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Background <p>The primary challenge for hemodialysis (HD) patients using permanent tunneled cuffed catheters is to prevent catheter-related bloodstream infections. This study assessed the effectiveness of sodium bicarbonate in preventing catheter-related bloodstream infections and compared its efficacy to antibiotic-containing locks.</p> Design, materials, and methods <p>We conducted a prospective single-center, open-label, cohort study over 30&#xa0;months&#xa0;with the aim to compare three cohorts: cohort I employed&#xa0;8.4% sodium bicarbonate solution lock, cohort II employed 0.5&#xa0;mg/ml gentamicin/acid citrate dextrose solution lock, and cohort III employed unfractionated conventional heparin 5000 U/ml solution lock. The primary endpoint was the first episode of catheter-related bloodstream infection, while the secondary endpoint was catheter loss due to catheter-related bloodstream infection.</p> Results <p>This study involved 204 HD patients with permanent tunneled cuffed central venous catheters (CVCs). A total of 58 cases of catheter-related bloodstream infection were documented. In the sodium bicarbonate-lock cohort, infection occurred in 17.24%,&#xa0;in the gentamicin/acid citrate-lock cohort in 36.21%, and&#xa0;in the heparin-lock cohort in 46.55%. Patients with sodium bicarbonate and gentamicin/acid citrate locks exhibited a statistically significant lower risk of developing infections (0.4/1000 catheter days and 0.7/1000 catheter days, respectively)&#xa0;compared to patients with heparin-lock (1.4/1000 catheter days). Patients with heparin lock faced a higher risk of losing a catheter due to infection compared to those with gentamicin/acid citrate lock and sodium bicarbonate-lock (Hazard Ratio (HR) = 1.26, 95% Confidence Interval (CI) [1.09–1.46], <i>P</i> = 0.001) and (HR = 1.10, 95% CI [1.01–1.19], <i>P</i> = 0.024).</p> Conclusion <p>The sodium bicarbonate locking solution demonstrated an&#xa0;infection-free catheter survival comparable to that of the gentamicin citrate solution and significantly decreased catheter-related bloodstream infection compared to heparin locks.</p> Graphical abstract <p></p>

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Impact of sodium bicarbonate locking solution on catheter-related blood stream infection in hemodialysis patients: comparative effectiveness of three locks

  • 期刊论文

  • 发表日期：

    2025年7月1日

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  • Tamar Kasradze,
  • Tamar Didbaridze,
  • Irma Tchokhonelidze

摘要

Background

The primary challenge for hemodialysis (HD) patients using permanent tunneled cuffed catheters is to prevent catheter-related bloodstream infections. This study assessed the effectiveness of sodium bicarbonate in preventing catheter-related bloodstream infections and compared its efficacy to antibiotic-containing locks.

Design, materials, and methods

We conducted a prospective single-center, open-label, cohort study over 30 months with the aim to compare three cohorts: cohort I employed 8.4% sodium bicarbonate solution lock, cohort II employed 0.5 mg/ml gentamicin/acid citrate dextrose solution lock, and cohort III employed unfractionated conventional heparin 5000 U/ml solution lock. The primary endpoint was the first episode of catheter-related bloodstream infection, while the secondary endpoint was catheter loss due to catheter-related bloodstream infection.

Results

This study involved 204 HD patients with permanent tunneled cuffed central venous catheters (CVCs). A total of 58 cases of catheter-related bloodstream infection were documented. In the sodium bicarbonate-lock cohort, infection occurred in 17.24%, in the gentamicin/acid citrate-lock cohort in 36.21%, and in the heparin-lock cohort in 46.55%. Patients with sodium bicarbonate and gentamicin/acid citrate locks exhibited a statistically significant lower risk of developing infections (0.4/1000 catheter days and 0.7/1000 catheter days, respectively) compared to patients with heparin-lock (1.4/1000 catheter days). Patients with heparin lock faced a higher risk of losing a catheter due to infection compared to those with gentamicin/acid citrate lock and sodium bicarbonate-lock (Hazard Ratio (HR) = 1.26, 95% Confidence Interval (CI) [1.09–1.46], P = 0.001) and (HR = 1.10, 95% CI [1.01–1.19], P = 0.024).

Conclusion

The sodium bicarbonate locking solution demonstrated an infection-free catheter survival comparable to that of the gentamicin citrate solution and significantly decreased catheter-related bloodstream infection compared to heparin locks.

Graphical abstract