Level of C‐Reactive Protein in Chronic Hemodialysis Patients: A Comparative Study Between Patients With Non‐Infected Catheters and Arteriovenous Fistula in a Large Saudi Hemodialysis Center

Saran, Khalid Al; Sabry, Alaa; Shalaby, Medhat; Sherbeiny, Sherrine Al; Abdel‐Kader, Mahmoud H.

doi:10.1111/j.1744-9987.2012.01116.x

Cited by 8 publications

(5 citation statements)

References 19 publications

(24 reference statements)

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“…Although inflammation etiology in patients undergoing hemodialysis is varied (15), they put on show the highest level of inflammation likely due to hidden infection associated with arteriovenous fistula or central venous catheters (16), confrontation with endotoxin, and other pollutants and bioincompatible dialysis solution and membrane (17). …”

Section: Introductionmentioning

confidence: 99%

Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

et al. 2013

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Background:Chronic inflammation is the most important cause of cardiovascular disease in patients undergoing hemodialysis, and vitamin C as a major antioxidant which could be effective to suppress inflammation.Objectives:This study was performed to evaluate the effect of vitamin C supplementation on C-reactive protein levels in patients undergoing hemodialysis.Patients and Methods:This randomized, placebo-controlled and double-blind trial was conducted on 151 patients on hemodialysis who were divided randomly by lottery method to three identical groups. In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each hemodialysis session three times a week for 8 weeks in a row. In the control group 1, same term of placebo saline was injected, and in the control group 2, no intervention was performed.Results:A total of 86 (61%) male and 55 female patients with mean hemodialysis duration of 39.74 ± 45.5 months, and a mean age of 61.36 ± 11.46 years-old, participated in this study. Hypertension and diabetes were the most common underlying diseases (79.4%). Median baseline CRP in the intervention, control 1 and control 2 groups were 16.8, 17.8, and 19.4 mg/L respectively. After 2 months, median CRP reduced significantly in the vitamin C group to 10.7 (P = 0.04) vs. 22.6, and 30.6 mg/L in control groups.Conclusions:Our findings demonstrated that vitamin C supplementation modifies the levels of CRP in patients on hemodialysis.

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Section: Introductionmentioning

confidence: 99%

Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

et al. 2013

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“…Some authors have demonstrated that, even in the absence of catheter-related infection, patients receiving hemodialysis through a catheter had significantly higher serum concentrations of C-reactive protein, suggesting that chronic inflammation could be the reason for their significantly higher mortality rate (2)(3)(4). However, some patients are unable to have an arteriovenous fistula and it is therefore highly important to identify the mechanism through which catheters trigger a chronic inflammatory response even in the absence of clinically evident infection.…”

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confidence: 99%

Tunneled Catheters with Taurolidine-Citrate-Heparin Lock Solution Significantly Improve the Inflammatory Profile of Hemodialysis Patients

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et al. 2014

Antimicrob Agents Chemother

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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-␣) were measured in serum, and levels of mRNA gene expression of IL-6, IL-10, and TNF-␣ were analyzed in peripheral blood mononuclear cells (PBMC). Samples were obtained at baseline and again after 3 months' use of taurolidinecitrate-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-␣ or IL-10 levels. Regarding cytokine gene expression in PBMC, the median mRNA expression levels of TNF-␣ 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. During the last few years, switching from a catheter to an arteriovenous fistula has been shown to be associated with a substantial decrease in mortality risk (1). Some authors have demonstrated that, even in the absence of catheter-related infection, patients receiving hemodialysis through a catheter had significantly higher serum concentrations of C-reactive protein, suggesting that chronic inflammation could be the reason for their significantly higher mortality rate (2-4). However, some patients are unable to have an arteriovenous fistula and it is therefore highly important to identify the mechanism through which catheters trigger a chronic inflammatory response even in the absence of clinically evident infection.The catheter lumen is colonized by microorganisms during its insertion or as a result of manipulating the hub (5). Once the microorganisms are attached to the intraluminal surface of the catheter, they embed themselves in a matrix of extracellular polymeric substances, thereby creating a biofilm (6). The maturation of this complex structure is a dynamic process that requires a chemically controlled detachment of biofilm fragments that starts after the third day of biofilm formation (7). Dittmer et al. (8) grew blood cultures from the catheter weekly after insertion in 31 patients with a central venous hemodialysis catheter. When the central cultures became positive, indicating cat...

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“…Indeed, it has been recognised that the use of CVC locking solutions maintains CVC patency and prevents infections, probably because of the reduction in conditioning biofilms. 28,29 Our study shows the presence of non-bacterial biofilms or conditioning films in all CVCs examined regardless of the type of locking solution used. According to our results, the taurolidine group was associated with significantly lower biofilm thickness and volume than the citrate 4% and heparin groups.…”

Section: Discussionmentioning

confidence: 58%

“…Moreover, in recent years, it has been shown that patients with CVCs have a greater inflammatory response (higher serum CRP) than patients with AVF, which has not been explained so far. 29,30 Possibly, the type of locking solution instilled into the CVC could reduce this response. 20 According to the results of previous studies, the presence of adherent biological materials 8 in CVCs could lead to clot formation and CVC dysfunction and become the optimal environment for the attachment of different bacteria or fungi.…”

Section: Discussionmentioning

confidence: 99%

Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation

et al. 2020

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Introduction: The surface of tunnelled cuffed catheters provides an optimal environment for the development of biofilms, which have recently been described as conditioning films because of the presence of adherent biological materials. These biofilms are associated with infection and thrombosis and potentially increase patients’ inflammatory response. These complications could be reduced by the use of locking solutions. Objective: To analyse biofilm formation, using confocal and electron microscopy, in tunnelled cuffed catheters locked with three different solutions and to determine the relationship between these solutions and inflammatory response. Study design: This prospective study included 35 haemodialysis patients with tunnelled cuffed catheter removal for non–infection-related reasons. The participants were divided into three groups according to the lock solution used: (1) heparin 1: 5000 IU; (2) citrate 4%; and (3) taurolidine 1.35%, citrate 4% and heparin 500 IU (taurolock); in the latter group, 25,000 IU taurolidine–urokinase was used in the last weekly session. All tunnelled cuffed catheters were cultured, and the inner surface was evaluated with confocal and electron microscopy. The inflammatory profile of included patients was determined at tunnelled cuffed catheter removal. Results: There were no differences in clinical or demographic variables between the three subgroups. Biofilm thickness was lower in the taurolidine group than in the citrate 4% and heparin groups (28.85 ± 6.86 vs 49.99 ± 16.56 vs 56.2 ± 15.67 µm, respectively; p < 0.001), as was biofilm volume (1.01 ±1.18 vs 3.7 ± 2.15 vs 5.55 ±2.44, µm3, respectively; p < 0.001). The mean interleukin-6 value was 39%, which was 50% lower than in the citrate and heparin groups, but without significance differences. Conclusion: Our results show that biofilms were found in all tunnelled cuffed catheters, but the thickness and volume were significantly lower in tunnelled cuffed catheters locked with taurolidine solution. Therefore, the type of locking solution used in tunnelled cuffed catheters should maintain tunnelled cuffed catheter sterility and prevent catheter-related bloodstream infections. No significant difference was observed in the inflammatory profile according to the type of locking solution.

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Level of C‐Reactive Protein in Chronic Hemodialysis Patients: A Comparative Study Between Patients With Non‐Infected Catheters and Arteriovenous Fistula in a Large Saudi Hemodialysis Center

Cited by 8 publications

References 19 publications

Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study

Tunneled Catheters with Taurolidine-Citrate-Heparin Lock Solution Significantly Improve the Inflammatory Profile of Hemodialysis Patients

Impact of locking solutions on conditioning biofilm formation in tunnelled haemodialysis catheters and inflammatory response activation

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