ArticlePloS one2016
Is Endotoxemia in Stable Hemodialysis Patients an Artefact? Limitations of the Limulus Amebocyte Lysate Assay and Role of (1→3)-β-D Glucan.
Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 22 citations in OpenAlex.
- The hemodynamic cost of intermittent hemodialysis and systemic organ stunning.Renal failure · 2026Review
- Quality Control for Medical Devices: A Review of Detection Technologies, Regulatory Standards and Matrix Interference Solutions.Sensors (Basel, Switzerland) · 2026Review
- Post-Hemodialysis Flow-Dependent Hepatic Function Impairment in Individuals With End Stage Kidney Disease and Chronic Inflammation.Hemodialysis international. International Symposium on Home Hemodialysis · 2026Article
- Effects of statins beyond lipid-lowering agents in ART-treated HIV infection.Frontiers in immunology · 2024Review
- The influence of continuous renal replacement therapy on 1,3-β-d-glucan levels in critically ill patients: a single-center retrospective propensity score study.Renal failure · 2023Article
- Effect of a Hemodialysis Session on Markers of Inflammation and Endotoxin.International journal of inflammation · 2022Article
- Circulating β-d-Glucan as a Marker of Subclinical Coronary Plaque in Antiretroviral Therapy-Treated People With Human Immunodeficiency Virus.Open forum infectious diseases · 2021Article
- Exploring the Link Between Hepatic Perfusion and Endotoxemia in Hemodialysis.Kidney international reports · 2021Article
- Beta-glucans in advanced CKD: role in endotoxaemia and inflammation.BMC nephrology · 2020Article
- Circulating (1→3)-β-D-glucan Is Associated With Immune Activation During Human Immunodeficiency Virus Infection.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Role of Metabolic Endotoxemia in Systemic Inflammation and Potential Interventions.Frontiers in immunology · 2020Review
- Circulating LPS and (1→3)-β-D-Glucan: A Folie à Deux Contributing to HIV-Associated Immune Activation.Frontiers in immunology · 2019Review
- Pro-resolving mediators promote resolution in a human skin model of UV-killed Escherichia coli-driven acute inflammation.JCI insight · 2018Article
- Lactobacillus rhamnosus L34 Attenuates Gut Translocation-Induced Bacterial Sepsis in Murine Models of Leaky Gut.Infection and immunity · 2018Article
- Intestinal Barrier Disturbances in Haemodialysis Patients: Mechanisms, Consequences, and Therapeutic Options.BioMed research international · 2017Review
- Impact of Water Treatment on Anemia in Hemodialysis Patients.Indian journal of nephrologyArticle
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElevated blood endotoxin levels are frequently reported in the dialysis population and are strongly linked with inflammation, a major predictor of mortality. Virtually all studies have employed the Limulus Amoebocyte Lysate (LAL) assay to detect endotoxin. However this assay is not endotoxin-specific and can be activated by (1→3)-β-glucan (BG), a component of fungal cell walls leading to false positive signals. Very few studies have taken account of this. We examined the influence of BG-based activation of the LAL assay on the detection of endotoxemia in this setting.
methodWe measured plasma endotoxin levels in 50 hemodialysis patients with and without the use of BG-blocking buffers. These buffers inhibit BG activation of the LAL assay to ensure that any signal detected is endotoxin-specific. Blood samples were measured for BG, interleukin-6 (IL-6), tumor necrosis factor-alfa (TNF-α) to examine the association between endotoxin signals, BG and inflammation.
resultsEndotoxin signals were detected in 50% of patients. On repeat measurement with a BG-blocking buffer, all detected endotoxin signals were extinguished. No patient had detectable endotoxemia. Plasma BG levels were significantly elevated in 58% of patients and were higher in those with detectable endotoxin signals using the LAL assay without BG-blocking buffers (78vs.54pg/mL;p<0.001). Endotoxin signal and BG levels did not correlate with levels of TNF-α or IL-6.
conclusionUse of the LAL assay for blood endotoxin detection in dialysis patients has its limitations due to high blood BG. Endotoxemia frequently reported in non-infected hemodialysis patients may be artefactual due to BG interference.
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