[Problems of biocompatibility in hemodialysis treatment]

Although hemodialysis is one of the best examined, and clinically best established, methods of patient treatment with artificial organs, a number of biocompatibility problems remain. This review discusses the problem of water quality. Recently, much concern has been focused on potential longterm risks from patients exposure to subthreshold concentrations of endotoxin in dialysate. Further problems comprise inorganic and organic contaminants, some of which with potential carcinogenetic hazards. Complement activation by, and thrombogenicity of, dialysis membranes have not been eliminated. Presumably, the hazards of complement activation are less acute shortterm reactions (which according to more recent studies appear to be ETO-related anaphylactoid reactions) but rather potential longterm hazards, e.g. beta 2 m related amyloid. However, the issue is not settled since we have recently found cell activation by dialysis membranes even in the absence of complement. Apart from membranes, dialysis tubing presents hazards, e.g. leakage of plasticizers and release of oligomers or radicals. The recognition of ETO as a potent immunogen, inducing antibodies detectable in approximately 40% of the dialysis population, will require to replace ETO as a sterilisant for dialysis devices. This demand is even more urgent in view of the recognized carcinogenicity of this alkylating agent.