Effect of taurolidine citrate and unfractionated heparin on inflammatory state and dialysis adequacy in hemodialysis patients

Abstract

Background and aim: HD patients using dialysis catheters have been associated with chronic inflammatory state. In Egypt 6.6% of HD patients use catheters, of which short term catheters represent 59.6% and 40.4% with long-term catheters. In this study, we aimed to assess the effect of Taurolidine citrate and unfractionated heparin combination (Taurolock-hep500™) as a lock solution compared to unfractionated heparin alone on inflammatory markers, incidence of catheter related blood stream infections (CRBSI) and dialysis adequacy in HD patients with temporary HD catheters only, for 4 weeks duration. Methods: Sixty ESRD patients from hemodialysis units in Ain-Shams University hospitals (ASUH) at the time of catheter insertion we enrolled in our study. They were randomized into two groups: Group 1: Thirty patients received Taurolock-hep500™ as a catheter lock solution at the end of each hemodialysis session. Group 2: Thirty patients received unfractionated heparin as a catheter lock solution. hsCRP and IL-6 were measured at baseline and 1 month after using the lock solutions. Blood cultures were done in patients who developed symptoms of catheter related infections. Results: At the end of the study, Inflammatory markers were significantly higher in group 2 ( p-value: 0.045, 0.001, and 0.018 for WBCs, hsCRP and IL-6, respectively). Group 1 had better dialysis adequacy assessed by URR ( p-value: 0.007 and 0.001, respectively). CRBSI were demonstrated in nine patients in group 2 (30%) in contrast to one patient only in group 1(3.3%) ( p-value: 0.006) with pseudomonas being the most common isolated organism (27.7%). Conclusion: Use of (Taurolock-hep500™) for temporary hemodialysis catheters was associated with lower levels of inflammation markers and lower incidence of CRBSI and better catheter performance.

Antifungal activity of Taurolidine against Mucorales: an in-vitro study on clinical isolates

“…Ezzat et al reported that the use of taurolidine for temporary hemodialysis catheters was associated with lower inflammation markers, lower incidence of catheter-related bloodstream infections, and better catheter performance [ 28 ].…”

Pharmacology of Heparin and Related Drugs: An Update

“…Another recent study has suggested that UFH can alleviate sepsis-induced ALI by reducing the levels of IL-6 in bronchoalveolar lavage fluid and improving the tight junctions in human lung microvascular endothelium by inhibiting the ERK1/2 MAPK pathway and downregulating the expression of claudin 5, occluding and ZO-1 (Liu et al, 2019). Furthermore, the use of UFH as a lock solution in catheters in patients undergoing hemodialysis also reduces the levels of IL-6 (Ezzat et al, 2021). Extracellular histones are known to be major contributors to organ dysfunction and death in patients with sepsis as they cause problems in the microcirculation.…”