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Nephrol Dial Transplant (2001) 16: 1986-1991
© 2001 European Renal Association-European Dialysis and Transplant Association

Controversy

Impact of contaminated dialysate on long-term haemodialysis-related complications: is it really that important?

Menso J. Nubé1, and Muriel P. C. Grooteman2

1 Department of Haemodialysis and Nephrology, Medical Centre Alkmaar, Wilhelminalaan, Alkmaar and 2 Department of Nephrology, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands

Introduction

Recently, in haemodialysis (HD) concern has been raised about the long-term consequences of non-sterile dialysate and the concomitant use of dialysers with large pore size, usually high-flux devices [1,2]. According to current opinion, monocytes are activated by the repeated transfer of bacteria-derived substances from the dialysate compartment to the circulation of the patient, resulting in the secretion of a variety of pro-inflammatory cytokines, such as interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF{alpha}). Due to the recurrent character of the stimulus, a chronic inflammatory state is induced, leading to a number of long-term HD-related complications, such as infections, malnutrition, dialysis-related amyloidosis (DRA), accelerated atherosclerosis and increased mortality [3].

However, the cause and nature of HD-induced monocyte activation is a controversial issue. Various provoking factors have been recognized, including complement activation [4], coagulation [5], mechanical stress and shear . . . [Full Text of this Article]

Monocyte activation in experimental closed-loop circuits

Clinical evidence of transfer across haemodialysis membranes

Antibodies against endotoxins
LAL activity in the blood
Intra- and peri-dialytical studies
Follow-up studies: clinical parameters

Conclusions

Editor's note

Notes

References


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