**5. Conclusion**

In conclusion, endotoxin contamination of fluid for dialysis therapy is an important aspect of patient safety and well-being. Regardless of the microbiological quality of the water coming into the hemodialysis machine, the dialysis membrane is the final barrier between potentially contaminated dialysis fluid, and the blood of the patient. We have examined how manipulation of specific fiber membrane parameters (geometric properties, materials, coatings, chemical modifications) can be utilized to improve the endotoxin retentive properties to limit trans-membrane flux, whether they contribute to adsorptive improvements, sieving improvements, or both. Membrane structure, surface chemistry, material, and surface coatings all have an impact on how endotoxin is filtered and adsorbed from solution. In addition to better understanding endotoxin-membrane interactions, studies of endotoxin removal by membrane modifications will result in better approaches to manufacture dialysis membranes that remove endotoxin from solution quickly and with improved efficiency.

As future hemodialysis membranes are designed to further improve upon convective removal of larger middle molecular solutes such as B2M, the opportunity for pyrogenic materials to enter the blood stream via back filtration becomes greater. An improved comprehension of how endotoxin is removed using a fiber membrane can lead to new improvements and future product designs, by streamlining concepts from development to production.
