Can sterile and pyrogen‐free on‐line substitution fluid be routinely delivered? A multicentric study on the microbiological safety of on‐line haemodiafiltration

Abstract

On-line HDF treatment can routinely be provided with ultra-pure dialysis fluids and sterile substitution fluids at pyrogen-free levels. The online preparation of substitution fluids thus can be considered microbiologically safe.

The Evolution of Biocompatibility: From Microinflammation to Microvesiscles

“…Water quality is a mandatory issue. The safety of online HDF has been shown repeatedly in several monocenter (Canaud et al, 1998, Pizzarelli et al, 1998 and multicenter studies (Canaud et al, 2001,Vaslaki et al, 2000. Nowadays, the philosophy of ''ultrapure dialysate''is in common practice (Kessler et al, 2002).…”

Advances in Hemodialysis Techniques

“…These solutions are usually industrially prepared in autoclaved expensive plastic bags, which have been used in earlier studies, in order to fulfill the requirement of sterile non-pyrogenic and endotoxin free buffered solutions [125]. However, the need of large quantities of these bags makes the implementation of this technique rather costly and impractical.…”

“…The recent advancement and improvement in the performance of water treatment plants that are capable of producing ultrapure water (almost nil bacterial growth and endotoxin free) have greatly contributed to the success of this technique [15,126]. Such quality of water, which is available continuously and in unlimited amounts at the dialysis machine during each treatment, has been used directly from the water treatment plant to form the dialysate and the replacing solutions for the HDF [125], and hence this technique is known as "online hemodiafiltration" [127].…”

Dialysis Membrane Manipulation for Endotoxin Removal

“…As tortuosity is increased, the greater the chance the membrane has at prohibiting the passage of endotoxin. Membrane geometry changes can lead to differences in the adsorptive capacity for endotoxin (Vanholder & Pedrini, 2008;Vaslaki et al, 2000) and for bacteria (Waterhouse & Hall, 1995). Changes in membrane permeability are controlled to enhance convective transfer, which targets middle molecular removal of species such as β 2 Microglobulin and vitamin B 12 .…”

“…The hydrophobic lipid A moiety is typically attracted to hydrophobic surfaces, however the hydrophilic polysaccharide component will also allow for adsorption to hydrophilic surfaces (Takemoto et al, 2003). Recent studies have shown this to be the case, particularly for ultrafilters which remove endotoxin by way of adsorption through ionic and hydrophobic interactions (Vaslaki et al, 2000). When adjusting the polymer ratios of dialysis fiber membrane, chemical changes as well as physical changes can be produced.…”