High level of recovery of fungi from water and dialysate in haemodialysis units.

The counts of yeasts and filamentous fungi were investigated in the municipal water supplies of haemodialysis centres, in the treated water and the dialysate from all 85 haemodialysis units in Greece, in order to estimate their occurrence, their correlation with contamination indicator bacteria and other influencing factors. Filamentous fungi and yeasts were isolated from 69 (81.2%) and from three (3.5%) feed water samples, from 74 (87.1%) and seven (8.2%) treated water samples and from 66 (77.7%) and 11 (12.9%) dialysate samples respectively. Aspergillus spp and Penicillium spp were the most frequent moulds, while Candida spp were the prevailing yeasts. The occurrence of yeasts was significantly higher in dialysate than in tap water samples. Counts of filamentous fungi in all 255 samples were significantly correlated with the counts of total heterotrophic bacteria and enterococci, whereas the counts of yeasts were correlated with faecal coliforms, total heterotrophic bacteria, as well as enterococci, Pseudomonas spp and total coliforms, while no correlation was detected with the age of either haemodialysis units, the age of water treatment system, the number of artificial kidney machines or the components of the water purification system. High recovery of fungi from haemodialysis aqueous environments implies a potential risk for haemodialysis patients and indicates the need for continuous maintenance and monitoring.

Effect of short-term rHuEPO treatment on insulin resistance in haemodialysis patients.

BACKGROUND/AIM: Decreased sensitivity to the hypoglycaemic action of insulin is an almost universal phenomenon in uraemic patients, and it is attributed either to uraemic toxins or to anaemia or even to secondary hyperparathyroidism. Considering the conflicting data of few existing studies, we examined the influence of erythropoietin (EPO) treatment on insulin resistance and tested the probable correlation of this influence with sympathetic nervous system (SNS) activity. METHODS: We studied 8 non-obese, non-diabetic, stable dialysis patients using the euglycaemic insulin clamp technique before administration of EPO (phase A), 10 days after (phase B), and after the correction of the haematocrit level, at least 8 weeks later (phase C). We estimated the indices (glucose infusion rate, mg/kg/min), M/G (glucose clearance), and M/I (tissue sensitivity to insulin), and we measured haematocrit, haemoglobin, triglyceride, ferritin, EPO, and fasting insulin levels in each phase. During each phase, we tested the SNS activity using the response of blood pressure to persistent handgrip and the response of blood pressure to the standing position. RESULTS: Our patients appeared to have an increased insulin resistance in phase A (M(A) = 6.24 +/- 1.01) which was significantly improved 10 days after the beginning of EPO treatment and before the rise of haematocrit (M(B) = 7.71 +/- 1.54, p < 0.05). There was no further improvement in phase C. Indices M/G and M/I behaved similarly. The serum triglyceride levels decreased in response to the increased insulin sensitivity. The patients studied did not demonstrate fasting hyperinsulinaemia, while the SNS activity was abnormal and remained unchanged throughout the study period in spite of some individual improvement. CONCLUSIONS: Our study proves the beneficial effect of EPO treatment on insulin resistance in dialysis patients which could be attributed to the EPO itself and not to the correction of anaemia and is accompanied by improvement in triglyceride levels. Amelioration of insulin resistance did not influence the SNS activity, making the association between EPO treatment and SNS-derived changes in blood pressure quite improbable.

Endotoxin concentration in treated water of all hemodialysis units in Greece and inquisition of influencing factors.

Mains and purified water samples from all hemodialysis centers in Greece were surveyed to assess hemodialysis water quality and the potential consequences on the dialysis population of any microbial and endotoxin contamination. Total heterotrophic bacteria counts were estimated employing the pour-plate method, the membrane filter technique, for total coliforms, fecal coliforms, enterococci and Pseudomonas spp., and the most probable number method for sulfite-reducing clostridia. Overall 170 paired samples were tested. Endotoxin concentrations were assayed in treated water samples, by the Limulus Amebocyte Lysate method, employing a chromogenic substrate. Endotoxin concentration varied from 0-30 EU/ml and exceeded 5 EU/ml in 30.6% of the centers. Endotoxin contaminated samples showed higher counts of total heterotrophic bacteria, fecal coliforms, enterococci and Pseudomonas spp. than the rest of the samples, though the difference was significant only for total heterotrophic bacteria and enterococci. Additionally, samples with endotoxin contamination derived from the mains water had significantly higher counts of fecal coliforms, enterococci and Pseudomonas spp. Endotoxin concentration was correlated with the presence of a deionization system, counts of fecal coliforms in supply water and counts of total coliforms, fecal coliforms and enterococci in treated water. These results demonstrate that hemodialysis centers in Greece need to monitor and preventively maintain the entire hemodialysis system, in order to ensure renal replacement therapy of good quality.