Impact of Water Quality and Dialysis Fluid Composition on Dialysis Practice

Abstract

An essential but frequently neglected aspect of dialysis treatment is the dialysis fluid produced by blending treated tap water with concentrated solutions containing electrolytes and buffer. Chemical and microbiological contaminants as well as the electrolyte and buffer composition of the dialysis fluid play major roles in the induction or modulation of morbidity associated with regular dialysis therapy.

Renal replacement therapy review

“…Additionally, glucose-based dialysis solutions have undergone much investigation, with recent data suggesting that a minimal amount of glucose limits extensive glucose losses with nutritional consequences without creating hyperglycemia and hyperinsulinemia associated with high glucose dialysate concentrations. 103,104 Hence, individualization of dialysate composition may improve individual patient outcomes and is recommended for on-line dialysate production. 103,105,106 Commercial fluid compositions for CRRT also vary the amount of potassium, glucose and calcium but with less flexibility of choice, however, as compared to on-line fluid production.…”

“…103,104 Hence, individualization of dialysate composition may improve individual patient outcomes and is recommended for on-line dialysate production. 103,105,106 Commercial fluid compositions for CRRT also vary the amount of potassium, glucose and calcium but with less flexibility of choice, however, as compared to on-line fluid production. 107 Calcium and bicarbonate content becomes important for patients on regional citrate anticoagulation (see section on anticoagulation), as calcium in dialysate counteracts the effects of citrate at the membrane and alkalosis may develop due to citrate metabolism and increased bicarbonate load.…”

“…No consistent evidence exists to support claims of improved morbidity by the reuse of dialyzers that the purity or quality of dialysate is associated with patient outcomes. 102,103,[108][109][110] The addition of reverse osmosis technology greatly improved water purity for hemodialysis and has been the standard for sometime. This process uses pressure to filter water through highly selective membranes that limit solute transfer, resulting in water with minimal impurities.…”

Risk of hypoglycemia during hemodialysis in diabetic patients is related to lower pre-dialysis glycemia

“…Moreover, the use of glucose-added dialysate showed a significant reduction and even the absence of intradialytic HG (3), and nowadays its use is indicated and largely diffused (4). Recently, we published a study in which we compared the occurrence of HG during dialysis with different levels of glucose (5).…”

Warning: An Anemia Outbreak Due to Chloramine Exposure in a Clean Hemodialysis Unit—an Issue to Be Revisited

“…[4,7,9] Presently, HD water is additionally treated to achieve ultra pure characteristics and is usually deprived from this contaminant. [10] Chloramines are inorganic substances that can pass through semi-permeable membranes, including those of the RO. [4,11] .…”