Nephrol Dial Transplant (2000) 15: 578-580
© 2000 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Water quality and complications of haemodialysis
Service de Néphrologie et Hémodialyse, Hôpital Sainte-Marguerite, Marseille, France
Introduction
Bacterial contamination of dialysate and the potential transfer of bacterial components from the dialysate into the blood compartment have been recognized as factors predisposing to clinical complications during chronic treatment by haemodialysis. This problem, however, has been largely neglected. Concerns regarding the improvement of dialysate quality have been raised further by two modifications in haemodialysis: (i) the increasing use of high-flux dialysers, which enhances backfiltration of dialysate and (ii) the introduction of on-line haemodiafiltration, which requires infusing large quantities of dialysate in the blood compartment as substitution fluid.
The clinical complications associated with bacterial contamination of dialysate are reviewed. The recommendations of Pharmacopoeia are also discussed.
What clinical complications are associated with the transfer of bacterial products from the dialysate into the patient blood?
Short-term complications
Exposure to high levels of bacteria and endotoxin is clearly associated with short-term complications. These complications range from pyrogenic reactions, including chills and fever, to septicaemia
Long-term complications
ß2m Amyloidosis
Atherosclerosis
Malnutrition
Does contamination vary with the type of membrane?
Is there a ‘safe’ level of bacterial contamination of dialysate?
Notes
References
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