During the sterilization process of the hemodialysis equipment system, dialysis water, dialysis concentrate, and dialysis fluid with endotoxin exceeding the standard will bring endotoxin into the blood of uremic patients, resulting in endotoxemia in uremic patients. Endotoxin acts on phagocytes, neutrophils, endothelial cells, platelets, complement system and coagulation system, and induces tumor necrosis factor-α (TNF-a), leukocytes. Bioactive substances such as interleukin (IL-1, see Figure 1), IL-6 and IL-8, histamine, and kallikrein cause insufficient capillary perfusion in tissues and organs, resulting in hypoxia and acidosis. High concentrations of endotoxin can also activate complement replacement pathways, triggering high fever, low blood pressure, and activating the coagulation system, leading to disseminated intravascular coagulation. In severe cases it can lead to endotoxin shock and even death characterized by microcirculatory failure and hypotension. After finding out the cause, the infected person should be given anti-infective treatment.
Figure 1. Protein structure of IL-1.
Endotoxin is a lipopolysaccharide (lipopolysaccharide) in the cell wall structure of Gram-negative bacteria, which is released after bacterial death. Endotoxin can bind to the cell membrane of the blood vessel wall, change the permeability of blood vessels, reduce blood pressure and cause shock. After hydrolysis, endotoxin can pass through the dialysis membrane and enter the patient's body, leading to acute heat-generating reactions, causing the patient to develop symptoms such as hypotension, muscle spasm, headache and fever, and severely can cause shock or endotoxemia.
The sources of endotoxin pollution related to dialysis mainly include the following 4 aspects.
(1) Water pretreatment system. Treatment systems for dialysis water include water pretreatment systems such as sedimentation filters, water softeners, and activated carbon filters, as well as reverse osmosis membrane systems or deionizers and ultrafilters.
(2) Reverse osmosis water transportation pipeline. The difference in pipe diameter, material and structure will cause bacteria to grow, and even biofilms will be attached to the surface of the pipeline, which will facilitate the growth of bacteria and pollute reuse water.
(3) In the process of preparing the dialysis concentrated solution, the contamination of the dialysis concentrated solution, the bicarbonate dialysate is very easy to grow bacteria.
(4) Contamination of the dialysis machine, disinfection between the upper and lower machines and between two shifts control.
Figure 2. Dialysis system.
According to the relevant standard requirements for endotoxin in hemodialysis treatment, the endotoxin content of the dialysate was detected by the limulus reagent method, and the management of the dialysis treatment process was strengthened based on the Deming Cycle (PDCA) management mode to improve the medical quality of dialysis treatment. Generally, special dialysis reagents (gel method) are used for qualitative and semi-quantitative testing of endotoxins, and dynamic turbidity method is used to detect endotoxin concentrations. According to international standards and industry standards, determine whether the measured dialysate is qualified.
Creative BioMart offers a corresponding endotoxin testing service. You can purchase the corresponding endotoxin removal kit and related accessory products according to the needs of your own samples. We guarantee that all instruments, water, reagents, and consumables used in the experiment are free of endotoxins, and the experiment is conducted in a clean room to ensure that low levels of endotoxins are returned to the sample. In addition, we can also provide you with related services including:
|Project name||Endotoxin testing in dialysate|
|Testing purpose||Dialysis water, dialysis concentrate, and dialysate that exceed endotoxin levels will bring endotoxins into the blood of uremic patients, causing endotoxemia in uremic patients.|
|Testing cycle||3-5 days.|
|Service including||We provide you with raw data and test reports.|