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Absence of bacteremia and endotoxemia despite contaminated dialyzate
Abstract:
Fevers associated with hemodialysis have been attributed to the transfer of relatively large endotoxin molecules and/or bacteria from contaminated dialyzate across the dialyzing membrane. We evaluated 27 patients during hollow-fiber dialysis when, due to a malfunction, dialysis fluids contained bacteria and endotoxin at levels previously reported to be associated with pyrogenic reactions. Neither endotoxin nor bacteria was detected in 54 venous and arterial blood specimens collected at the termination of hemodialysis. Temperature elevations did not occur during or within 1/2 hr after dialysis. In an extended study, 20 dialyzers were collected after single patient use and the dialyzate compartment was filled with highly contaminated dialyzate, while the blood compartment was filled with sterile pyrogen-free saline. Following 5 to 7 days incubation, bacteria were present in the blood compartments of 4 of 20 dialyzers, probably due to contamination during dialyzer handling. However, the much smaller endotoxin molecule could not be detected in the absence of bacterial contamination. These results indicate that the intact cellophane membrane is an effective barrier to endotoxin and bacteria under clinical conditions.
Insights
Hollow-fiber hemodialysis membranes effectively block bacteria and endotoxins, preventing fever during dialysis even with contaminated fluids. Cellophane membranes act as a reliable barrier against pyrogenic reactions.
Area of Science:
- Nephrology
- Biomedical Engineering
- Infectious Disease
Background:
- Hemodialysis-associated fevers are often linked to endotoxin or bacteria transfer from dialysate.
- Contaminated dialysate poses a risk for pyrogenic reactions in patients undergoing hemodialysis.
Purpose of the Study:
- To evaluate the effectiveness of hollow-fiber dialysis membranes in preventing endotoxin and bacteria transfer during hemodialysis.
- To assess the pyrogenic potential of contaminated dialysis fluids under clinical conditions.
Main Methods:
- Studied 27 patients during hollow-fiber dialysis with contaminated fluids.
- Collected blood samples post-hemodialysis and analyzed dialyzers for bacterial and endotoxin contamination.
- Simulated contamination in dialyzer compartments to test membrane integrity.
Main Results:
- No endotoxin or bacteria detected in patient blood samples post-dialysis.
- No temperature elevations observed in patients despite exposure to contaminated fluids.
- Intact cellophane membranes prevented endotoxin transfer; bacteria were found only with handling contamination.
Conclusions:
- The cellophane membrane in hollow-fiber dialyzers serves as an effective barrier against endotoxins and bacteria.
- Hemodialysis membranes prevent pyrogenic reactions even when dialysis fluids are contaminated.
- Clinical hemodialysis with intact membranes is safe regarding endotoxin and bacterial transfer.