**Author details**

BPA could migrate into food from food and beverage containers with internal epoxy resin coatings and from products made of polycarbonate plastic such as tableware, food containers, and water bottles. BPA exposure results from either the release of unpolymerized monomers or the slow decay of polymer bonds in polycarbonate, leading to monomer release into foods and liquids. Starting from this information, data analysis coming from several large studies in various countries shows that the majority of the population examined have detectable levels of BPA conjugates in the urine. Indeed, in view of the rapid conjugation and elimination half-time of BPA, these levels reflect the exposure of the past hours just before the sample

On the contrary, in patients with limited or absent kidney function, BPA may accumulate in the serum. The BPA accumulation in these subjects accounts from diet and medical device containing BPA, that is, extracted from the device by hydrophobic components present in the blood. Repeated loading of BPA during hemodialysis with BPA-containing membranes may aggravate the problem due to migration of BPA from dialyzers to the blood of patients and its inefficient removal due to the high protein-bound fraction of

Some recent studies on the chronic use of BPA-free dialyzers indicate decrease of BPA serum levels in dialyzed patients reflecting a potential beneficial effect on inflammation and oxida-

Furthermore, additional BPA contamination sources come from water and medical devices

It is also advised that attention should be taken to avoid BPA cross contamination during medical devices production, with particular consideration to hemodialyzers. The possibility to replace BPA in these products should be assessed as well as the toxicological profile of the alternative materials. This issue could be a criterion for the purchase of medical devices com-

In conclusion, patients on hemodialysis have higher levels of serum and intracellular BPA with respect to healthy controls and the choice of dialysis membrane impacts on these levels. Dialyzers with BPA-containing membranes increase serum BPA levels. Studies indicate an increase of BPA serum concentration after a single dialysis session, confirming that hemodi-

Use of BPA-containing dialysis membranes further adds to the BPA burden of patients on hemodialysis. In contrast, it would be advisable the chronic use of BPA-free dialyzers to

The authors are full employees of Bellco (part of Medtronic) company. A company that pro-

used to produce the dialysate fluid involved in hemodialysis treatment.

alysis does not compensate lack of urine BPA excretion.

decrease BPA serum levels and related clinical effects.

duces and commercializes medical devices.

collection.

86 Bisphenol A Exposure and Health Risks

plasma BPA.

tive stress.

monly used in hemodialysis.

**Conflict of interest**

Giuseppe Palladino\* and Luisa Sereni

\*Address all correspondence to: giuseppe.palladino@medtronic.com

Scientific Affairs Department, Bellco, Mirandola, Italy
