Is Systemic Heparin a Risk Factor for Catheter-Related Sepsis in Dialysis Patients?

Abstract

Background: Biofilms are dense aggregates of surface adherent microorganisms embedded in a polysaccharide matrix. Intravenous iron and heparin are thought to promote the formation of biofilm. Both are commonly employed during hemodialysis treatments which might affect the incidence of catheter-related sepsis. Methods: 559 patients who underwent hemodialysis treatment with a catheter were reviewed. Episodes of sepsis were analyzed for the use of systemic heparin and intravenous iron as well as all other risk factors for sepsis. Results: Sepsis developed in 141 of the 796 catheters. Analysis of variance revealed that the number of days that the catheter remained in place was the most significant variable (p < 0.0001) associated with catheter-related sepsis along with multiple other variables, but a Cox proportional hazards analysis revealed that only the two biofilm risk factors (intravenous iron [p < 0.001], and mid-treatment bolus of heparin [p = 0.046]) along with previously reported factor of a depressed serum albumin (p = 0.001) are of significance. Conclusion: In addition to duration of catheter use, we found three significant risk factors for sepsis and two of those three have been associated with the development of biofilm.

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

“…99 In a study published in 2005, heparin was shown to facilitate the creation of biofilm, sheets of bacteria that adhere to the surfaces of devices like catheters, so it potentially can increase the rate of infection. 100 In that study, 559 long-term hemodialysis patients using catheters were followed up during a 6-year period.…”

A Taurolidine–Citrate–Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients

“…20 Other variables such as diabetes mellitus, low serum albumin, low serum calcium, systemic heparin have also been reported to affect the incidence of catheter infections. 16,21,22 Even though the analysis showed that, the study group and the control did not differ in regard to those variables.…”

“…Unfortunately, on the other hand, the systemic heparin doses have also been reported to affect the incidence of catheter-related infection and catheter biofilm colonization. 16 However, one might expect a slight increase in the incidence of infections when using taurolidine-citrate-heparin in comparison with when using taurolidine-citrate alone, and no statistically significant differences were discovered. 17 Although a taurolidine-citrate-urokinase lock solution was only applied once, it seems that its value cannot be underestimated in this regard.…”

Novel Insights into the Pathobiology of the Vascular Access – Do They Translate into Improved Care?

“…Sepsis is extremely common in patients on hemodialysis [111] and 23% of those infections occur even without central catheters [112] , and a chronic inflammatory state unrelated to active infection is also common and is associated with malnutrition and poor survival [113] . Unfortunately, we now also know that inflammation increases thrombosis by increasing tissue factor, while decreasing thrombomodulin and plasminogen activator inhibitor 1.…”