When good water goes bad: how it happens, clinical consequences and possible solutions.

Abstract:

: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.

journal_name

Blood Purif

journal_title

Blood purification

authors

Lonnemann G

doi

10.1159/000074932

subject

Has Abstract

pub_date

2004-01-01 00:00:00

pages

124-9

issue

1

eissn

0253-5068

issn

1421-9735

pii

74932

journal_volume

22

pub_type

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