The level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers

Medicina (Kaunas). 2010;46(8):556-60.


The composition and quality of the dialysis fluid play an important role in the modulation of dialysis-related complications. During hemodialysis, patient's blood has a contact with dialysate through a semipermeable membrane. Bacterial endotoxins can pass through the membrane pores into the patient's blood and cause a silent chronic microinflammation. The aim of this study was to determine the level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers. Dialysis water (n=50) and dialysate (n=50) were collected from 91% (n=50) of all hemodialysis centers. The presence of bacterial endotoxins was evaluated using a sensitive Limulus amebocyte lysate test, which detects intact lipopolysaccharides. The level of endotoxins was lower than 0.25 EU/mL in 43 (86%) dialysis water samples and in 46 (92%) dialysate samples, and complied with the recommendations of the European Pharmacopoeia and the European Best Practice Guidelines for pure dialysis fluid. The dialysate of 39 (78%) Lithuanian hemodialysis centers complied with the definition of an ultrapure dialysis fluid. The water and dialysate were of insufficient quality in 14% and in 8% of Lithuanian hemodialysis centers, respectively, and this could be improved by the establishment of routine investigation of endotoxins.

Publication types

  • Evaluation Study

MeSH terms

  • Chronic Disease
  • Data Interpretation, Statistical
  • Endotoxins / analysis*
  • Endotoxins / blood*
  • Europe
  • Hemodialysis Solutions* / standards
  • Humans
  • Inflammation / etiology
  • Kidneys, Artificial
  • Limulus Test
  • Lithuania
  • Practice Guidelines as Topic
  • Renal Dialysis* / adverse effects
  • Water


  • Endotoxins
  • Hemodialysis Solutions
  • Water