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Nephrol Dial Transplant (1992) 7: 333-339
© 1992 European Renal Association-European Dialysis and Transplant Association

research-article

Endotoxin transfer through dialysis membranes: small- versus large-pore membranes

R. Vanholder, E. Van Haecke, N. Veys and S. Ringoir

Nephrology Department, University Hospital Ghent, Belgium

Correspondence and offprint requests to: R. Vanholder, Nephrology Department, University Hospital, De Pintelaan, 185, B9000. Ghent. Belgium

In this in-vivo study, dialysate and serum endotoxin was evaluated before and after haemodialysis with small-pore (PS400) and large-pore (PS600) polysulphone dialysers, and before and after haemodiafiltration with the PS600 filter. The source of the endotoxin was the presence in dialysate of Pseudomonads at a concentration of 103–104 CFU/ml. Endotoxin was measured by a modified chromogenic limulus amoebocyte lysate (LAL) assay. In spite of dialysate endotoxin concentrations > 100 pg/ml, no changes in pre- versus posttreatment LAL reactivity were observed in PS400 dialysis and PS600 haemodiafiltration. In contrast, PS600 haemodialysis was related to an increase in serum LAL reactivity from 1.3 ± 1.5 to 3.8 ± 2.0 pg/ml (n=15, 1<0.01), and five patients (33.3%) showed a post-dialysis value in excess of 5 pg/ml. Our data are consistent with the absence of in-vivo endotoxin transfer during haemodialysis with small-pore dialyser membranes, and during haemodiafiltration with membranes with larger pores. An increase in LAL reactivity during haemodialysis with membranes with larger pores is, however, present, presumably due to the occurrence of backdiffusion/filtration with that specific strategy.

Keywords: backdiffusion; backfiltration; bacterial contamination; biocompatibility; dialysate; endotoxin; haemodiafiltration; haemodialysis; pyrogen; water treatment


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