Occurrence of endotoxin in dialysis fluid from 39 dialysis units

Kulander, Lena; Nisbeth, Ulf; Danielsson, B; Eriksson, Ola

doi:10.1016/0195-6701(93)90087-g

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…A recent survey among dialysis professionals on the quality of dialysis fluid showed that the majority are confident that the fluid they use has the prescribed quality ( 10). Still, several microbiological surveys of the quality of water and dialysis fluid in the U.S.A. as well as in Europe have established that compliance with the respective standard is far from satisfactory ( 4, –13).…”

Section: Standards For Dialysis Fluidmentioning

confidence: 99%

“…Kulander et al. found that diluting dialysis fluid samples with endotoxin‐free water increased the endotoxin levels significantly ( 13). In actively growing bacterial cultures, the cells are often surrounded by nutritious slime, which could prevent reactions of lipid A with the LAL reagent.…”

Section: Measuring Endotoxin Versus Bacteriamentioning

confidence: 99%

“…The most common source of contamination in a fluid system is growth in the distribution pipes. Kulander found that the endotoxin levels in the dialysis water increased with the length of the tubing from the RO system to the dialysis machines ( 13). Unless the water pipes are frequently disinfected, a bacterial biofilm will develop on the inner surface.…”

Section: Improving the Fluid Qualitymentioning

confidence: 99%

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Defining the Microbiological Quality of Dialysis Fluid

Ledebo¹,

Nystrand²

1999

Artificial Organs

111

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With increasing awareness about the degree and the potential impact of microbiological contamination in dialysis fluids, there is a desire to improve their microbiological quality. To achieve this goal, the origin of the microbiological contamination has to be identified. The water, the bicarbonate concentrate, and the fluid distribution system can be major contributors. Regular disinfection of the entire fluid path is necessary to prevent the formation of biofilm. The bicarbonate concentrate should be handled with special attention because it constitutes an excellent growth medium for microflora that may not be detected with regular assays. With a well maintained reverse osmosis (RO) system, frequent disinfection of the entire flow path, and microbiological awareness, it is possible to produce dialysis fluid that meets the most stringent standard (<10(2) colony forming units (CFU)/ml and <0.25 IU/ml of endotoxin). Adding a step of ultrafiltration just before the dialyzer can make the dialysis fluid ultrapure (<10(-1) CFU/ ml and <0.03 IU/ml). One additional step of controlled ultrafiltration provides sterile and pyrogen-free fluids (<10(-6) CFU/ml and <0.03 IU/ml) that can be used for infusion.

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Section: Standards For Dialysis Fluidmentioning

confidence: 99%

Section: Measuring Endotoxin Versus Bacteriamentioning

confidence: 99%

Section: Improving the Fluid Qualitymentioning

confidence: 99%

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Defining the Microbiological Quality of Dialysis Fluid

Ledebo¹,

Nystrand²

1999

Artificial Organs

111

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“…Since then, contaminations have been found in the pure water (Klein et al, 1990;Pegues et al, 1992;Kulander et al, 1993;Bambauer et al, 1994), the machines, especially to areas with low circulation or dead spaces, which serve as a reservoir for bacteria (Phillips et al, 1994), filter materials (Schouten et al, 2000), and bicarbonate concentrates (Pegues et al, 1992).…”

Section: Dialysismentioning

confidence: 99%

Development, validation and applications of the monocyte activation test for pyrogens based on human whole blood

Schindler

Aulock

Daneshian

et al. 2009

ALTEX

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“…Recent surveys from literature on dialysis water quality results show that still an high percentage of water samples, in many dialysis units, are not complying with standards of either microbiological (8-49%) or chemical (14%), both in United States [24] and Canada [25] or in Europe [26][27][28][29]. The presence of an updated water treatment system guarantees for water quality but cornerstones in assuring a persistent optimal quality are maintenance protocols, disinfection procedures and results evaluation through periodical testing: in a nutshell the implementation of a quality assurance system to validate water quality [30].…”

Section: Disinfection Procedures and Quality Assurance Systemmentioning

confidence: 99%

Water Treatment for Hemodialysis: A 2005 Update

Cappelli¹,

Ravera²,

Ricardi³

et al. 2005

Contributions to Nephrology

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Water for dialysis represents an additive risk factors to the chronic inflammatory state documented in patients on ESRD. The possibility of sustaining proinflammatory cytokines through microbial derived products, coming from dialysate or infused solutions, is enhanced by biofilm presence on piping and on water treatment system or monitor components. Spread use of reverse osmosis, loop distribution system and pre-treatment components tailored to local raw water characteristics have greatly contributed to a general improvement in final water quality. Notwithstanding these contributions literature still reports fatal accidents or significant percentage of dialysis units not complying to the water quality standards. Technological improvement lowers chemical contamination but microbial quality relays more on quality assurance programs than on technology. Optimal water quality represents part of the anti-inflammatory strategies we need to assure to our dialysis patients to improve outcome.

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Occurrence of endotoxin in dialysis fluid from 39 dialysis units

Cited by 15 publications

References 23 publications

Defining the Microbiological Quality of Dialysis Fluid

Defining the Microbiological Quality of Dialysis Fluid

Development, validation and applications of the monocyte activation test for pyrogens based on human whole blood

Water Treatment for Hemodialysis: A 2005 Update

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