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Review: Clinical usefulness of ultrapure dialysate--recent evidence and perspectives

Ikuto Masakane1

  • 1Kidney and Dialysis Center, Yabuki Hospital, Yamagata, Japan. masakane@yabuki.yamagata.jp

Therapeutic Apheresis and Dialysis : Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
|August 17, 2006
PubMed

Insights

Biological contamination in dialysis fluid worsens patient outcomes. Ultrapure dialysate offers clinical benefits, but establishing bacterial cell count standards in Japan faces system challenges.

Area of Science:

  • Nephrology
  • Biotechnology
  • Medical Technology

Background:

  • Biological contamination of dialysis fluid is linked to complications like dialysis-related amyloidosis (DRA) and malnutrition-inflammation-atherosclerosis (MIA) syndrome.
  • Inflammatory responses can be triggered by minimal contamination, and traditional methods like endotoxin levels, viable cell counts, or biofilm analysis are insufficient to guarantee dialysate quality.
  • New international standards from ERA/EDTA and ANSI/AAMI emphasize strict control of viable bacterial cell counts in dialysate.

Purpose of the Study:

  • To review the clinical benefits of ultrapure dialysate.
  • To discuss the challenges and perspectives of establishing dialysate standards, specifically for bacterial cell counts, in Japan.

Main Methods:

  • Review of existing evidence on the clinical utility of ultrapure dialysate.
  • Analysis of current standards and challenges in implementing bacterial cell count monitoring for dialysate.

Main Results:

  • Ultrapure dialysate demonstrates clinical usefulness in improving dialysis therapy and reducing complications.
  • Japan's centralized dialysate supply systems present difficulties in standardizing viable bacterial cell counts due to disinfection weaknesses.

Conclusions:

  • Ultrapure dialysate is clinically valuable for enhancing dialysis biocompatibility and mitigating complications.
  • Developing robust standards for bacterial cell counts in dialysate is crucial, particularly in Japan, to ensure patient safety and optimize dialysis therapy.

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