This article summarise the main data in the literature on the role of
bacteriological contamination of the dialysate fluid in inflammatory r
eactions in hemodialysis. Pyrogenic substances of small molecular weig
ht from Gramnegative bacteria grown in dialysate can pass across intac
t dialyzer membrane to stimulate cytokine production by peripheral blo
od mononuclear cells. Cellulosic hemodialysis membranes are more perme
able to endotoxins than synthetic membranes. Polysulfone membranes and
polyamide membranes are able to adsorb bacterial toxins on the dialys
ate side. The diffusive transfer of bacterial products across dialysis
membrane from dialysate fluid was demonstrated. Transmembrane passage
of cytokine-inducing bacterial products across reprocessed dialyzers
is greater than across new dialyzers. Bacteriological contamination of
the dialysate fluid is a problem which must be considered with much m
ore care by nephrologists, especially as LAL test is unable to detect
all the bacterial products which can contaminate the dialysate fluid.