Figure 324

Backfiltration, or reverse filtration, of endotoxins (ET) from dialysate to blood. Reverse filtration of ET is particularly prone to occur when high-flux membranes are used and the dialysate is heavily contaminated with bacteria (>2000 CFU/mL) and may result in pyrogenic reactions. The dialysis membranes are impermeable to intact ET; however, their fragments (some of which still are pyrogenic) may be small enough to traverse the membrane. Although the membrane is impermeable to bacteria and blood cells, a mechanical break in the membrane could result in bacteremia.

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