Ultrapure dialysis fluid
- Nicholas Hoenich, PhD
Nicholas Hoenich, PhD
- Associate Member
- Institute of Cellular Medicine, Newcastle University
- Richard A Ward, PhD
Richard A Ward, PhD
- Professor of Medicine
- University of Louisville
Dialysis fluid is required to meet quality standards in order to protect hemodialysis patients from exposure to chemical and microbiologic contaminants [1-3]. Quality standards for dialysis fluid and the water used in its preparation have been published by national standards organizations based on international standards . Best practice guidelines covering those aspects of hemodialysis therapy have also been published [1,5-8].
The standards and practice guidelines are in broad agreement with respect to permitted levels of chemical contaminants. However, there are differences in the maximum allowable levels of bacteria and endotoxin. Lower bacterial levels are more commonly recommended in more recent standards and guidelines than in earlier publications. (See 'National quality standards' below.)
The use of dialysis fluid of much higher microbiologic purity (called ultrapure dialysis fluid) than is required by some international and national standards may decrease inflammation and improve outcomes among chronic dialysis patients. The routine clinical use of ultrapure dialysis fluid is not required by regulation; however, as its production is technically and economically feasible in most dialysis facilities, standards and clinical practice guidelines recommend its use for all forms of hemodialysis [1,5,9-12].
Ultrapure dialysis fluid may also be a starting solution that is further filtered for use for "on-line" therapies such as on-line hemodiafiltration and hemofiltration . (See "Alternative renal replacement therapies in end-stage renal disease".)
This topic reviews methods of production and monitoring of ultrapure dialysis fluid and reviews studies that have examined the effect of ultrapure dialysis fluid on selected outcomes. A general overview of maintaining water quality for hemodialysis is presented separately. (See "Maintaining water quality for hemodialysis".)
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- NATIONAL QUALITY STANDARDS
- PRODUCTION OF ULTRAPURE DIALYSIS FLUID
- MONITORING DIALYSIS FLUID QUALITY
- CLINICAL BENEFITS OF ULTRAPURE DIALYSIS FLUID
- Anemia correction
- Beta2-microglobulin and dialysis-related amyloid
- Nutritional status
- Other clinical outcomes
- SUMMARY AND RECOMMENDATIONS