Long-term experience with an ultrapure individual dialysis fluid with a batch type machine

Kleophas, Werner; Haastert, Burkhard; Backus, G; Hilgers, P; Westhoff, A; Endert, G.

doi:10.1093/ndt/13.12.3118

Cited by 60 publications

(39 citation statements)

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“…0.05). Similar results were reported by Kleophas et al [13], who analyzed the incidence of CTS in patients treated for up to 13 years predominantly with Cuprophan dialyzers and an ultrapure dialysate produced by a special dialysis system with individual reverse osmosis and ultraviolet irradiation of dialysate (GENIUS ® ). The cumulative incidence of CTS after 13 years was 15%.…”

Section: Clinical Consequences Of Contaminated Dialysis Fluidsupporting

confidence: 84%

When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible Solutions

Lonnemann

2004

Blood Purif

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Dialysis fluid produced by state-of-the-art water preparation and distribution is contaminated with gram-negative bacteria and cytokine-inducing substances (CIS) derived from these microorganisms. The presence of a biofilm increases the risk of continuous contamination of dialysis fluid. Depending on the type of dialyzer membrane (cellulosic vs. synthetic) and the mode of dialysis (low flux vs. high flux with backfiltration), CIS may penetrate intact dialyzer membranes, induce cytokine production in the patient’s blood and contribute to chronic inflammation associated with long-term hemodialysis therapy. Measures to improve the microbiological quality of dialysis fluid are: (1) the awareness of the problem and regular testing of dialysate samples using adequate methods; (2) disinfection of the entire water preparation and distribution system on a regular basis, replacement of biofilm-containing tubings, and (3) installation of ultrafilters in the dialysate circuit in particular when high-flux hemodialysis modalities are performed.

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Section: Clinical Consequences Of Contaminated Dialysis Fluidsupporting

confidence: 84%

When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible Solutions

Lonnemann

2004

Blood Purif

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“…In an uncontrolled series with 399 patients, we reported about long-term survival in our center which was observed about 10-20% higher than in other published series [15] (fig. 5).…”

Section: Clinical Experiencecontrasting

confidence: 50%

“…Technical designs of the system have been described [14][15][16]. The Genius ® batch machine receives fresh dialysis fluid from a special automated filling station.…”

Section: Treatment Proceduresmentioning

confidence: 99%

A Simplified Method for Adequate Hemodialysis

Kleophas

Backus²

2000

Blood Purif

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“…If one believes in the importance of ultrapure dialysate, of individualized dialysate electrolyte composition and of ultrafiltration control, one will not be surprised to see that in the uncontrolled series of Kleophas et al [4] a rate of long-term patient survival was observed which was about 10-20% higher than in other published series, e.g. the EDTA Registry data.…”

Section: The Clinical Experiencementioning

confidence: 85%

Experience with the GENIUS<sup>®</sup> Hemodialysis System

Fassbinder¹

2003

Kidney Blood Press Res

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The late B. Tersteegen devised a clever way to combine the advantages of a closed tank hemodialysis system with the efficacy and bacteriological safety of a single-pass system. The Teerstegen equipment is now marketed as the GENIUS^® hemodialysis system. For each treatment, fresh dialysis fluid is prepared according to the physician’s prescription by mixing sterile ingredients (electrolytes and glucose) with preheated ultrapure water. The total amount of dialysis fluid is put into a thermally insulated glass tank (volume 75 l) of the hemodialysis machine. The filling and emptying process is completely automated. An UV radiator is used for desinfection. Due to a consequent hygienic concept, the system operates with an almost sterile and usually pyrogen-free dialysis fluid. During treatment, fresh dialysis fluid is taken from the top of the system, and the used dialysate is returned to the bottom. There is a sharp interface between the fresh and used dialysis fluids because of a small difference in temperature (1°C). True volumetric ultrafiltration control is simply achieved; ultrafiltration rates between 100 and 1,000 ml/h can be selected as considered appropriate by the physician. Microbiological examination: We cultured more than 2,000 dialysate specimens to examine bacterial contamination, and found either no bacterial growth at all (in the vast majority of the cases) or less than 1 CFU/ml dialysate. Clinical experience: We have utilized the GENIUS^® system since 1994. Meanwhile, more than 40,000 treatments have been performed in our center. Biochemical results of the first 19 stable hemodialysis patients (mean age 66 years, range 45–82), who had been treated with conventional hemodialysis systems for at least 6 months (range 6–157) before changing to GENIUS^®, were evaluated. We observed an increase of mean serum albumin concentration from 4.1 (±0.4 SD) g/dl to 4.8 (±0.3) g/dl (p < 0.01) within 6 months. Most patients reported improved well-being. Of these 19 patients, 18 preferred further treatment with the GENIUS^® system in comparison to conventional hemodialysis machines. Conclusion: The GENIUS^® hemodialysis system permits an individualized therapy of high quality; most patients prefer this system to conventional hemodialysis machines. Serum albumin levels increased significantly from normal to high normal values after change from conventional hemodialysis machines to GENIUS^®, probably due to less catabolic stress during the hemodialysis sessions.

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Long-term experience with an ultrapure individual dialysis fluid with a batch type machine

Abstract: The setup described permits individualized therapy of high quality. The high serum albumin values and our very low incidence of carpal tunnel syndrome underline the importance of water and dialysate quality.

Cited by 60 publications

References 0 publications

When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible Solutions

When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible Solutions

A Simplified Method for Adequate Hemodialysis

Experience with the GENIUS<sup>®</sup> Hemodialysis System

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