Baurmeister U, Travers M, Vienken J, Harding G, Million C, Klein E, Pass T, Wright R
Institute for Medical Membrane Application, Akzo, Fibers and Polymers Division, Wuppertal, FRG.
ASAIO Trans. 1989 Jul-Sep;35(3):519-22. doi: 10.1097/00002480-198907000-00112.
Endotoxins, or fragments thereof, can reach the blood stream of dialysis patients, transported by diffusion and connection across the intact high-flux membrane. This transfer depends upon the phenomenon of back filtration. Back filtration generally occurs under conventional high-flux dialysis conditions with membranes having an ultrafiltration coefficient in blood (UF-C) above 20 ml/hr/m2/mmHg. The clinical consequences of back filtration vary from center to center depending primarily on the quality of dialysate. We therefore surveyed the bacterial and endotoxin levels of purified water and effluent dialysate in a cross section of dialysis centers in the central United States. Using a high recovery medium, we found that 53% of the centers had bacterial counts above the Association for the Advancement of Medical Instruments standard in water (20% cfu/ml) and 35% above the standard in dialysate (2,100 cfu/ml). Endotoxin concentrations higher than 5.0 EU/ml in both water and dialysate were found in 4% and 11.8% of the centers, respectively. Since high-flux membranes are believed to be of benefit for long-term dialysis patients, manufacturers will have to offer dialysate preparation systems with additional safety features. The proper membrane design will be a key to the success of such systems.
内毒素或其片段可通过完整的高通量膜扩散和连接进入透析患者的血流。这种转移取决于反滤过现象。反滤过通常发生在传统的高通量透析条件下，使用血液超滤系数（UF-C）高于20 ml/hr/m2/mmHg的膜。反滤过的临床后果因中心而异，主要取决于透析液的质量。因此，我们在美国中部的一系列透析中心调查了纯化水和透析废液中的细菌和内毒素水平。使用高回收率培养基，我们发现53%的中心水中细菌计数高于医疗仪器促进协会标准（20% cfu/ml），35%的中心透析液中细菌计数高于标准（2100 cfu/ml）。分别有4%和11.8%的中心水中和透析液中的内毒素浓度高于5.0 EU/ml。由于高通量膜被认为对长期透析患者有益，制造商将不得不提供具有额外安全功能的透析液制备系统。合适的膜设计将是此类系统成功的关键。
