Vol. 26, No. 1, 2008
Issue release date: January 2008
Blood Purif 2008;26:6–11
Add to my selection

Impact of Water Quality and Dialysis Fluid Composition on Dialysis Practice

Hoenich N.a, b · Thijssen S.b · Kitzler T.b · Levin R.b · Ronco C.c
aSchool of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; bRenal Research Institute, New York, N.Y., USA; cDepartment of Nephrology, St. Bortolo Hospital, Vicenza, Italy
email Corresponding Author

 goto top of outline Key Words

  • Water quality
  • Haemodialysis
  • Dialysis fluid
  • Calcium
  • Sodium
  • Endotoxin

 goto top of outline 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.

Copyright © 2008 S. Karger AG, Basel

 goto top of outline References
  1. Grassmann A, Gioberge S, Moeller S, Brown G: End-stage renal disease: global demographics in 2005 and observed trends. Artif Organs 2006;30:895–897.
  2. Burmeister JE, Scapini A, da Rosa Miltersteiner D, da Costa MG, Campos BM: Glucose-added dialysis fluid prevents asymptomatic hypoglycaemia in regular haemodialysis. Nephrol Dial Transplant 2007;22:1184–1189.
  3. Ward RA: Worldwide water standards for hemodialysis. Hemodial Int 2007;11:S18–S25.

    External Resources

  4. Lindsay D, von Holy A: Bacterial biofilms within the clinical setting: what healthcare professionals should know. J Hosp Infect 2006;64:313–325.
  5. Cappelli G, Ballestri M, Perrone S, Ciuffreda A, Inguaggiato P, Albertazzi A: Biofilms invade nephrology: effects in hemodialysis. Blood Purif 2000;18:224–230.
  6. Cappelli G, Tetta C, Canaud B: Is biofilm a cause of silent chronic inflammation in haemodialysis patients? A fascinating working hypothesis. Nephrol Dial Transplant 2005;20:266–270.
  7. Schindler R, Beck W, Deppisch R, Aussieker M, Wilde A, Gohl H, Frei U: Short bacterial DNA fragments: detection in dialysate and induction of cytokines. J Am Soc Nephrol 2004;15:3207–3214.
  8. Masakane I: Review: clinical usefulness of ultrapure dialysate – recent evidence and perspectives. Ther Apher Dial 2006;10:348–354.
  9. Bommer J, Jaber BL: Ultrapure dialysate: facts and myths. Semin Dial 2006;19:115–119.
  10. Gotch FA, Evans MC, Keen ML: Measurement of the effective dialyzer Na diffusion gradient in vitro and in vivo. Trans Am Soc Artif Intern Organs 1985;31:354–358.
  11. De Paula FM, Peixoto AJ, Pinto LV, Dorigo D, Patricio PJ, Santos SF: Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004;66:1232–1238.
  12. Moret K, Aalten J, van den Wall Bake W, Gerlag P, Beerenhout C, van der Sande F, Leunissen K, Kooman J: The effect of sodium profiling and feedback technologies on plasma conductivity and ionic mass balance: a study in hypotension-prone dialysis patients. Nephrol Dial Transplant 2006;21:138–144.
  13. De Paula FM, Peixoto AJ, Pinto LV, Dorigo D, Patricio PJ, Santos SF: Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004;66:1232–1238. Erratum in Kidney Int 2004;66:2108.
  14. Stiller S, Bonnie-Schorn E, Grassmann A, Uhlenbusch-Korwer I, Mann H: A critical review of sodium profiling for hemodialysis. Semin Dial 2001;14:337–347.
  15. Tang HL, Wong SH, Chu KH, Lee W, Cheuk A, Tang CM, Kong IL, Fung KS, Tsang WK, Chan HW, Tong KL: Sodium ramping reduces hypotension and symptoms during haemodialysis. Hong Kong Med J 2006;12:10–14.
  16. Song JH, Park GH, Lee SY, Lee SW, Lee SW, Kim MJ: Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances. J Am Soc Nephrol 2005;16:237–246.
  17. Sigrist M, McIntyre CW: Calcium exposure and removal in chronic hemodialysis patients. J Ren Nutr 2006;16:41–46.
  18. Toussaint ND, Polkinghorne KR, Kerr PG, Somerville CA, Agar JW: Comparison between different dialysate calcium concentrations in nocturnal hemodialysis. Hemodial Int 2007;11:217–224.
  19. Kyriazis J, Glotsos J, Bilirakis L, Smirnioudis N, Tripolitou M, Georgiakodis F, Grimani I: Dialysate calcium profiling during hemodialysis: use and clinical implications. Kidney Int 2002;61:276–287.
  20. Arenas MD, Alvarez-Ude F, Gil MT, Soriano A, Egea JJ, Millan I, Amoedo ML, Muray S, Carreton MA: Application of NKF-K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease: changes of clinical practices and their effects on outcomes and quality standards in three haemodialysis units. Nephrol Dial Transplant 2006;21:1663–1668.
  21. Kitzler TM, Gotch F, Wystrychowski G, Thijssen S, Handelman G, Levin NW: Mission accomplished? The practicability of the K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Maintenance Hemodialysis Patients. ASN Abstract 2007.
  22. Kopple JD, Coburn JW: Metabolic studies of low protein diets in uremia. II. Calcium, phosphorus and magnesium. Medicine (Baltimore) 1973;52:597–607.
  23. Hothi DK, Harvey E, Piva E, Keating L, Secker D, Geary DF: Calcium and phosphate balance in adolescents on home nocturnal haemodialysis. Pediatr Nephrol 2006;21:835–841.
  24. Fabrizi F, Bacchini G, Di Filippo S, Pontoriero G, Locatelli F: Intradialytic calcium balances with different calcium dialysate levels. Effects on cardiovascular stability and parathyroid function. Nephron 1996;72:530–535.
  25. Gotch F, Kotanko P, Handelman G, Levin N: A kinetic model of calcium mass balance during dialysis therapy. Blood Purif 2007;25:139–149.
  26. Santoro A, Mancini E, Gaggi R, Cavalcanti S, Severi S, Cagnoli L, Badiali F, Perrone B, London G, Fessy H, Mercadal L, Grandi F: Electrophysiological response to dialysis: the role of dialysate potassium content and profiling. Contrib Nephrol. Basel, Karger, 2005, vol 149, pp 295–305.
  27. Capdevila M, Ruiz IM, Ferrer C, Monllor F, Ludjvick C, Garcia NH, Juncos LI: The efficiency of potassium removal during bicarbonate hemodialysis. Hemodial Int 2005;9:296–302.
  28. Elsharkawy MM, Youssef AM, Zayoon MY: Intradialytic changes of serum magnesium and their relation to hypotensive episodes in hemodialysis patients on different dialysates. Hemodial Int 2006;10(suppl 2):S16–S23.

    External Resources

  29. Sangill M, Pedersen EB: The effect of glucose added to the dialysis fluid on blood pressure, blood glucose, and quality of life in hemodialysis patients: a placebo-controlled crossover study. Am J Kidney Dis 2006;47:636–643.
  30. Bommer J, Locatelli F, Satayathum S, Keen ML, Goodkin DA, Saito A, Akiba T, Port FK, Young EW: Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2004;44:661–671.
  31. Kraemer M: Physiological monitoring and control in hemodialysis: state of the art and outlook. Expert Rev Med Devices 2006;3:617–634.

    External Resources

  32. Doorenbos CJ, Bosma RJ, Lamberts PJ: Use of urea containing dialysate to avoid disequilibrium syndrome, enabling intensive dialysis treatment of a diabetic patient with renal failure and severe metformin induced lactic acidosis. Nephrol Dial Transplant 2001;16:1303–1304.
  33. Sam R, Vaseemuddin M, Leong WH, Rogers BE, Kjellstrand CM, Ing TS: Composition and clinical use of hemodialysates. Hemodial Int 2006;10:15–28.

    External Resources

  34. Emelife-Obi C, Chow MT, Qamar-Rohail H, Leehey DJ, Gandhi VC, Ing TS: Use of a phosphorus-enriched hemodialysate to prevent hypophosphatemia in a patient with renal failure-related pericarditis. Clin Nephrol 1998;50:131–133.
  35. Ahmad S, Callan R, Cole JJ, Blagg CR: Dialysate made from dry chemicals using citric acid increases the dialysis dose. Am J Kidney Dis 2000;35:493–499.
  36. Huang KC, Yang CC, Hsu SP, Lee KT, Liu HW, Morisawa S, Otsubo K, Chien CT: Electrolyzed-reduced water reduced hemodialysis-induced erythrocyte impairment in end-stage renal disease patients. Kidney Int 2006;70:391–398.

 goto top of outline Author Contacts

Nicholas Hoenich
School of Clinical Medical Sciences, Newcastle University
Framlington Place
Newcastle upon Tyne NE2 4HH (UK)
Tel. +44 191 222 6998, Fax +44 191 222 0723, E-Mail nicholas.hoenich@newcastle.ac.uk

 goto top of outline Article Information

Published online: January 10, 2008
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 0, Number of References : 36

 goto top of outline Publication Details

Blood Purification

Vol. 26, No. 1, Year 2008 (Cover Date: January 2008)

Journal Editor: Ronco, C. (Vicenza)
ISSN: 0253–5068 (print), 1421–9735 (Online)

For additional information: http://www.karger.com/BPU

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.