Preparation and Quality Management of Fluids for Hemodialysis

In 2008, the Japanese Society for Dialysis Therapy (JSDT) proposed a standard for the quality of fluids for hemodialysis. The standard was geared toward Japan, where the central dialysis fluid delivery system is routinely used. After establishment of the standard, dialysis fluid quality was markedly improved in facilities across the country. Moreover, the number of on-line hemodiafiltration patients dramatically increased.

However, the 2008 standard specifies only microbiological qualities and does not cover toxic chemicals. The basis of toxic chemical management depends on the source water and water treatment equipment for hemodialysis, but no standard applies to water treatment equipment as a medical device. Specifications for the equipment were, for the most part, entrusted to individual manufacturers. Key Messages: The JSDT is investigating revision of its standard for dialysis fluid quality for hemodialysis to add control standards for toxic chemicals and water treatment equipment, with the aim of achieving quality of dialysis water superior to that of terminal dialysis fluid.