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Should ultra‐pure dialysate be mandatory?

2000· review· en· W2139801200 on OpenAlexaboutno aff
Gerhard Lonnemann

Bibliographic record

VenueNephrology Dialysis Transplantation · 2000
Typereview
Languageen
FieldMedicine
TopicDialysis and Renal Disease Management
Canadian institutionsnot available
Fundersnot available
KeywordsMedicineIntensive care medicine

Abstract

fetched live from OpenAlex

brane proteins, as well as actively secreted proteins Bacterial growth and pyrogen contamination in such as exotoxin A from P. aeruginosa, which may be water and standard dialysate present in routine dialysate.These substances are pyrogenic but are not detectable by the LAL assay.As an According to the recommendations of the Association alternative assay, the biological activity of these subfor the Advancement of Medical Instrumentation stances can be assessed using a bioassay in which (AAMI ) as well as the German 'Dialysestandard' of human donor blood is incubated in vitro with dialysate 1993, microbial counts in haemodialysis water and samples [4].In cases where the dialysate contains dialysate must not exceed 200 and 2000 colony-forming pyrogenic substances, the mononuclear cells (PBMC ) units per millilitre (cfu/ml ), respectively.Although in the whole blood incubation will be stimulated to sterile and pyrogen-free dialysis fluid has been considproduce cytokines such as interleukin-1b (IL-1b) and ered desirable, no mandatory regulations exist to date.tumour necrosis factor-a ( TNF-a).After incubation, Several multi-centre studies have been conducted in cytokines can be measured by immunoassays in the the USA, Canada and Germany in order to assess the plasma supernatants of the whole-blood samples as a degree of bacterial growth and endotoxin contaminaread-out of bacterial pyrogens present in the dialysate.tion in water for dialysis and dialysate [1][2][3].According This whole-blood cytokine-induction assay is nonto these three multi-centre studies, 13-35% of water specific but is sensitive enough to detect all pyrogenic samples contain more than 200 cfu/ml and 12-19% of substances including the LAL-negative products, which dialysate samples contain more than 2000 cfu/ml of are small enough to penetrate intact dialyser memwater-born micro-organisms.Gram-negative bacteria, branes and may cause pyrogenic reactions in patients such as various Pseudomonas species are most comduring haemodialysis.Recently, we were able to monly detected, Gram-positive bacteria are rare, and demonstrate that bicarbonate dialysate of good microfungi may be present.Gram-negative micro-organisms biological quality (<125 cfu/ml ) contains enough are considered to be the most harmful, because they pyrogenic activity to induce significant IL-1b producrelease lipopolysaccharides (LPS, endotoxins) from tion in the whole-blood cytokine-induction assay [4].their outer membrane into the water and dialysate.Several studies demonstrated no correlation between LPS are powerful exogenous pyrogens and may cause bacterial growth and endotoxin concentration or cytopyrogen fever during haemodialysis if sufficient kine-inducing activity in contaminated dialysate [1,4].amounts (pg) get access to the patient's blood.LPS Therefore, in order to monitor the microbiological can be measured by a specific assay, the Limulus quality of dialysate fluid, it is recommended that a amebocyte lysate (LAL) assay.The LAL assay has dialysate culture is performed to determine bacterial been used to measure the endotoxin content in water growth (cfu/ml ) plus an endotoxin test (LAL test) or and dialysate.Although there are no standards for a cytokine-induction assay.For reasons such as donor-LPS contamination in dialysate, it is generally accepted dependent variabilities in the sensitivity of the cytokinethat dialysate should not contain more than 5 endoinduction assay it is difficult to standardize this assay toxin units (EU )/ml which is ~1 ng/ml of endotoxin.for routine use.This test should, therefore, be restricted The multi-centre studies mentioned above showed that to specialized laboratories, who could be asked for 2-35% of water samples and 6-28% of dialysate cooperation if LAL-negative pyrogens are to be samples contained more than 5 EU/ml of endotoxin.detected.In addition to endotoxins, which are the most potent exogenous pyrogens, there are other components of the bacterial cell wall of Gram-negative micro- Permeability of dialyser membranes to pyrogensorganisms, such as peptidoglycans and outer memderived from contaminated dialysate

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesMeta-epidemiology (narrow), Insufficient payload (model declined to judge)
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Other design · Consensus signal: none
GenreCandidate signal: Review · Consensus signal: Review
Teacher disagreement score0.970
Threshold uncertainty score1.000

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0010.001
Meta-epidemiology (broad)0.0030.002
Bibliometrics0.0010.001
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0010.001
Insufficient payload (model declined to judge)0.0020.001

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.038
GPT teacher head0.318
Teacher spread0.280 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designOther design
Domainnot available
GenreReview

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations30
Published2000
Admission routes1
Has abstractyes

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