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No evidence for endotoxin transfer across high flux polysulfone membranes
Abstract:
Recently, there has been some concern that high-flux membranes may expose dialysis patients to the risk of endotoxin transfer secondary to backfiltration within the dialyzer. To evaluate the safety of high-flux polysulfone dialyzers, we examined in an in vitro recirculation system whether lipopolysaccharides (LPS) and lipid A respectively penetrate from the dialysate to the blood compartment and vice versa using a F-60 hemofilter (Fresenius AG). For the detection of endotoxin, a sensitive, kinetic limulus amebocyte lysate (LAL) microtiter test was used. It can be concluded that LPS and lipid A do not pass from either side through the filter system used when saline was recirculated for more than 10 h on both sides of the membrane.
Insights
High-flux dialyzers are safe, as endotoxins like lipopolysaccharides (LPS) and lipid A do not transfer between compartments in vitro. This study confirms the safety of polysulfone dialyzers against endotoxin backfiltration during dialysis.
Area of Science:
- Nephrology
- Biomedical Engineering
- Infectious Disease
Background:
- High-flux membranes in dialysis may pose an endotoxin transfer risk via backfiltration.
- Concerns exist regarding patient exposure to endotoxins during hemodialysis.
Purpose of the Study:
- To evaluate the safety of high-flux polysulfone dialyzers.
- To determine if endotoxins (LPS and lipid A) penetrate the dialyzer membrane in either direction.
Main Methods:
- An in vitro recirculation system was utilized.
- A F-60 hemofilter (polysulfone) was tested.
- Lipopolysaccharides (LPS) and lipid A penetration were assessed using a kinetic Limulus Amebocyte Lysate (LAL) test.
Main Results:
- Lipopolysaccharides (LPS) and lipid A did not pass from the dialysate to the blood compartment.
- Endotoxins did not transfer from the blood compartment to the dialysate.
- No endotoxin transfer was observed during 10 hours of saline recirculation on both sides.
Conclusions:
- High-flux polysulfone dialyzers effectively prevent endotoxin transfer.
- The F-60 hemofilter demonstrates safety against endotoxin backfiltration.
- Dialysis patients are not at risk of endotoxin exposure from backfiltration with these membranes.