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Bacterial and endotoxin permeability of hemodialysis membranes
Abstract:
Dialysis fluids containing at least 10(7) bacteria per milliliter and as much as 12,500 ng of endotoxin equivalents per milliliter were dialyzed and ultrafiltered with three types of disposable hemodialyzers. Neither bacteria nor endotoxin, as measured by the Limulus lysate assay, was detected in the sterile compartment despite ultrafiltration. Under these favorable conditions for endotoxin transfer, the maximum transfer rate was calculated to be less than 3.5 ng of endotoxin equivalents per hour. At this rate, it is unlikely that pyrexia during hemodialysis is due to the transfer of endotoxin across an intact dialyzing membrane. Provided that the integrity of the dialyzing membrane is maintained, this investigation indicates that the risk of endotoxemia or bacteremia associated with the use of contaminated dialysis fluids is negligible.
Insights
Contaminated dialysis fluids pose negligible risk of endotoxemia or bacteremia. Even with high bacteria and endotoxin levels, sterile compartments remained free of contaminants, indicating membrane integrity prevents transfer.
Area of Science:
- Nephrology
- Biomedical Engineering
- Infectious Disease
Background:
- Dialysis fluids can become contaminated with bacteria and endotoxins.
- Endotoxins are potent pyrogens that can cause fever during hemodialysis.
Purpose of the Study:
- To assess the risk of endotoxin and bacteria transfer across hemodialyzer membranes.
- To determine if contaminated dialysis fluids pose a risk of endotoxemia or bacteremia.
Main Methods:
- Three types of disposable hemodialyzers were used.
- Dialysis fluids with high levels of bacteria and endotoxin were ultrafiltered.
- Limulus lysate assay was used to detect endotoxin and bacteria.
Main Results:
- No bacteria or endotoxin were detected in the sterile compartment post-ultrafiltration.
- Maximum endotoxin transfer rate was calculated to be less than 3.5 ng/hour.
- The integrity of the dialyzing membrane prevented significant contaminant transfer.
Conclusions:
- Pyrexia during hemodialysis is unlikely due to endotoxin transfer across intact membranes.
- The risk of endotoxemia or bacteremia from contaminated dialysis fluids is negligible if membrane integrity is maintained.