The level of endotoxins in hemodialysis water and dialysate

Hemodialysis is a process when the blood of patients contacts with dialysate through a semipermeable membrane. Water used for dialysis is not sterile. Microorganisms cannot pass through the membrane pores, but bacterial endotoxins can diffuse to the blood of patients. Several acute and long-term complications (pyrogenic reactions, silent chronic inflammation, malnutrition) in dialysis patients might be associated with dialysate contamination. The aim of this study was to determine the level of endotoxins in hemodialysis water and dialysate in several hemodialysis centers of different Lithuanian cities. Material and methods. Material was dialysis water (n=6) and dialysate (n=14) from six hemodialysis centers in three different cities of Lithuania. Bacterial endotoxin levels were measured using a sensitive Limulus Amebocyte Lysate (LAL) assay. Results and conclusions. The level of endotoxins was less than 0.25 endotoxin unit (EU)/mL in all hemodialysis water (n=6) and dialysate (n=14) samples. One sample of water (16.7%) and two of dialysate (14.3%) had the level of endotoxins above 0.03 EU/mL. Therefore, the level of endotoxins in hemodialysis water and dialysate in studied Lithuanian hemodialysis centers (n=6) complied with the recommendations of the European Pharmacopoeia and the ERA-EDTA best practice guidelines for conventional dialysis modalities. The level of endotoxins in dialysate of five Lithuanian hemodialysis centers complied with the recommendations of the ERA-EDTA best practice guidelines for ultrapure dialysate