Article

A prospective study of pyrogenic reactions in hemodialysis patients using bicarbonate dialysis fluids filtered to remove bacteria and endotoxin

Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
Journal of the American Society of Nephrology (Impact Factor: 9.34). 11/1992; 3(4):1002-7.
Source: PubMed

ABSTRACT

Pyrogenic reactions (PR) are a well-recognized complication of hemodialysis and have been associated with dialyzer reuse, high-flux dialysis, and bicarbonate dialysate. However, the roles of bacteria and endotoxin in dialysate for producing PR are not well defined. To determine the effect of removing most bacteria and endotoxin from the dialysate on the incidence of PR, a cohort of chronic hemodialysis patients receiving high-flux, high-efficiency, or conventional hemodialysis at three centers with bicarbonate dialysis fluids that had been filtered with a polysulfone high-flux hemodialyzer was prospectively studied. Unfiltered bicarbonate concentrate had median bacterial and endotoxin concentrations of 479,000 CFU/mL and 39,800 pg/mL, respectively. After filtration of the bicarbonate concentrate at the central proportioner, dialysate had a median 9.2 CFU/mL of bacteria and 17.8 pg/mL of endotoxin. Dialysate filtered at individual proportioning dialysis machines had a median 0.001 CFU/mL of bacteria and 0.19 pg/mL of endotoxin. Nine PR were identified among 303 patients after 28,007 hemodialysis treatments (0.3 PR/1,000 treatments). The rate of PR was similar for the three hemodialysis treatment modalities and for first-use compared with reused dialyzers. Although the PR rate in this study was lower (P = 0.046) than the PR rate of a previous study with unfiltered dialysis fluids (0.7 PR/1,000 treatments), it represents a difference of only 10 PR in over 28,000 treatments. It was concluded that filtration of hemodialysis fluids is efficacious in removing bacterial and endotoxin contamination and can result in a lower incidence of PR in patients receiving high-flux, high-efficiency, or conventional hemodialysis.

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    • "χλωρίου) από τα συστήµατα επεξεργασίας, καθώς και η παρουσία στάσιµων και νεκρών σηµείων στο δίκτυο διανοµής, αυξάνουν την πιθανότητα σχηµατισµού βιοϋµενίου (biofilm). Το βιοϋµένιο αποτελεί υπόστρωµα για την ανάπτυξη µικροοργανισµών (βακτηρίων, µυκήτων και άλγεων) ικανών να παράγουν ενδοτοξίνες και ενώσεις µικρού µοριακού βάρους (0.5-200 kDa), όπως πολυσακχαρίτες και µουραµυλοπεπτίδια του κυτταρικού τοιχώµατος, που έχουν τη δυνατότητα να διαπερνούν τις µεµβράνες της αιµοδιάλυσης και να εισέρχονται στην κυκλοφορία του αιµοκαθαιρούµενου ασθενούς µε κίνδυνο πρόκλησης φλεγµονωδών αντιδράσεων (Lonnemann 2000, Pegues et al. 1992, Lowrie 2002). Η αντιµετώπιση αυτών των κινδύνων είναι εξαιρετικής σηµασίας λόγω της υποκλινικής ή/και ασυµπτωµατικής τους δράσης που συσσωρεύει την πιθανότητα µιας οξείας αντίδρασης µε πολυοργανικές επιπτώσεις. "

    Full-text · Dataset · Oct 2015
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    • "χλωρίου) από τα συστήµατα επεξεργασίας, καθώς και η παρουσία στάσιµων και νεκρών σηµείων στο δίκτυο διανοµής, αυξάνουν την πιθανότητα σχηµατισµού βιοϋµενίου (biofilm). Το βιοϋµένιο αποτελεί υπόστρωµα για την ανάπτυξη µικροοργανισµών (βακτηρίων, µυκήτων και άλγεων) ικανών να παράγουν ενδοτοξίνες και ενώσεις µικρού µοριακού βάρους (0.5-200 kDa), όπως πολυσακχαρίτες και µουραµυλοπεπτίδια του κυτταρικού τοιχώµατος, που έχουν τη δυνατότητα να διαπερνούν τις µεµβράνες της αιµοδιάλυσης και να εισέρχονται στην κυκλοφορία του αιµοκαθαιρούµενου ασθενούς µε κίνδυνο πρόκλησης φλεγµονωδών αντιδράσεων (Lonnemann 2000, Pegues et al. 1992, Lowrie 2002). Η αντιµετώπιση αυτών των κινδύνων είναι εξαιρετικής σηµασίας λόγω της υποκλινικής ή/και ασυµπτωµατικής τους δράσης που συσσωρεύει την πιθανότητα µιας οξείας αντίδρασης µε πολυοργανικές επιπτώσεις. "
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