Current Status of Central Concentrate Delivery System for Hemodialysis in Korea

Abstract

So far, less than 10% of hemodialysis (HD) facilities in Korea have adopted a kind of central delivery system (CDS) for dialysates, the so-called Korean central concentrate delivery system (CCDS). In our CCDS, all concentrate solutions of the acid and bicarbonate dry powder mixed with the treated reverse osmosis (RO) water in the mixing tank and stored in the holding tank are centrally delivered to individual HD machines via two streams along with a one further stream for dilution RO water. This mode of Korean CCDS is different from the central dialysate delivery system (CDDS), which uses already fully proportioned acid and bicarbonate concentrates with dilution RO water delivering it via a single stream. At present, the most popular CCDS in Korea is NephroMix Premium®, which is an all-in-one system that combines the mixing tank, the holding tank, and the control functions into one unified case. Moreover, all CCDS data can be monitored in real-time through a user-friendly touch-screen panel, and stored on a desktop PC linked to the manufacturer’s main office. For the disinfection and sterility of NephroMix Premium®, ozone is used besides a three-step filtering system for removing endotoxin and microbials. Compared to the conventional system in Korea with individual concentrate delivery to single-patient dialysis machines, the Korean-style CCDS seems to be superb in the way of convenience, environmental friendliness, and economy, and also needs less space in the dialysis unit. However, full proof of its safety and effectiveness is required for further verification in the future.

Current Understanding of Ozone Use for Disinfecting Hemodialysis Water Treatment Systems

“…tem [11] . For adequate disinfection of water treatment systems the NANT Dialysis Technology manual recommends: 1 ppm ozone for 10 min or 0.5 ppm ozone for 20 min [26] .…”

“…For adequate disinfection of water treatment systems the NANT Dialysis Technology manual recommends: 1 ppm ozone for 10 min or 0.5 ppm ozone for 20 min [26] . The presence and absence of ozone in the water and ambient air can be monitored regularly by tests (indigo trisulfonate or a digital colorimeter) [11] .…”