Effect of taurolidine–citrate–heparin lock solution on inflammatory response and hemodialysis adequacy in hemodialysis patients with tunneled catheters

Abstract

Background Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in hemodialysis (HD) patients using dialysis catheters. Short-term and long-term catheters are still being used as a vascular access in HD patients in our country. The aim of this study was to assess the effect of TauroLock-HEP500 as a lock solution on the incidence of CRBSIs, performance of HD permanent catheters, and HD adequacy. Patients and methods This was a randomized controlled trial carried out on 60 patients at Al-Zaitoun Specialized Hospital and Al-Demerdash Hospital – Ain Shams University. The patients were divided into two groups: taurolock group (group 1), which included 30 patients who received TauroLock-HEP500 (taurolidine, 4% citrate and 500 IU/ml heparin are combined in this solution), and heparin group (group 2), which included 30 patients who received unfractionated heparin (heparin sodium 5000 IU/ml) as a permanent catheter lock solution. Patients were followed up for 1 month for monitoring HD adequacy and incidence of CRBSI. Result At the end of the study, C-reactive protein was significantly higher in heparin group than the taurolock group (P=0.01). Moreover, urea reduction ratio significantly increased within group 1 (taurolock) (P≤0.001) and significantly decreased in group 2 (heparin) (P=0.034). Moreover, urea reduction ratio was significantly higher in group 1(taurolock) compared with group 2 (heparin) at the end of the study (P≤0.001). Regarding blood flow rate (BFR), there was a significant increase of BFR within group 1 (taurolock) after 1 month compared with the baseline (P≤0.001), whereas there was no significant change in group 2 (heparin) (P=0.387). Moreover, at the end of the study, there was a significant increase of BFR in group 1 (taurolock) than in group 2 (heparin) (P=0.056). One case with CRBSIs was demonstrated in the taurolock group compared with five cases in the heparin group (P=0.19). Conclusion The use of taurolidine–citrate–heparin lock solution in HD patients with dialysis catheters may be associated with better HD adequacy, lower incidence of CRBSI) and lower inflammatory markers in comparison with the use of heparin.