Nephrology: How to improve and maintain dialysis water purity

Nephrology: Dialysis water free of bacterial contamination and void of chemical contaminants is of paramount importance, and continuous actions should be taken to improve and maintain its status. Dialysis water purity requirements have evolved over the time to satisfy new therapeutic objectives in the renal replacement therapy. The new textbook "Water and Dialysis Fluids" provides medical rationale supporting the use of high grade water and dialysis fluid purity, several engineering water treatment options, water delivery and filtering systems, monitoring and quality control assurance process, maintenance of water treatment system and regulatory aspects.

The fluid in dialysis therapy consists of dialysis concentrates and mainly of water. Whereas the concentrate is commonly produced commercially at a consistent composition, the water used may vary widely in its composition and quality. The source of dialysis water is drinking water which is submitted to a purification cascade that involves, among others, pressure driven membranes processes such as reverse osmosis. Dialysis water depends on its source (ground water, surface water), its geographical and geological origin, seasonal variations and the water treatment processes used and their subsequent performance.

Typically a healthy adult is exposed (via ingestion) to 10-20 litres of water per week. Water goes across a selective barrier of the gastrointestinal tract and some toxic contaminants are removed by the renal function.

In contrast, hemodialysis patients undergiong 4-hour dialysis sessions, thrice weekly may be exposed to more than 360 litres of dialysis fluid per week. Dialysis fluids and consequently water contaminants (if present) may pass through the non-selective dialyzer membrane and the limited renal function cannot maintain the normal balance of contaminants. Moreover, the highly permeable membranes used today as well as the increased prescription of more convective and high volumes therapies rises the risk of contaminants load passing through the membrane and consequently into the blood.

>> Carlo Boccato, David Evans, Rui Lucena, Jörg Vienken: Water and Dialysis Fluids - A quality management guide. (Good Dialysis Practice Vol. 8; Series Editor Jörg Vienken) Pabst, 262 pages colour, hardcover. ISBN 978-3-95853-111-6
http://www.pabst-science-publishers.com/index.php?30&backPID=30&swords=bocc&tt_products=177
eBook: http://www.ciando.com/ebook/bid-1999484-water-and-dialysis-fluids-a-quality-management-guide/

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