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[Dialysate and biocompatibility in hemodialysis]
1Service de néphrologie-hémodialyse, Hôpital Sainte-Marguerite, Marseille.
Nephrologie
|December 4, 1998
Summary
Bacterial contamination in hemodialysis fluid can trigger inflammatory responses. Even with synthetic membranes, pyrogenic substances may pass through, necessitating careful consideration by nephrologists.
Area of Science:
- Nephrology
- Microbiology
- Immunology
Context:
- Inflammatory reactions in hemodialysis patients are a significant concern.
- Bacteriological contamination of dialysate fluid is a potential trigger for these reactions.
Purpose:
- To review the literature on the role of dialysate fluid contamination in hemodialysis-related inflammation.
- To highlight the mechanisms by which bacterial products induce inflammatory responses.
Summary:
- Pyrogenic substances from Gram-negative bacteria in dialysate can cross dialyzer membranes, stimulating cytokine production.
- Cellulosic membranes are more permeable to endotoxins than synthetic ones like polysulfone and polyamide, which can adsorb toxins.
- Reprocessed dialyzers show greater transmembrane passage of these bacterial products compared to new ones.
Impact:
- Highlights the limitations of the Limulus Amebocyte Lysate (LAL) test in detecting all contaminating bacterial products.
- Emphasizes the need for nephrologists to address dialysate fluid contamination more rigorously to mitigate patient inflammatory responses.