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High-flux dialysis membranes used with bicarbonate dialysis fluid increase the risk of back diffusion of bacterial endotoxin into the blood during hemodialysis. Endotoxin transfer of various synthetic fiber membranes was tested with bacterial culture filtrates using an in vitro system testing both diffusive and convective conditions. Membranes were tested in a simulated dialysis mode with endotoxin challenge material (approximately 420 EU/mL) added to the dialysis fluid, with saline used to model both blood and dialysis fluid. Samples were taken of both blood and dialysis fluid, and analyzed using a kinetic turbidimetric Limulus amoebocyte lysate assay. Endotoxin was found in all of the blood circuit samples, except for the Fresenius Optiflux F200NR(e) and thick-wall membranes. All membranes tested removed approximately 95% of the endotoxin from solution, with the residual approximately 5% recirculating within the dialysis fluid compartment. Endotoxin distribution through the fiber membrane was examined using a fluorescent-labeled endotoxin conjugate. Fluorescence images indicate that adsorption occurs throughout the membrane wall, with the greatest concentration of endotoxin located at the inner lumen. Contact angle analysis was able to show that all membranes exhibit a more hydrophilic lumen and a more hydrophobic outer surface except for the polyethersulfone membranes, which were of equal hydrophobicity. Resulting data indicate that fiber geometry plays an important role in the ability of the membrane to inhibit endotoxin transfer, and that both adsorption and filtration are methods by which endotoxin is retained and removed from the dialysis fluid circuit.

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Four patients have been studied with maintenance hemodiafiltration. The predominant finding to date has been better control of blood pressure. The mechanism(s) for this improved blood pressure control are under study.

During hemodialysis bacterial lipopolysaccharide (LPS) in contaminated dialysate solution may translocate across the hollow fiber membrane (HFM) to a patient's blood, resulting in fever and possible systemic shock. This study investigates LPS transfer across, and adsorption within, native and modified Fresenius Optiflux® F200NRe polysulfone (PS)/polyvinyl pyrrolidone (PVP) HFMs. Modifications include varied PVP content, addition of a PS‐poly(ethylene glycol) copolymer (PS‐PEG), and bleach sterilization. Under clinically relevant flow conditions LPS from >400 EU mL−1 spiked dialysate is not detected (<0.1 EU mL−1) in the lumens of native fibers, but is detected to varying degrees (0.2–15 EU mL−1) in the lumens of the modified fibers. Fluorescently labeled LPS predominantly adsorbs near the lumen of all membranes except the PS‐PEG containing membrane, where LPS localizes on the outer wall. Thus, addition of PS‐PEG may entrap LPS in the HFM spongy matrix, away from the blood‐contacting fiber lumen. © 2014 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015, 132, 41550.