Effect of the tunneled-cuffed central venous catheters on oxidative stress indices and inflammation in chronic hemodialysis patients

Abstract

Objectives: The use of central venous catheters as hemodialysis (HD) vascular access is associated with worse morbidity and mortality in HD patients. This occasion is often attributed to comorbidities of the patients with central venous catheters. Studies reveal that a biofilm layer occurs on most of the tunneled-cuffed central venous catheters (TC-CVCs). This study aimed to determine the oxidative stress (OS) and systemic inflammation (SI) status in patients with TC-CVCs as HD vascular access without clinical signs and symptoms of infection.

Methods: The study is composed of eighty-five patients with a minimum HD vintage of one year. Patients with a history of infection or a cardiovascular event within six months, malignancy, systemic inflammatory diseases, or malnutrition were excluded. OS indices and SI markers were studied and compared in patients with arteriovenous fistula (AVF) and TC-CVCs.

Results: Mean native thiol/total thiol (NT/TT) ratio was significantly higher and mean disulphide/total thiol (DT/TT) ratio was significantly lower in AVF group comparing TC-CVC group (0.46 ± 0.17 and 0.36 ± 0.17, p = 0.03 for NT/TT; 0.27 ± 0.08 and 0.31 ± 0.08, p = 0.04 for DS/TT; respectively). Mean OS index was significantly lower in the AVF group comparing TC-CVC group (0.15 ± 0.14 and 0.24 ± 0.23, p = 0.04; respectively]. Median hs-CRP levels and median IL-6 levels were significantly lower in AVF group comparing TC-CVC group (5.8 [min: 3.0-max: 82.5] mg/L and 9.7 [min: 3.0-max: 45.4] mg/L, p = 0.004 for hs-CRP; 6.2 [min: 2.0-max:159.0] pg/mL and 12.2 [min: 2.6-max: 41.3) pg/mL, p = 0.01 for IL-6; respectively).

Conclusions: TC-CVCs inversely affect OS and systemic inflammatory status in HD patients, presumably due to foreign body reactions and biofilm layers.

Keywords

• Arteriovenous fistula
• central venous catheters
• hemodialysis vascular access
• oxidative stress
• systemic inflammation

References

1. 1. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int 2002;62:620-6.
2. 2. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J; CHOICE Study. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 2005;16:1449-55.
3. 3. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 2004;15:477-86.
4. 4. Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS. The survival benefit of “Fistula First, Catheter Last” in hemodialysis is primarily due to patient factors. J Am Soc Nephrol 2017;28:645-52.
5. 5. Sheikh Z, Brooks P, Barzilay O, Fine N, Glogauer M. Macrophages, foreign body giant cells and their response to implantable biomaterials. Materials 2015;8:5671-701.
6. 6. Murga R, Miller J, Donlan R. Biofilm formation by gram-negative bacteria on central venous catheter connectors: effect of conditioning films in a laboratory model. J Clin Microbiol 2001;39:2294-7.
7. 7. Perez E, Williams M, Jacob JT, Reyes MD, Tejedor SC, Steinberg JP, et al. Microbial biofilms on needleless connectors for central venous catheters: comparison of standard and silver-coated devices collected from patients in an acute care hospital. J Clin Microbiol 2014;52:823-31.
8. 8. Kanaa M, Wright M, Sandoe J. Examination of tunnelled haemodialysis catheters using scanning electron microscopy. Clin Microbiol Infect 2010;16:780-6.

9. 9. Mermel LA. What is the evidence for intraluminal colonization of hemodialysis catheters? Kidney Int 2014;86:28-33.
10. 10. Francois P, Vaudaux P, Nurdin N, Mathieu H, Descouts P, Lew DP. Physical and biological effects of a surface coating procedure on polyurethane catheters. Biomaterials 1996;17:667-78.
11. 11. Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJL, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 2012;380:1662-73.
12. 12. Cristol J, Canaud B, Rabesandratana H, Gaillard H, Serre A, Mion C. Enhancement of reactive oxygen species production and cell surface markers expression due to haemodialysis. Nephrol Dial Transplant 1994;9:389-94.
13. 13. Modlinger PS, Wilcox CS, Aslam S. Nitric oxide, oxidative stress, and progression of chronic renal failure. Semin Nephrol 2004;24:354-65.
14. 14. Liakopoulos V, Roumeliotis S, Gorny X, Dounousi E, Mertens PR. Oxidative stress in hemodialysis patients: a review of the literature. Oxid Med Cell Longev 2017;2017:3081856.
15. 15. Scott SD. Dose conversion from recombinant human erythropoietin to darbepoetin alfa: recommendations from clinical studies. Pharmacotherapy 2002;22(9P2):160S-5S.
16. 16. Shemin D, Bostom AG, Laliberty P, Dworkin LD. Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis 2001;38:85-90.
17. 17. Erel O, Neselioglu S. A novel and automated assay for thiol/disulphide homeostasis. Clin Biochem 2014;47:326-32.
18. 18. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem 2005;38:1103-11.
19. 19. Moist LM, Trpeski L, Na Y, Lok CE. Increased hemodialysis catheter use in Canada and associated mortality risk: data from the Canadian Organ Replacement Registry 2001-2004. Clin J Am Soc Nephrol 2008;3:1726-32.
20. 20. Dhingra RK, Young EW, Hulbert-Shearon T, Leavey SF, Port FK. Type of vascular access and mortality in US hemodialysis patients. Kidney Int 2001;60:1443-51.
21. 21. Quinn RR, Oliver MJ, Devoe D, Poinen K, Kabani R, Kamar F, et al. The effect of predialysis fistula attempt on risk of all-cause and access-related death. J Am Soc Nephrol 2017;28:613-20.
22. 22. Flemming H-C, Wingender J, Szewzyk U, Steinberg P, Rice SA, Kjelleberg S. Biofilms: an emergent form of bacterial life. Nat Rev Microbiol 2016;14:563-75.
23. 23. Cappelli G, Tetta C, Canaud B. Is biofilm a cause of silent chronic inflammation in haemodialysis patients? A fascinating working hypothesis. Nephrol Dial Transplant 2005;20:266-70.
24. 24. Aviram M, Dornfeld L, Rosenblat M, Volkova N, Kaplan M, Coleman R, et al. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotic apolipoprotein E-deficient mice. Am J Clin Nutr 2000;71:1062-76.
25. 25. van Leuven SI, Franssen R, Kastelein J, Levi M, Stroes ES, Tak PP. Systemic inflammation as a risk factor for atherothrombosis. Rheumatology 2007;47:3-7.
26. 26. Cachofeiro V, Goicochea M, De Vinuesa SG, Oubiña P, Lahera V, Luño J. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int Suppl 2008;(111):S4-S9.
27. 27. Cremers CM, Jakob U. Oxidant sensing by reversible disulfide bond formation. J Biol Chem 2013;288:26489-96.
28. 28. Banerjee T, Kim SJ, Astor B, Shafi T, Coresh J, Powe NR. Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Am J Kidney Dis 2014;64:954-61.
29. 29. Ravani P, Palmer SC, Oliver MJ, Quinn RR, MacRae JM, Tai DJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Amn Soc Nephrol 2013;24:465-73.
30. 30. Wasse H, Speckman RA, McClellan WM. Arteriovenous fistula use is associated with lower cardiovascular mortality compared with catheter use among ESRD patients. Semin Dial 2008;21:483-9.