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Nephrol Dial Transplant (2001) 16: 1992-1994
© 2001 European Renal Association-European Dialysis and Transplant Association

Controversy

Sterile filtration of dialysate: is it really of no use?

Jürgen Bommer

Nephrology Department, University Clinic Heidelberg, Heidelberg, Germany

For many years, nephrologists accepted the idea that the small pore size of low-flux dialysis membranes prevented clinically relevant transfer of pyrogenic substances, such as endotoxins or bacteria. Even though some authors noted occasional febrile reactions on dialysis, the water quality was a neglected problem of haemodialysis treatment till the 1980s [1].

Dialysis water contamination

In 1972, Raij et al. reported the occurrence of circulating endotoxins in patients with febrile reactions at the end of dialysis sessions and, in parallel, high endotoxin levels in the dialysate [2]. Even nowadays, neither tap water nor purified water or dialysate are sterile. In more than 14 000 analysed water probes of city and village water systems in South-West Germany, 5.6% contained coliform bacteria and 3.6% contained Escherichia coli [3]. Recently, Arvanitidou et al. found E. coli in 12% of tap water samples in a study of all Greek . . . [Full Text of this Article]

Role of dialysis, machine and dialyser

Evidence from in vitro studies

Evidence from clinical studies

Conclusions

Editor's note

Notes

References


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