Pyrogen retention: Comparison of the novel medium cut-off (MCO) membrane with other dialyser membranes

Haemodialysis effectively removes small solutes and smaller-sized middle molecules from the blood; however, the clearance of larger middle molecules, which have been associated with negative effects, is poor. The novel medium cut-off (MCO) dialysis membrane has larger pore sizes and a more open stru...

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Bibliographic Details
Published in:Scientific reports 2019-05, Vol.9 (1), p.6791, Article 6791
Main Authors: Hulko, Michael, Dietrich, Verena, Koch, Ilona, Gekeler, Alexander, Gebert, Michael, Beck, Werner, Krause, Bernd
Format: Article
Language:English
Subjects:
692/4022
692/4022/1950
Albumins - metabolism
Bacteria
Blood
Cell Membrane Permeability
Contaminants
Contamination
Deoxyribonucleic acid
Dialysis
Dialysis Solutions - metabolism
DNA
Endotoxins
Endotoxins - metabolism
Fluctuations
Hemodialysis
Humanities and Social Sciences
Humans
Lipopolysaccharides
Lipopolysaccharides - metabolism
Membrane permeability
Membranes
Membranes, Artificial
multidisciplinary
Peptidoglycans
Permeability
Pyrogens
Pyrogens - metabolism
Science
Science (multidisciplinary)
Solutes
Toll-like receptors
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Summary:Haemodialysis effectively removes small solutes and smaller-sized middle molecules from the blood; however, the clearance of larger middle molecules, which have been associated with negative effects, is poor. The novel medium cut-off (MCO) dialysis membrane has larger pore sizes and a more open structure than other high-flux membranes, providing improved removal of larger middle molecules while retaining albumin. However, larger pore sizes may potentially increase permeability to pyrogens, including endotoxins and other bacterial contaminants, that could be present in the dialysis fluid. In this study, we tested the capacity of low-flux, high-flux, MCO and high cut-off dialyser membranes with different pore sizes to prevent pyrogens crossing from dialysate to the blood side in a closed-loop test system, differentiating among lipopolysaccharides, peptidoglycans and bacterial DNA using a toll-like receptor assay. Even though the bacterial contamination levels in our test system exceeded the acceptable pyrogen dose for standard dialysis fluid, levels of lipopolysaccharides, peptidoglycans and bacterial DNA in the blood-side samples were too low to identify potential differences in pyrogen permeability among the membranes. Our results suggest that MCO membranes are suitable for haemodialysis using ISO standard dialysis fluid quality, and retain endotoxins at a similar level as other membranes.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-019-43161-2