Water treatment for dialysis: technology and clinical implications

The dialytic process utilizes high volumes of water in the preparation of the dialysis fluid. Improvements in water treatment equipment have resulted in improvements in chemical quality. Awareness that endotoxin and bacterial fragments present in the water distribution loop within the dialysis, are able to cross the dialyser membrane, has resulted in an increased focus on this aspect of water quality. Practically, the age of many water treatment plants, extensions of distribution systems and suboptimal cleaning procedures have prevented the achievement of optimal microbiological quality on a routine basis. When achieved and maintained, clear benefits to the patient have been demonstrated. Hemodialysis patients are also subject to increased oxidative stress which may also contribute to their morbidity and mortality. Recent clinical studies using dialysis fluid made with electrolytereduced water have demonstrated benefits to antioxidant status of dialysis patients, offering a further technological solution to the problem of increased cardiovascular disease in dialysis patients.