Abstract:
Mortality and morbidity are significantly higher among patients with dialysis catheters, which has been associated with chronic activation of the immune system. We hypothesized that bacteria colonizing the catheter lumen trigger an inflammatory response. We aimed to evaluate the inflammatory profile of hemodialysis patients before and after locking catheters with an antimicrobial lock solution. High-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNFa) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10 and TNFa were analyzed in peripheral blood mononuclear cells (PBMC). Samples were obtained at baseline and again after 3 months’ use of Taurolidine-citrate-heparin lock solution (TCHLS) in 31 hemodialysis patients. The rate of catheter-related bloodstream infections (CRBSI) was 1.08 per 1000 catheter-days in the heparin period and 0.04 in the TCHLS period (P = 0.023). Compared with baseline, serum levels of hs-CRP and IL-6 showed a median percent reduction of 18.1% and 25.2%, respectively (P < 0.01), without significant changes in TNFa or IL-10. Regarding cytokine gene expression in PBMC, the median mRNA expression level of TNFa and IL-6 decreased by 20% (P < 0.05) and 19.7% (P = 0.01), respectively, without changes in IL-10 expression levels. The use of TCHLS to maintain the catheter lumen sterile significantly reduces the incidence of CRBSI and improves the inflammatory profile in hemodialysis patients with tunneled catheters. Further studies are needed to evaluate the potential beneficial effects on clinical outcomes.
Reference:
Fontseré, N., Cardozo, C., Donate, J., Soriano, A., Muros, M., Pons, M., Mensa, J., Campistol, J.M., Navarro-González, J.F. and Maduell, F. (2014) Lock tunneled catheters with Taurolidine-citrate-heparin lock solution significantly improves inflammatory profile in hemodialysis patients. Antimicrobial Agents and Chemotherapy. May 12th. (epub ahead of print).