Official recommendations for quality of fluids in dialysis -the need for standardisation.

Recommendations/guidelines regarding the microbiological and chemical quality of fluids in dialysis are increasing in numbers, both nationally and internationally. As dialysis is a worldwide issue, with many elements being similar regardless of geographical area, it is logical to have the same quality requirements on fluids used in dialysis. At present, there are large differences between the different documents.

Microbiology of water and fluids for hemodialysis.

In hemodialysis, huge amounts of water are used for diluting the concentrates to produce dialysis fluid. The water is produced on site by reverse osmosis units. The chemical and microbiological quality of the water is essential for dialysis patients.

The microbial world and fluids in dialysis.

The fluids used in dialysis are all water based. Water, which is necessary for life, is also a good environment for micro-organisms. The result of this is quite simply that microbial growth, i.

Modern microbiological techniques and their use in dialysis fluid systems: What are the benefits?

Modern microbiological techniques using characterization of DNA are increasingly used in ecological microbiology to describe the diversity of microfloras. The benefit is that systems can be described with a much higher degree of reality. In dialysis, one application is the evaluation of fluid-system disinfection strategies.

On-line technique for producing substitution fluid in haemodiafiltration and haemofiltration.

When the kidneys are not able to fulfil their task anymore the individual reaches a situation known as End-Stage Renal Disease (ESRD). Haemodialysis may be carried out. In order to have a more efficient dialysis the treatment modes haemodiafiltration and haemofiltration are also in use.

Thoughts about biofilm in dialysis water systems.

What is a biofilm? Basically, a biofilm is formed when a structure or a surface has a growth on it. The growth consists of a community of micro-organisms, which is active. Growth means that there are metabolic processes taking place.

Endotoxin and 'on line' production of substitution fluid in haemodiafiltration and haemofiltration.

In dialysis, machines intended for use in the treatment modes haemodiafiltration (HDF) and haemofiltration (HF) have been on the market about 10 years. These machines are equipped to be able to produce the substitution fluid to be used for direct infusion. In principle, this is done by using the reverse osmosis water of the clinic and mixing in concentrates as usual to form dialysis fluid.

Dialysis fluid contamination of pathways and life of microbes.

The fluid systems of a dialysis clinic are reviewed from a microbiological standpoint. Water, concentrate and dialysis fluid are the main fluids in the clinic. The quality of these fluids cannot be dealt with, without at the same time reviewing the systems delivering these fluids.

Defining the microbiological quality of dialysis fluid.

With increasing awareness about the degree and the potential impact of microbiological contamination in dialysis fluids, there is a desire to improve their microbiological quality. To achieve this goal, the origin of the microbiological contamination has to be identified. The water, the bicarbonate concentrate, and the fluid distribution system can be major contributors.

Collaborative study of a control standard endotoxin using the Limulus amebocyte (gel-clot) test.

A collaborative study was undertaken to determine the potency in endotoxin Units (EU) and International Units (IU) of a control standard endotoxin, LIF-1. Five laboratories from the Swedish Pharmaceutical Industry participated in the study. As reference preparations, two official standards, USP reference standard endotoxin, EC-5 (expressed in EU) and WHOs international standard endotoxin (expressed in IU), were used.

Sterile versus non-sterile dialysis fluid in chronic hemodialysis treatment.

As the quality of water in the dialysis fluid varies considerably, and in view of the fact that endotoxin or active derivatives can cause acute side effects in patients, the dialysis fluid must be sterile. Therefore, we introduced ultrafiltration of dialysis fluid before entering the dialyzer. Fifteen patients, (ten women, five men) were treated for 4 weeks with nonsterile, and then with sterile dialysis fluid.

Determination of endotoxins in sugar with the Limulus test.

The Limulus amebocyte lysate test has been used for determination of pyrogens in sugar of different qualities. All the samples of domestic white sugar and beet raw sugar produced in Sweden during 1976 had a very low content of endotoxins, less than 10 ng/g of sugar. Imported cane raw sugar was, however, highly contaminated.