Current topics of purification and constitutions of dialysis fluid

Dialysis fluid is a fundamental component of hemodialysis treatment, and its roles include the correction of electrolyte levels, pH, and osmolality, as well as the removal of uremic solutes from the blood of patients with renal failure. In recent years, purification of dialysis fluid has become essential due to the use of high-flux membrane dialyzers. Therefore, rigorous standards have been established for the purification of dialysis fluid, which is becoming widely practiced in Japan. The effects of dialysis fluid purification include the prevention of micro-inflammation, preservation of residual renal function, improvement of nutritional status, and resolution of resistance to erythropoiesis-stimulating agents. When purifying the dialysis fluid used in the central dialysis fluid delivery system, validation of the system is also important. Dialysis fluid that does not contain acetate has become available, and there have been reports of decreased micro-inflammation, etc., with this innovation. In addition, dialysis fluid containing a higher concentration of bicarbonate than is conventionally employed has become available. Although correction of acidosis remains important, excess alkalosis may reportedly worsen the survival prognosis of hemodialysis patients. Sufficient attention should be paid to these issues.