Biofilms in Hemodialysis

  • Mark PasmoreEmail author
  • Karine Marion
Part of the Springer Series on Biofilms book series (BIOFILMS, volume 3)


During end stage renal disease the kidneys are not functioning properly and as such longer adequately remove waste from the blood stream. Hemodialysis is an invasive medical treatment were by the human body is routinely treated with large quantities of water as a mean to flush these waste from the body. As in all water systems this system is susceptible to biofilms. Advanced water purification system are used to purify the water entering these systems, however, bacteria have adapted to low nutrient niches such as this and a even a single bacteria may be sufficient to start biofilm development. These biofilms have been shown to develop throughout hemodialysis systems and have in some cases are suspected of causing out breaks for infection within dialysis centers. Additionally, biofilms produce endotoxins and other cytokines that can migrate across the dialysis membrane and cause an inflammatory response, which in time causes chronic inflammatory syndrome and further damages the body of what often very ill patients. Making the problem more challenging is the difficulty of removing biofilms from in-place water systems, as such as is used in clinical settings. For this reason a multi-step cleaning, descaling, and disinfection process in recommended for these system. With the ever-increasing numbers of patients on dialysis and other invasive medical treatment the need for understanding, treatment for and prevention of medical biofilms will only continue to expand.


Dialysis Membrane Peracetic Acid Dialysis Session Dialysis Fluid Reverse Osmosis Membrane 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Anonymous: Circulaire DGS/DH/AFSSAPS n∘ 2000–337 du 20 Juin 2000 relative à la diffusion d’un guide pour la production d’eau pour hémodialyse des patients insuffisants rénauxGoogle Scholar
  2. AAMI (2004) Recommended practice: Dialysate for hemodialysis, ANSI/AAMI RD52-2004. Association for the Advancement of Medical Instrumentation, ArlingtonAAMI (2003) Recommended practice: Reuse of hemodialyzers, ANSI/AAMI RD47-2003. Association for the Advancement of Medical Instrumentation, ArlingtonGoogle Scholar
  3. Allard B (1999) Désinfection des générateurs d’hémodialyse. Des expertises sous influence. Le moniteur hospitalier 114:33–40Google Scholar
  4. Alter MJ, Tokars JI, Arduino MJ, Favero MS (2004) Control of infections associated with hemodialysis. In Mayhall CJ (ed) Hospital epidemiology and infection control, 3 rd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 1139–1160Google Scholar
  5. Archibald LK, Khoi NN, Jarvis WR et al (2006) Pyrogenic reactions in hemodialysis patients, Hanoi, Vietnam. Infect Control Hasp Epidemiol. 27:424–426CrossRefGoogle Scholar
  6. Banche G, Allizond V, Giacchino F et al (2006) Effect of dialysis membrane biocompatibility on polymorphonuclear granulocyte activity in dialysis patients. Nephrol Dial Transplant 21:3532–3538PubMedCrossRefGoogle Scholar
  7. Berland Y (1998) Dialysat et biocompatibilité en hémodialyse. Néphrologie 19:329–334PubMedGoogle Scholar
  8. Block C, Backenroth R, Gershon E, Israeli R, Simhon A, Popovtzer M, Shapiro MR (1999) Outbreak of bloodstream infections associated with dialysis machine waste ports in a hemodialysis facility. Eur J Clin Microbiol Infect Dis 18(10):723–725PubMedCrossRefGoogle Scholar
  9. Bolan G, Reingold AL, Carson LA, Silcox VA, Woodley CL, Hayes PS, Hightower AW, McFarland L, Brown JW 3rd, Petersen NJ et al (1985) Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis. 152(5): 1013–1019PubMedGoogle Scholar
  10. Bommer J, Jaber B (2006) Ultrapure dialysate: facts and myths. Semin Dial 19:115–119PubMedCrossRefGoogle Scholar
  11. Canaud B, Bosc JY, Leray H et al (2000) Microbiological purity of dialysate for on-line substitution fluid preparation. Nephrol Dial Transplant 15(Suppl 2):21–30CrossRefGoogle Scholar
  12. Canaud B, Wizemann V, Pizzarelli F et al. (2001) Cellular interleukin-1 receptor antagonist production in patients receiving on-line haemodiafiltration. Nephrol Dial Transplant 16:2181–2187PubMedCrossRefGoogle Scholar
  13. Capelli G, Ballestri M, Perrone S et al (2000) Biofilms invade nephrology. Blood Purif 18:224–230CrossRefGoogle Scholar
  14. Capelli G, Ravera F, Ricardi M et al (2005) Water treatment for hemodialysis: a 2005 update. Contrib Nephrol 149:42–50CrossRefGoogle Scholar
  15. Comila M, Gasco J, Busquets A et al (2005) Identification of culturable bacteria present in haemodialysis water and fluid. FEMS Microbiol Ecol 52 (1): 101–114CrossRefGoogle Scholar
  16. Center for Disease Control (1998) Outbreaks of Gram-negative bacterial bloodstream infections traced to probable contamination of hemodialysis machines. Canada, 1995; United States, 1997; and Israel, 1997. JAMA 279:646–647CrossRefGoogle Scholar
  17. Elasri MO, Miller RV (1999) Study of the response of a biofilm bacterial community to UV radiation. Appl Environ Microbiol 65:2025–2031PubMedGoogle Scholar
  18. Flaherty JP, Garcia-Houchins S, Chudy R et al (1993) An outbreak of Gram-negative bacteremia traced to contaminated O-rings in reprocessed dialyzers. Ann Intern Med 119:1072–1078PubMedGoogle Scholar
  19. European Pharmacopoeia, European Council Ed, Strasbourg, France, 4th Edn, 2002. Monograph 01–167. Eau pour hémodialyse; Solutions concentrées pour hémodialyseGoogle Scholar
  20. Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ (2005) National surveillance of dialysisassociated diseases in the United States, 2002. Semin Dial 18(1):52–61PubMedCrossRefGoogle Scholar
  21. Ghezzi PM, Bonello M, Ronco C (2007) Disinfection of dialysis monitors. Nephrol 154:39–60Google Scholar
  22. Gibson H, Taylor JH, Hall KE et al (1999) Effectiveness of cleaning techniques used in food industry in terms of removal of bacterial biofilms. J Appl Micro 87:41–48CrossRefGoogle Scholar
  23. Hoenich NA, Levin R (2003) The implications of water quality in hemodialysis. Semin. Dial 16(6):492–497PubMedCrossRefGoogle Scholar
  24. Hoenich NA, Ronco C, Levin R (2006) The importance of water quality and hemodialysis fluid composition. Blood Purif 24(1):11–8PubMedCrossRefGoogle Scholar
  25. Holmes CJ, Degremont A, Kubey W et al (2004) Effectiveness of various chemical disinfectants versus cleaning combined with heat disinfection on Pseudomonas biofilm in hemodialysis machines. Blood Purif 22:461–468PubMedCrossRefGoogle Scholar
  26. Ismail N, Becker BN, Hakim RM (1996) Water treatment for hemodialysis. Am J Nephrol 16:60–72PubMedCrossRefGoogle Scholar
  27. Jofre R, Rodrigez-Benitez P, Lopez-Gomez JM et al (2006) Inflammatory syndrome in patients on hemodialysis. J Am Soc Nephrol 17:S274–S280PubMedCrossRefGoogle Scholar
  28. Jochimsen EM, Frenette C, Delorme M, Arduino M, Aguero S, Carson L, Ismail J, Lapierre S, Czyziw E, Tokars JI, Jarvis WR (1998) A cluster of bloodstream infections and pyrogenic reactions among hemodialysis patients traced to dialysis machine waste-handling option units. Am J Nephrol 18(6):485–489PubMedCrossRefGoogle Scholar
  29. Johansen C, Falholt P and Gram L (1997) Enzymatic removal and disinfection of bacterial biofilms. Appl Environ Microbiol 63:3724–3728PubMedGoogle Scholar
  30. Ledebo I, Nystrand R (1999) Defining the microbiological quality of dialysis fluids. Artif Organs 23(l):37–43PubMedCrossRefGoogle Scholar
  31. Lonneman G (2000a) Chronic inflammation in hemodialysis: the role of contaminated dialysate. Blood Purif 18:214–223CrossRefGoogle Scholar
  32. Lonneman G (2000b) Should ultra-pure dialysate be mandatory? Nephrol Dial Transplant 15 (l):55–59CrossRefGoogle Scholar
  33. Lonneman G (2004) When good water goes bad: how it happens, clinical consequences and possible solutions. Blood Purif 22:124–129CrossRefGoogle Scholar
  34. Magalhaes M, Doherty C, Govan JRW et al (2003) Polyclonal outbreak of Burkholderia cepacia complex bacteraemia in hemodialysis patients. J Hasp Infect 54:120–123CrossRefGoogle Scholar
  35. Man NK, Degremont A, Darbord JC et al (1998) Evidence of bacterial biofilm in tubing from hydraulic pathway of hemodialysis system. Artif Organs 22(7):596–600PubMedCrossRefGoogle Scholar
  36. Man NK (2004) Controversies and issues in hemodiafiltration therapy. Blood Purif22:2–7PubMedCrossRefGoogle Scholar
  37. Marion-Ferey K, Pasmore M, Stoodley P et al (2003) Biofilm removal from silicone tubing: an assessment of the efficacy of dialysis machine decontamination procedures using an in-vitro model. J Hosp Infect 53:64–71PubMedCrossRefGoogle Scholar
  38. Marion K, Pasmore M, Freney J et al (2005) A new procedure allowing the complete removal and prevention of hemodialysis biofilms. Blood Purif 23:339–348PubMedCrossRefGoogle Scholar
  39. Marion-Ferey K, Leid J, Bouvier G, Pasmore M, Husson G, Vilagines R (2005) Endotoxin level measurement in hemodialysis biofilm using ‘the Whole Blood Assay’. Artif Organs 29:475–481PubMedCrossRefGoogle Scholar
  40. Morin P (2000) Identification of the bacteriological contamination of a water treatment line used for hemodialysis and its disinfection. J Hasp Infect 45:218–224CrossRefGoogle Scholar
  41. Nagayoshi M, Fukuizumi T, Kitamura C et al (2004) Efficacy of ozone on survival and permeability of oral microorganisms. Oral Microbiol Immunol 19:240–246PubMedCrossRefGoogle Scholar
  42. Ofsthun NJ, Leypoldt JK (1995) Ultrafiltration and backfiltration during hemodialysis. Artif Organs 19:1143–1161PubMedCrossRefGoogle Scholar
  43. Phillips G, Hudson S, Stewart WK (1994) Persistence of microflora in biofilm within fluid pathways of contemporary hemodialysis monitors (Gambro AK-10). J Hasp Infect 27(2): 117 125CrossRefGoogle Scholar
  44. Pizzarelli F, Cerrai T, Biagini M et al (2004) Dialysis water treatment systems and monitoring in Italy. Results of a national survey. J Nephrol 17:565–569PubMedGoogle Scholar
  45. Pozos N, Scow K, Wuertz S et al (2004) UV disinfection in a model distribution system: biofilm growth and microbial community. Water Res 38:3083–3091PubMedCrossRefGoogle Scholar
  46. Roth VR, Jarvis WR (2000) Outbreaks of infection and/or pyrogenic reactions in dialysis patients. Semin Dial 13:92–96PubMedCrossRefGoogle Scholar
  47. Rudnick JR, Arduino MJ, Bland LA et al (1995) An outbreak of pyrogenic reactions in chronic hemodialysis patients associated with hemodialyzer reuse. Artif Organs 19:289–294PubMedCrossRefGoogle Scholar
  48. Smeets E, Kooman J, Van der Sande F et al (2003) Prevention of biofilm formation in dialysis water treatment systems. Kidney Int 63:1574–1576PubMedCrossRefGoogle Scholar
  49. Sparwasser T, Miethke T, Lipford G, Erdmann A, Hacker H, Heeg K, Wagner H (1997) Macrophages sense pathogens via DNA motifs: induction of tumor necrosis factor-a-mediated shock. Eur J Immunol 27:1671–1679PubMedCrossRefGoogle Scholar
  50. Stagier A (2005) Is ultraviolet radiation on hemodialysis RO water beneficial? EDTNA ERCA J 31:194–198Google Scholar
  51. U.S. Renal Data System (USRDS) (2005) Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2005. (Available from Scholar
  52. Weber V, Linsberger I, Rossmanith E et al (2004) Pyrogen transfer across high and low flux hemodialysis membranes. Artif Organs 28:210–217PubMedCrossRefGoogle Scholar
  53. Williams R (2005) Enzymes plus detergent effective in cleaning hemodialysis machines. Nat Clin Prac Nephrol 1:67Google Scholar
  54. Xavier JB, Picioreanu C, Rani SA et al (2005) Biofilm-control strategies based on enzymatic disruption of the extracellular polymeric substance matrix- a modeling study. Microbiology 151:3817–3822PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  1. 1.Sterility Assurance/Technology ResourcesBaxter Healthcare CorporationRound LakeUSA
  2. 2.Faculte de Pharmacie, Laboratoire de MicrobiologieUniversite Lyon1LyonFrance

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