8
views
0
recommends
+1 Recommend
1 collections
    0
    shares

      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

      Submit here before July 31, 2024

      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

      • Record: found
      • Abstract: found
      • Article: found

      Impact of Water Quality and Dialysis Fluid Composition on Dialysis Practice

      review-article

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          An essential but frequently neglected aspect of dialysis treatment is the dialysis fluid produced by blending treated tap water with concentrated solutions containing electrolytes and buffer. Chemical and microbiological contaminants as well as the electrolyte and buffer composition of the dialysis fluid play major roles in the induction or modulation of morbidity associated with regular dialysis therapy.

          Related collections

          Most cited references28

          • Record: found
          • Abstract: found
          • Article: not found

          Bacterial biofilms within the clinical setting: what healthcare professionals should know.

          Bacterial biofilm formation is the prevailing microbial lifestyle in natural and manmade environments and occurs on all surface types. Biofilm formation develops in several phases and is influenced by various parameters, both environmental and inherent to the attaching cell. Biofilms also serve as protective niches for particular pathogens when outside a host. Although it is accepted that biofilms are ubiquitous in nature, the significance of biofilms in clinical settings, especially with regard to their role in medical-related infections, is often underestimated. It has been found that several aspects of human pathogenesis within a clinical context are directly related to biofilm development. Various types of surfaces in clinical settings are prone to biofilm development and an increased risk of disease may be a direct consequence of their formation. This review describes the process of biofilm formation, highlights the importance of bacterial associations with surfaces in clinical settings and describes various methods for biofilm visualization and control.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients.

            Predialysis plasma sodium (Na(+)) concentration is relatively constant in hemodialysis (HD) patients, and a higher dialysate Na(+) concentration can promote an increase in the interdialytic fluid ingestion to achieve an individual's osmolar set point, and individualization of dialysate Na(+) concentration may improve interdialytic weight gain (IDWG), blood pressure (BP), and HD-related symptoms. Twenty-seven nondiabetic, non-hypotension prone HD patients were enrolled in a single-blind crossover study. Subjects underwent nine consecutive HD sessions with the dialysate Na(+) concentration set to 138 mEq/L (standard Na(+) HD), followed by nine sessions wherein the dialysate Na(+) was set to match the patients average pre-HD plasma Na(+) measured three times during the standard Na(+) phase multiplied by 0.95 (individualized dialysate Na(+) HD). Dry weight, dialysis prescription, and medications were not modified during the six weeks of the study. Pre-HD Na(+) was similar in both periods of the study (standard Na(+) HD, 134.0 +/- 1.4 mEq/L; individualized Na(+) HD, 134.0 +/- 1.5 mEq/L; P= 0.735). There was a significant decrease in interdialytic weight gain (2.91 +/- 0.87 kg vs. 2.29 +/- 0.65 kg; P< 0.001), interdialytic thirst scores, and episodes of intradialytic hypotension in the individualized Na(+) period compared with the standard phase. Pre-HD BP was lower in individualized Na(+) HD in patients with uncontrolled BP at baseline (N= 15), but not in those with controlled BP at baseline (N= 12) (DeltaBP -15.6/-6.5 mm Hg in uncontrolled vs. DeltaBP +6.4/+4.5 mm Hg in controlled, P= <0.001 for systolic BP and P= <0.001 for diastolic BP). An individualized Na(+) dialysate based on predialysis plasma Na(+) levels decreases thirst, IDWG, HD-related symptoms, and pre-HD BP (in patients with uncontrolled BP at baseline).
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances.

              Excessive sodium gain is a major hindrance of sodium profiling hemodialysis (HD) that offsets the benefit in reducing intradialytic hypotension-related discomforts (IHD). Patients who showed frequent IHD (>30% of the sessions; n = 11) were enrolled in a prospective study that consisted of two phases. In the phase 1 study, eight treatment modalities were evaluated: Conventional HD (control), sodium balance-positive step-down sodium profiling HD (PS), sodium balance-neutral step-down sodium profiling HD (NS), sodium balance-neutral alternating sodium profiling HD (NA) without ultrafiltration (UF) profile, and all those with UF profile (UF only, PS+U, NS+U, and NA+U). The incidences of "dialysis failure," defined as the occurrence of one or more of (1) session failure (discontinuation of session <75% of planned time), (2) UF failure (%UF achieved <70%), and (3) delivery failure (Kt/V <1.1), were 48.5, 21.2, 42.4, 39.4, 45.5, 18.2, 21.2, and 18.2% in control, PS, NS, NA, UF only, PS+U, NS+U, and NA+U, respectively. Four treatments, PS, PS+U, NS+U, and NA+U, reduced the incidence of dialysis failure significantly as compared with control (P < 0.05) and were evaluated in the phase 2 study, a randomized controlled 6-wk crossover study. Parameters were measured in the steady state after a 6-wk maintenance of each treatment. Diffusive sodium gain (DeltaNa) was significantly increased with sodium balance-positive profiles with or without UF profile, PS and PS+U (PS 1.9 +/- 1.1, PS+U 1.7 +/- 1.0 mEq/L; both P < 0.05 to control -0.1 +/- 0.2, NS+U 0.5 +/- 0.4, NA+U 0.4 +/- 0.2 mEq/L). They also increased the interdialytic weight gain (PS 3.8 +/- 0.6, PS+U 4.0 +/- 0.6 kg; both P < 0.05 to control 2.7 +/- 0.6, NS+U 3.3 +/- 0.6 kg; both P = NS to NA+U 3.5 +/- 0.6 kg). Predialysis weight and the required amount of UF also increased significantly with these sodium balance-positive profiles. Although the absolute amount of UF was larger with PS and PS+U, %UF achieved targeting dry weight was higher with sodium balance-neutral profiles with UF profiles, NS+U and NA+U (NS+U 92.7 +/- 3.8, NA+U 93.7 +/- 6.8%; both P < 0.05 to control 72.6 +/- 14.0, PS 88.3 +/- 6.6, PS+U 88.2 +/- 8.2%). Postdialysis weight was closest to dry weight with these treatments showing Delta (postdialysis weight - dry weight) of 0.3 +/- 0.1 and 0.3 +/- 0.2 kg in NS+U and NA+U (both P < 0.05 to control 1.0 +/- 0.6 kg; both P = NS to PS 0.5 +/- 0.3, PS+U 0.5 +/- 0.4 kg). Incidence of excessive weight gain and subjective discomforts during the interdialytic period increased significantly with PS. In conclusion, continuous use of sodium balance-positive sodium profiles resulted in an undesirable steady state with sodium and fluid expansion offsetting their hemodynamic benefit. Sodium balance-neutral sodium profiles in combination with UF profile were associated with less sodium and weight gains, better UF performance with postdialysis weight closest to dry weight, and fewer interdialytic problems with the equivalent hemodynamic benefit. Therefore, it is proposed that sodium balance-neutral sodium profiling HD with UF profile is a better choice, ensuring the dialysis of quality without sodium gain-related complications.
                Bookmark

                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-8467-8
                978-3-8055-8468-5
                0253-5068
                1421-9735
                2008
                January 2008
                10 January 2008
                : 26
                : 1
                : 6-11
                Affiliations
                aSchool of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; bRenal Research Institute, New York, N.Y., USA; cDepartment of Nephrology, St. Bortolo Hospital, Vicenza, Italy
                Article
                110556 Blood Purif 2008;26:6–11
                10.1159/000110556
                18182788
                226e0918-4d14-42c7-8c00-00ea519abb99
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 1, References: 36, Pages: 6
                Categories
                Paper

                Cardiovascular Medicine,Nephrology
                Dialysis fluid,Sodium,Endotoxin,Haemodialysis,Calcium,Water quality
                Cardiovascular Medicine, Nephrology
                Dialysis fluid, Sodium, Endotoxin, Haemodialysis, Calcium, Water quality

                Comments

                Comment on this article