Kidney Week

Abstract: SA-PO972

Nitric Oxide (NO) Releasing Tunneled Dialysis Catheters (TDC) Reduce Catheter Related Blood Stream Infection (CRBSI) and Dysfunction

Session Information

• Dialysis: Vascular Access - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 704 Dialysis: Vascular Access

Authors

• Celdran-Bonafonte, Diego, University of Arizona, Tucson, Arizona, United States

Diego Celdran-Bonafonte,

• Wang, Li Hua, The Second Hospital of Tianjin Medical University, Tianjin, China

Li Hua Wang,

• Lautner-Csorba, Orsolya, University of Michigan, Ann Arbor, Michigan, United States

Orsolya Lautner-Csorba,

• Brisbois, Elizabeth, University of Central Florida, Orlando, Florida, United States

Elizabeth Brisbois,

• Jarrouj, Aous, Banner-University of Arizona, Tucson, Arizona, United States

Aous Jarrouj,

• Kim, Maria, University of Michigan, Ann Arbor, Michigan, United States

Maria Kim,

• Janda, Jaroslav, University of Arizona, Tucson, Arizona, United States

Jaroslav Janda,

• Kohler, Lindsay N., University of Arizona, Tucson, Arizona, United States

Lindsay N. Kohler,

• Lewis, Taylor G., University of Arizona, Tucson, Arizona, United States

Taylor G. Lewis,

• Brosius, Frank C., University of Arizona, Tucson, Arizona, United States

Frank C. Brosius,

• Meyerhoff, Mark, University of Michigan, Ann Arbor, Michigan, United States

Mark Meyerhoff,

• Roy-Chaudhury, Prabir, University of Arizona, Tucson, Arizona, United States

Prabir Roy-Chaudhury,

Background

Tunneled dialysis catheter complications, due to infection, thrombosis and central vein stenosis are responsible for a very significant morbidity, mortality and economic cost. Nitric oxide (NO) is an important biological mediator, which has potent anti-microbial, anti-platelet and anti-smooth muscle cell activities. We have previously developed a novel and innovative technology that results in a prolonged polymer based (silicone rubber, polyurethanes, etc.) release of NO. The goal of this study, therefore, was to assess the impact of NO releasing TDCs on infection, thrombosis and central vein stenosis, using a validated pig model of TDC complications

Methods

9 Yorkshire cross pigs were used in this study. 4 non-treated commercial catheters and 5 NO-releasing catheters were placed using a percutanous jugular approach. Catheters were accessed twice a week in a sterile fashion, in order to mimic the dialysis procedure and to score TDC dysfunction using a semi-quantitative scale. Study animals were monitored daily for signs and symptoms of infection. Catheter and tissue samples were collected in a standardized fashion at the time of sacrifice or at 28 days, and analyzed using standard histological and scanning electron microscopy(SEM) techniques

Results

NO-releasing catheters had a significantly delayed time to onset of infection (19.4±8.6d vs 8±3.36d; p = 0.03 ) and also a delayed (but not significant), onset of catheter dysfunction (12.4±9.9d vs 6.7±3.4d). Despite this significant clinical benefit, a compact fibrin sheath was detected in both the control and treated arms, together with a significant degree of central stenosis. SEM imaging revealed the presence of biofilm formation in both groups.

Conclusion

Our data demonstrate for the first time, an important clinical benefit of NO releasing TDCs on infection and dysfunction. Interestingly, this clinical benefit seemed to occur independently of the presence of a fibrin sheath, venous wall thickening and biofilm formation. We believe that a prolonged release of NO using our innovative polymer technology could result in a very significant reduction of the morbidity, mortality and economic cost currently associated with TDC complications.

Funding

• Other NIH Support