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American Journal of Kidney Diseases

Direct Antistaphylococcal Effects of High-Dose Aspirin in Hemodialysis Patients?

      To the Editor:
      In their retrospective study, Sedlacek et al
      • Sedlacek M.
      • Gemery J.M.
      • Cheung A.L.
      • et al.
      Aspirin treatment is associated with a significantly decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters.
      demonstrated that high-dose (324 mg) aspirin, rather than the 81-mg “baby” aspirin, was associated with decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters. However, this high-dose aspirin in hemodialysis patients might deplete the iron store
      • Goicoechea M.
      • Caramelo C.
      • Ochando A.
      • et al.
      Antiplatelet therapy alters iron requirements in hemodialysis patients.
      due to bleeding diathesis, and subsequently interfere with host immunity.
      In vitro studies have demonstrated that iron overload can impede chemotactic migration, phagocytosis, oxidative burst, and intracellular killing by polymorphonuclear cells.
      • Brewster U.C.
      • Perazella M.A.
      Intravenous iron and the risk of infection in end-stage renal disease patients.
      There is also clinical evidence suggesting increased infection rates in iron-overloaded hemodialysis patients.
      • Teehan G.S.
      • Bahdouch D.
      • Ruthazer R.
      • et al.
      Iron storage indices: novel predictors of bacteremia in hemodialysis patients initiating intravenous iron therapy.
      It should be noted that iron is so critical for bacterial metabolic and signaling functions that S aureus evolved complex protein transport systems to acquire iron.
      • Maresso A.W.
      • Schneewind O.
      Iron acquisition and transport in Staphylococcus aureus.
      • Skaar E.P.
      • Humayun M.
      • Bae T.
      • et al.
      Iron-source preference of Staphylococcus aureus infections.
      The iron status of the host could significantly influence bacterial virulence and growth and consequently affect the risks of bacteremia. For instance, iron supplementation may affect the colonization of permanent hemodialysis catheters by S aureus.
      • Brewster U.C.
      • Coca S.G.
      • Reilly R.F.
      • et al.
      Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection.
      Therefore, we suggest taking into account the possible confounding by patients’ decreased iron status after taking high-dose aspirin before concluding the direct antistaphylococcal effects of high-dose aspirin.
      Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.
      Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors.

      References

        • Sedlacek M.
        • Gemery J.M.
        • Cheung A.L.
        • et al.
        Aspirin treatment is associated with a significantly decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters.
        Am J Kidney Dis. 2007; 49: 401-408
        • Goicoechea M.
        • Caramelo C.
        • Ochando A.
        • et al.
        Antiplatelet therapy alters iron requirements in hemodialysis patients.
        Am J Kidney Dis. 2000; 36: 80-87
        • Brewster U.C.
        • Perazella M.A.
        Intravenous iron and the risk of infection in end-stage renal disease patients.
        Semin Dial. 2004; 17: 57-60
        • Teehan G.S.
        • Bahdouch D.
        • Ruthazer R.
        • et al.
        Iron storage indices: novel predictors of bacteremia in hemodialysis patients initiating intravenous iron therapy.
        Clin Infect Dis. 2004; 38: 1090-1094
        • Maresso A.W.
        • Schneewind O.
        Iron acquisition and transport in Staphylococcus aureus.
        Biometals. 2006; 19: 193-203
        • Skaar E.P.
        • Humayun M.
        • Bae T.
        • et al.
        Iron-source preference of Staphylococcus aureus infections.
        Science. 2004; 305: 1626-1628
        • Brewster U.C.
        • Coca S.G.
        • Reilly R.F.
        • et al.
        Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection.
        Nephrology (Carlton). 2005; 10: 124-128

      Linked Article

      • In Reply
        American Journal of Kidney DiseasesVol. 50Issue 2
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          A study of United States Renal Data System (USRDS) data found that aspirin use was not a risk factor for upper gastrointestinal bleeding in dialysis patients.1 In endoscopy studies of iron-deficiency anemia, the use of aspirin predicted neither finding potential bleeding sources nor their location.2,3 The amount of asymptomatic blood loss related to aspirin has been estimated as not significant enough to interfere with fecal occult blood tests.4 In addition to gastrointestinal losses, hemodialysis patients lose iron from frequent blood tests and retention of blood in dialysis lines and filters.
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      • Aspirin Treatment Is Associated With a Significantly Decreased Risk of Staphylococcus aureus Bacteremia in Hemodialysis Patients With Tunneled Catheters
        American Journal of Kidney DiseasesVol. 49Issue 3
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          Hemodialysis patients with tunneled catheters are at increased risk of bacteremic Staphylococcus aureus infections. In vitro and in vivo studies showed that aspirin has direct antistaphylococcal effects by inhibiting expression of α-toxin and matrix adhesion genes through activation of sigma factor B stress-induced operon. We hypothesized that long-term treatment with aspirin may decrease the frequency of S aureus bacteremia in such patients.
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