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Endotoxin detection in end-stage kidney disease
  1. Jonathan Wong1,2,
  2. Hassan Jeraj3,
  3. Enric Vilar1,2,
  4. Adie Viljoen4,5,
  5. Ken Farrington1,2
  1. 1Department of Renal Medicine, Lister Hospital, Hertfordshire, UK
  2. 2Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire, UK
  3. 3Quality Control Department, Lister Hospital, Hertfordshire, UK
  4. 4Department of Biochemistry, Cambridge University Hospitals, Hertfordshire, UK
  5. 5Department of Postgraduate Medicine, University of Bedfordshire, Bedfordshire, UK
  1. Correspondence to Dr Jonathan Wong, Department of Renal Medicine, Lister Hospital, Corey Mills Lane, Stevenage, Hertfordshire SG1 4AB, UK; jonathan.wong{at}


Aims Endotoxin detection assays are not validated for use in end-stage kidney disease (ESKD). We investigated the accuracy and precision of the kinetic turbidimetric Limulus amoebocyte lysate (LAL) assay to detect endotoxin in plasma from patients with ESKD. Optimisation of endotoxin recovery from plasma using the detergent Tween 80 was also explored.

Methods Plasma samples from 7 patients with ESKD and 7 healthy subjects were spiked with different concentrations of endotoxin. Repeated measurements for endotoxin at each level of spike were performed to assess the accuracy and precision of spike recovery. Endotoxin recovery in plasma samples diluted in Tween 80 and water was compared.

Results Mean endotoxin spike recovery was 111.6% and 125.2% in ESKD and healthy subjects, respectively. There was no statistical difference in spike recovery between ESKD and healthy plasma. Precision of the LAL assay in plasma spiked with low (0.05 EU/mL) and high (0.5 EU/mL) concentration of endotoxin spikes was 24.1% and 8.9%, respectively. The use of Tween 80 as a diluent for plasma significantly improved spike recovery in ESKD plasma (100.1% vs 70.4%, p<0.001).

Conclusions The kinetic LAL turbidimetric assay is a valid tool for the detection of blood endotoxin in patients with ESKD, although in blood specimens with low-level endotoxemia (≤0.05 EU/mL) the assay may be less accurate and precise. Tween 80 can be used as a diluent to optimise recovery of endotoxin in ESKD plasma.


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