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Nephrol Dial Transplant (2002) 17: 51-54
© 2002 European Renal Association-European Dialysis and Transplant Association

SECTION IV: Dialysis fluid purity

IV.6 Dialysis fluid purity: implications in the haemocompatibility network system

Abstract

Over the last decade, microbiological contamination of the dialysis fluid has become a major concern [70–72]. In the early 1980s dialysis fluid purity was mainly targeted to prevent pyrogenic reactions associated with the use of bicarbonate buffer and back-transport phenomena (back-filtration, back-diffusion) of dialysis fluid to the blood [73]. From this perspective, the role of the dialyzer membrane is essential to prevent the blood passage of cytokine-inducing substances from dialysis fluid [74–77] and/or to prevent immunization against dialysis fluid endotoxin [78]. From the late 1990s the dialysis fluid purity was considered as one of the main factors in the complex haemocompatibility network [79–82].

UPD is a concept introduced in the mid 1990s that qualifies a sterile and non-pyrogenic dialysate produced extemporaneously by ‘cold sterilization’ by means of ultrafilters [83]. Over the last few years it has been recognized that dialysate purity should tend to ultrapure product for contemporary dialysis to prevent the potential hazards associated with contaminated dialysate [84–88].

Guideline IV.6.1

A. Regular use of UPD appears desirable in long-term haemodialysis patients to prevent and/or to delay the occurrence of dialysis related complications.

(Evidence level: B)


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