Microbiological Quality

Febrile reactions were common in the early dialysis procedures. The electrolyte concentrates in use today are manufactured in accordance with internationally recog nised standards such as ISO 13958, Concentrates for Hae-modialysis and Related Therapies. The acid concentrates do not support bacterial growth, however liquid bicarbonate concentrates have been shown to support bacterial growth and there may be a rapid increase in levels after dilution [22]. High levels in the dialysis fluid lead to pyrogen reactions and fever [23, 24]. Intact bacteria cannot cross the dialyser membrane, however bacterial products such as endotoxins, muramyl di-peptides and exotoxins, potent inducers of cytokines and stimulators of the acute phase response, are able to transfer leading to the stimulation of mononuclear cells and contributing to chronic inflammation associated with long-term hae-modialysis therapy. Such transfer is related to the type of dialyser membrane (cellulosic vs. synthetic) and the mode of dialysis (low flux vs. high flux with back filtration).

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