DIALYSATE AND SUBSTITUTION FLUID QUALITY FOR ONLINE HEMODIAFILTRATIONAND HEMOFILTRATION

A multicentre study concerning the fluid quality for on-line haemodiaf iltration/haemofiltration (GDF/HF) treatment was carried out to assure safety and biocompatibility, and a standard for fluid quality has bee n established. Endotoxin (ET) concentration in the substitution fluid of not less than 1 IU/L caused minimally, yet significantly greater bo dy temperature rises than those less than 1 IU/L (3.52+/-0.49 us 0.08 +/- 0.40 degrees C, P<0.01) when 20 L of volume was replaced by 4 h po st dilution HDF treatment. The post treatment plasma levels for tumour necrosis factor-a but not interleukin-6 were correlaed with the ampli tude of temporal body temperature rise (r=0.75, P<0.01). By sticking t o the standard for on-line HDF/HF treatment that calls for the ET leve ls in the proportioned dialysate before and the substitution fluid aft er serial ultrafiltration to be <50 IU/L and 1 IU/L, respectively, no such deleterious symptoms as fever and hypotension have been observed. Moreover, no enhancement of the plasma ET levels was detected after t he first and 6 months of on-line HDF treatment. In conclusion, the new ly established advisory standard assures safety and improved biocompat ibility of the on-line HDF/HF treatment.