Pegues D A, Oettinger C W, Bland L A, Oliver J C, Arduino M J, Aguero S M, McAllister S K, Gordon S M, Favero M S, Jarvis W R
Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
J Am Soc Nephrol. 1992 Oct;3(4):1002-7. doi: 10.1681/ASN.V341002.
Pyrogenic reactions (PR) are a well-recognized complication of hemodialysis and have been associated with dialyzer reuse, high-flux dialysis, and bicarbonate dialysate. However, the roles of bacteria and endotoxin in dialysate for producing PR are not well defined. To determine the effect of removing most bacteria and endotoxin from the dialysate on the incidence of PR, a cohort of chronic hemodialysis patients receiving high-flux, high-efficiency, or conventional hemodialysis at three centers with bicarbonate dialysis fluids that had been filtered with a polysulfone high-flux hemodialyzer was prospectively studied. Unfiltered bicarbonate concentrate had median bacterial and endotoxin concentrations of 479,000 CFU/mL and 39,800 pg/mL, respectively. After filtration of the bicarbonate concentrate at the central proportioner, dialysate had a median 9.2 CFU/mL of bacteria and 17.8 pg/mL of endotoxin. Dialysate filtered at individual proportioning dialysis machines had a median 0.001 CFU/mL of bacteria and 0.19 pg/mL of endotoxin. Nine PR were identified among 303 patients after 28,007 hemodialysis treatments (0.3 PR/1,000 treatments). The rate of PR was similar for the three hemodialysis treatment modalities and for first-use compared with reused dialyzers. Although the PR rate in this study was lower (P = 0.046) than the PR rate of a previous study with unfiltered dialysis fluids (0.7 PR/1,000 treatments), it represents a difference of only 10 PR in over 28,000 treatments. It was concluded that filtration of hemodialysis fluids is efficacious in removing bacterial and endotoxin contamination and can result in a lower incidence of PR in patients receiving high-flux, high-efficiency, or conventional hemodialysis.
热原反应（PR）是血液透析中一种公认的并发症，与透析器复用、高通量透析和碳酸氢盐透析液有关。然而，透析液中细菌和内毒素在引发PR中的作用尚未明确界定。为了确定从透析液中去除大部分细菌和内毒素对PR发生率的影响，对一组在三个中心接受高通量、高效或常规血液透析的慢性血液透析患者进行了前瞻性研究，这些患者使用的碳酸氢盐透析液经过聚砜高通量血液透析器过滤。未过滤的碳酸氢盐浓缩液中细菌和内毒素的中位数浓度分别为479,000 CFU/mL和39,800 pg/mL。在中央配液装置对碳酸氢盐浓缩液进行过滤后，透析液中细菌的中位数为9.2 CFU/mL，内毒素为17.8 pg/mL。在各个比例配液透析机上过滤后的透析液中细菌的中位数为0.001 CFU/mL，内毒素为0.19 pg/mL。在28,007次血液透析治疗后，303例患者中发现9例PR（0.3例PR/1000次治疗）。三种血液透析治疗方式的PR发生率以及首次使用与复用透析器的PR发生率相似。尽管本研究中的PR发生率（P = 0.046）低于之前使用未过滤透析液的研究中的PR发生率（0.7例PR/1000次治疗），但在超过28,000次治疗中，两者仅相差10例PR。研究得出结论，血液透析液过滤在去除细菌和内毒素污染方面是有效的，并且可以降低接受高通量、高效或常规血液透析患者的PR发生率。
