Microbiologic purity of dialysate: Rationale and technical aspects

Dialysate purity has become a major concern in hemodialysis since it has be en shown that microbial-derived products were stimulating the production an d the release of proinflammatory cytokines in hemodialysis patients. This c hronic microinflammatory state induced by hemodialysis has been putatively implicated in the development of dialysis-related pathology. In order to pr event risk related to these offenders and to reduce patient/dialysis intera ction, it appears highly desirable to use ultrapure dialysis fluid aiming a t sterility and apyrogenicity on a regular basis. Ultrapure dialysate resul ts from a complex chain of production where purity grade relies on the weak er link of this chain. Technical aspects and pitfalls in the production of ultrapure dialysate are summarized in this paper. Production of ultrapure d ialysate may be achieved on a routine basis, provided adequate components a re used, and hygienic handling is regularly ensured. It includes the use of ultrapure water, clean and or sterile electrolytic concentrates (liquid or powder), implementation of ultrafilters on hemodialysis machines, microbio logic monitoring and hygienic handling of the chain with frequent disinfect ion. Safety and reliability of ultrapure dialysate production relies on a c ontinuous quality assurance process, where results are coupled to correctiv e action in a feedback loop process. Copyright (C) 2000 S. Karger AG, Basel .