Should ultrapure dialysate be part of standard therapy in hemodialysis?

摘要

Over the years, hemodialyzer membranes have gained in performance translating into major increases in both small and middle molecule clearances (high-flux membranes) and marked improvements in biocompatibility (synthetic high-flux membranes) (1). These membrane changes, as well as alterations in dialyzer geometric design, have resulted in an increase in back-transport (2) making the microbiological purity of dialysate a critical component in the hemodialysis biocompatibility network (3). Standards for the purity of water and dialysate established in the seventies were later recognized as inadequate for contemporary hemodialysis conditions (4). A recent transcontinental agreement (Europe, US, Japan) recognizes the necessity of upgrading water and dialysate quality for all dialysis modalities. For this purpose, guidelines supporting the regular use of ultrapure dialysis fluid (UPDF) for all hemodialysis modalities have been produced (5-7).