title: Tunneled catheters with taurolidine-citrate-heparin lock solution significantly improve the inflammatory profile of hemodialysis patients.
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 (hs-CRP), interleukin-6 (IL-6), IL-10, and tumor necrosis factor alpha (TNF-α) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10, and TNF-α 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 1,000 catheter-days in the heparin period and 0.04 in the TCHLS period (P = 0.023). Compared with the baseline data, serum levels of hs-CRP and IL-6 showed median percent reductions of 18.1% and 25.2%, respectively (P < 0.01), without significant changes in TNF-α or IL-10 levels. Regarding cytokine gene expression in PBMC, the median mRNA expression levels of TNF-α 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 sterility 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.
authors.affiliation: Department of Nephrology, Vascular Access Unit, Hospital Clinic, Barcelona, Spain fontsere@clinic.ub.es.
authors.forename: Néstor
authors.initials: N
authors.lastname: Fontseré
authors.affiliation: Department of Infectious Diseases, Vascular Access Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Cardozo
authors.affiliation: Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Donate
authors.affiliation: Department of Infectious Diseases, Vascular Access Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Clinical Análisis Services, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Muros
authors.affiliation: CETIRSA, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pons
authors.affiliation: Department of Infectious Diseases, Vascular Access Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Department of Nephrology, Vascular Access Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
authors.affiliation: Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Navarro-González
authors.affiliation: Department of Nephrology, Vascular Access Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Maduell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants; D002097:C-Reactive Protein / Q000032:analysis; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000382:microbiology*; D019343:Citric Acid / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000517:prevention & control; D016753:Interleukin-10 / Q000097:blood / Q000235:genetics; D015850:Interleukin-6 / Q000097:blood / Q000235:genetics; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012333:RNA, Messenger / Q000096:biosynthesis; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D012333:RNA, Messenger; D013829:Thiadiazines; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D013654:Taurine; D019343:Citric Acid; C012566:taurolidine; D006493:Heparin; D002097:C-Reactive Protein