When Good Water Goes Bad: How It Happens, Clinical Consequences and Possible SolutionsLonnemann G.
Gemeinschaftspraxis Nephrology/Dialysis, Langenhagen, Germany
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.
Gerhard Lonnemann, MD
DE–30851 Langenhagen (Germany)
Tel. +49 511 786560, Fax +49 511 7865625, E-Mail GLonnemann@t-online.de
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 2, Number of References : 21
Founded 1983; edited by K. Schaefer (1983–1988)
Official Journal of the International Society of Blood Purification and the Vascular Access Society (VAS)
Vol. 22, No. 1, Year 2004 (Cover Date: 2004)
Journal Editor: K.M.L. Leunissen, Maastricht
ISSN: 0253–5068 (print), 1421–9735 (Online)
For additional information: http://www.karger.com/bpu