistan
  • Armughan Ahmad Consultant/Physician (Nephrology), Federal Government Services Hospital/Polyclinic, Islamabad Pakistan



Catheter-related infections, Central venous catheter thrombosis


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.

Methodology: A randomized controlled trial was conducted at a nephrology department's hemodialysis unit in Pakistan Institute of Medical Sciences (PIMS) between August 2022 and February 2023. Total 110 consecutive end-stage renal disease patients, aged above 18 years, undergoing hemodialysis with temporary central venous catheters, were divided into two groups. Group-I received trisodium citrate 46.7% as a lock solution, while Group-II received heparin 2000 U/ml (control).

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).

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.






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