Assessment of inflow of endotoxin and its fragments in patients on maintenance hemodialysis.
BACKGROUND
We estimated the flow of endotoxins (ET) from dialysates into the blood of patients on hemodialysis (HD) using limulus amebocyte lysate (LAL) assays and endotoxin activity (EA) determined by neutrophil respiratory burst activity.


METHODS
A cross-sectional study compared groups given ultrapure bicarbonate (n = 15; group A), acetate-free bicarbonate dialysates (n = 20; group B) and conventional bicarbonate dialysate (n = 23; group C). A prospective study of group C examined the effect of changing the purity of the dialysate. Biomarkers of inflammation and oxidative stress were measured and ET in blood was assessed by LAL assays and EA.


RESULTS
Serum ET levels did not differ among the groups, whereas EA and the biomarkers were significantly increased in group C compared with those in groups A and B. HD using conventional dialysate was independently associated with an increase in EA. Purifying the dialysate significantly decreased EA in group C.


CONCLUSIONS
Measuring EA is useful to assess the influence of dialysate contamination in HD patients.
Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Hiroki
H
Suzuki
Hirokazu
H
Honda
Noriyuki
N
Kato
Tetsuo
T
Michihata
Keiko
K
Takahashi
Kanji
K
Shishido
Tadao
T
Akizawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004731:Endotoxins / Q000097:blood* / Q000378:metabolism; D005260:Female; D015312:Hemodialysis Solutions / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers; D004731:Endotoxins; D015312:Hemodialysis Solutions; D018836:Inflammation Mediators