Endotoxin and Dialysis Water

The dialysis water and dialysis fluid purity are of great importance for the safety of HD patients. Hospitals’ dialysis units must deliver high purity water, which is free from contaminants. In that regard when considering the possible contaminants which are present in water used to prepare dialysis fluid, we can distinguish three types: Physiochemical and microbial contamination.To achieve the quality chemical properties of dialysis water, Reverse Osmosis is most effective treatment system whether the source of water is municipal or ground water. RO removes over 95 % of chemical constituents. The micro-organisms such as bacteria, fungi and yeasts, a large variety of microbial derivatives or fragments can be released into any fluid during active growth and lysis of the micro-organisms, this is what we refer to endotoxin. It can become a health concern when it grows and spreads in human-made water systems like

Endotoxin, this is a toxic substance bound to the bacterial cell wall and released when the bacterium ruptures or disintegrates, other substance are pyrogen. Endotoxin is the major component of the outer cell wall of gram-negative bacteria. Dialysis water must not contain endotoxin contaminants at concentrations in excess (0.25 EU/ml) with an action level of 0.125EU/ml and (100 colony forming units (CFU)/ml) as per AAMI….

Patients undergoing conventional hemodialysis three times per week are exposed to 300-600 litres of water per week, depending on their prescription (Coulliette, 2013). More than 90% of the dialysate delivered to the dialyzer is water (Layman-Amato, 2013). Bacterial and/or endotoxin contamination of the dialysis water and/or dialysate can threaten the life and health of an HD patient.

  • Bacterial contamination: May result in bacteremia and/or chronic inflammation. Chronic inflammation, in turn, contributes to or complicates cardiovascular disease (CVD), the leading cause of death for dialysis patients. Chronic inflammation has also been linked: poor nutritional status, reduced response to erythropoietin therapy, decline in residual renal function and carpal tunnel syndrome (Coulliette, 2013).
  • Endotoxin contamination: Fragments of endotoxins in the dialysate bath may pass through the dialyzer membranes and result in symptoms of septicemia or a pyrogenic reaction (Coulliette, 2013).It recommended monthly monitoring of bacterial contamination of the dialysis water.

Aqualytic technical team ensures the sampling and analysis follows the standard protocol LAL (Limulus amoebocye lysate) method