Water Treatment for Contemporary Hemodialysis

  • Bernard J. M. Canaud
  • Charles M. Mion


Maintenance hemodialysis is an accepted life support system ensuring long term survival of half a million end stage renal failure patients worldwide. Hemodialysis patients are regularly exposed to 300–400 liters of hemodialysis fluids per week during dialysis. The quality of water used to dilute the concentrated dialysate fluid is important because of the nature of the contact between dialysate and the patient’s blood. The end stage renal failure patient is the last link of a complex chain leading to the hemodialysis process, where patient’s blood is exposed to dialysate. One can look at the hemodialysis system as the end point of an hydraulic circuit where city water is changed in water for HD through municipal water supply, water treatment system, distribution system and delivering dialysate through the artificial kidney (Figure 1).


Reverse Osmosis Dialysis Fluid Dialysis Unit Reverse Osmosis Membrane Carbon Filter 
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  1. 1.
    Man NK, Funck-Brentano JL: Dialyzers and water treatment. in Therapy of Renal Diseases and Related Disorders, edited by Suki WN, Massry SG, Boston, Martinus Nijhoff Publishers, 1984, p 545Google Scholar
  2. 2.
    Easterling RE: Mechanical aspects of dialysis including dialysate delivery systems and water for dialysate. in Clinical Dialysis, edited by Nissenson AR, Fine RN, Gentile DE, Philadelphia, Hanley & Belfus, Inc, 1984, p 53Google Scholar
  3. 3.
    Luehmann DA: Water purification for hemodialysis. Med Instrum 20: 74, 1986PubMedGoogle Scholar
  4. 4.
    Comty CM, Shapiro FL: Pretreatment and preparation of city water for hemodialysis. in Replacement of Renal Function by Dialysis, edited by Drukker W, Parsons FM, Maher JF, Martinus Nijhoff Publishers, 1986, p 155Google Scholar
  5. 5.
    Laskey DA, Schell D: Addressing new water treatment standards and technologies. Contemp Dial Nephrol 10: 35, 1989Google Scholar
  6. 6.
    Vallot D: Purified water fror hemodialysis: present needs (Part 1) (in French). Techniques Hospitalières 529: 65, 1989Google Scholar
  7. 7.
    Vallot D: Purified water fror hemodialysis: present needs (Part 2) (in French). Techniques Hospitalières 529: 45, 1989Google Scholar
  8. 8.
    Man NK, Ciancioni CH, Guyomard S, Biais D, Delons S, Funck-Brentano JL: Risks and hazards of contaminated dialysate associated with high flux membranes. in Prevention in Nephrology, edited by Buccianti G, Masson, Italia, 1987, p 227Google Scholar
  9. 9.
    Keshaviah P, Luehmann D: The importance of water treatment in haemodialysis and haemofiltration. Proc Eur Dial Transplant Assoc Eur Renal Assoc 21: 111, 1984Google Scholar
  10. 10.
    Meeks JN: Water refining considerations for high flux dialysis (Part 1). Contemp Dial Nephrol 10: 27, 1989Google Scholar
  11. 11.
    Meeks JN: Water refining considerations for high flux dialysis (Part 2). Contemp Dial Nephrol 10: 38, 1989Google Scholar
  12. 12.
    Baumeister U, Travers M, Vienken J, Harding G, Millon C, Klein E, Pass T, Wright R: Dialysate contamination and back filtration may limit the use of high-flux dialysis membranes. Trans Am Soc Artif Intern Organs 35: 519, 1989Google Scholar
  13. 13.
    Leypoldt JK, Schmidt B, Gurland HJ: Measurement of backfi ltration rates during hemodialysis with highly permeable membranes. Blood Purif 9: 74, 1991PubMedGoogle Scholar
  14. 14.
    Leypoldt JK, Schmidt B, Gurland HJ: Net ultrafiltration may not eliminate backfiltration during hemodialysis with highly permeable membranes. Artif Organs 15: 164, 1991PubMedGoogle Scholar
  15. 15.
    Vanholder R, Van Haecke E, Ringoir S: Endotoxin transfer through dialysis membranes: small-versus large-pore membranes. Nephrol Dial Transplant 7: 333, 1992PubMedGoogle Scholar
  16. 16.
    Petersen J, Hyver SW, Cajias J: Backfiltration during dialysis: a critical assessment. Semin Dial 5: 13, 1992Google Scholar
  17. 17.
    Klinkmann H, Ebbighausen H, Uhlenbusch I, Vienken J: High-flux dialysis, dialysate quality and backtransport. in Contrib Nephrol, Vol 103, Basel, Karger, 1993, p 89Google Scholar
  18. 18.
    Favero MS, Petersen NJ, Carson LA, Bond WW, Hindman SH: Gram-negative water bacteria in hemodialysis systems. J Am Soc Microbiol (HLS) 12: 321, 1975Google Scholar
  19. 19.
    Petersen NJ, Boyer KM, Carson LA, Favero MS: Pyrogenic reactions from inadequate disinfection of a dialysis fluid distribution system. Dial Transplant 7: 52, 1978Google Scholar
  20. 20.
    Watzke H, Mayer G, Schwartz HP, Stanek G, Rotter M, Hirschl AM, Graf H: Bacterial contamination of dialysate in dialysis-associated endotoxaemia. J Hosp Infect 13: 109, 1989PubMedGoogle Scholar
  21. 21.
    Goetz A, Yu VL, Hanchett JE, Rihs JD: Pseudomonas Stutzeri bacteriemia associated with hemodialysis. Arch Intern Med 143: 1909, 1983PubMedGoogle Scholar
  22. 22.
    Dinarello CA, Krueger JM: Induction of interleukin 1 by synthetic and naturally occuring muramyl peptides. Fed Proc 45:2545. 1986PubMedGoogle Scholar
  23. 23.
    Bingel M, Lonnemann G, Shaldon S, Koch KM, Dinarello CA: Human Interleukin-1 production during hemodialysis. Nephron 43: 161, 1986PubMedGoogle Scholar
  24. 24.
    Mion CM, Canaud B: ‘On-site’ preparation of sterile apyrogenic electrolyte solutions for hemofiltration and hemodiafiltration. in Short Dialysis, edited by Cambi V, Boston, Martinus Nijhoff Publishers, 1987, p 261Google Scholar
  25. 25.
    Canaud B, Flavier JL, Argiles A, Stec F, Nguyen QV, Bouloux Ch, Garred LJ, Mion C: Hemodiafiltration with on-line production of substituion fluid: long-term safety and quantitative assessment of efficacy. Contrib Nephrol 108: 12, 1994PubMedGoogle Scholar
  26. 26.
    Petersen NJ, Carson LA, Favero MS: Bacterial endotoxin in new and reused hemodialyzers: a potential cause of endotoxinemia. Trans Am Soc Artif Intern Organs 28: 155, 1981Google Scholar
  27. 27.
    Bolan G, Reingold AL, Carson LA, Silcox VS, Woodley CL, Hayes PS, Hightower AW, McFarland L, Brown JW, Petersen NJ, Favero MS, Good RC, Broome CV: Infections with Mycobacterium Chelonei in patients receiving dialysis and using processed hemodialyzers. J Infect Dis 152: 1013, 1985PubMedGoogle Scholar
  28. 28.
    Lowry PW, Beck-Sague CM, Bland LA, Aguero SM, Arduino MJ, Minuth AN, Murray RA, Swenson JM, Jarvis WR: Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. J Infect Dis 161: 85, 1990PubMedGoogle Scholar
  29. 29.
    Alter MJ, Favero MS, Miller JK, Moyer LA, Bland LA: National surveillance of dialysis-associated diseases in the United States, 1987. Trans Am Soc Artif Intern Organs 35: 820, 1989Google Scholar
  30. 30.
    Vanholder R, Vanhaecke E, Ringoir S: Waterborne Pseudomonas septicemia. Trans Am Soc Artif Intern Organs 36: M215, 1990Google Scholar
  31. 31.
    Alter MJ, Favero MS, Moyer LA, Bland LA: National surveillance of dialysis-associated diseases in the United States. Trans Am Soc Artif Intern Organs 37: 97, 1991Google Scholar
  32. 32.
    Held PJ, Levin NW, Bovbjerg RR, Pauly MV, Diamond LH: Mortality and duration of hemodialysis treatment. JAMA 265: 871, 1991PubMedGoogle Scholar
  33. 33.
    Gordon SM, Oettinger CW, Bland LA, Oliver JC, Arduino MJ, Aguero SM, McAllister SK, Favero MS, Jarvis WR: Pyrogenic reactions in patients receiving conventional, high-efficiency, or high-flux hemodialysis treatments with bicarbonate dialysate containing high concentrations of bacteria and endotoxin. J Am Soc Nephrol 2: 1436, 1992PubMedGoogle Scholar
  34. 34.
    Tokars JI, Alter MJ, Favero MS, Moyer LA, Bland LA: National surveillance of hemodialysis associated diseases in the United States. ASAIO J 39: 71, 1993PubMedGoogle Scholar
  35. 35.
    Bland L, Alter M, Favero M, Carson L, Cusick L: Hemodialyzer reuse: practices in the united states and implication for infection control. Trans Am Soc Artif Intern Organs 31: 556, 1985PubMedGoogle Scholar
  36. 36.
    Canaud B, Peyronnet P, Armynot AM, Nguyen QV, Attisso M, Mion C: Ultrapure water: A need for future dialysis. Proc Eur Dial Transplant Assoc-Eur Renal Assoc 23 (Abstract): 113, 1986Google Scholar
  37. 37.
    McNulty J: The proper sizing of ultrapure water delivery systems. Contemp Dial Nephrol 12: 30, 1991Google Scholar
  38. 38.
    McNulty J: Improving your water-treatment system? Here is how to get the latest technology and cut costs. Contemp Dial Nephrol 13: 18, 1992Google Scholar
  39. 39.
    Curtis JR, Wing AJ, Coleman JC: Bacillus cereus bacteraemia: a complication of intermittent haemodialysis. Lancet 1: 136, 1967PubMedGoogle Scholar
  40. 40.
    Alfrey AC, Mishell JM, Burks J, Contiguglia SR, Rudolph H, Lewin E, Holmes JH: Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Intern Organs 18: 257, 1972PubMedGoogle Scholar
  41. 41.
    Ward MK, Pierides AM, Fawcett P, Shaw DA, Perry RH, Tomlinson BE, Kerr DNS: Dialysis encephalopathy syndrome. Proc Eur Dial Transplant Assoc 13: 348, 1976Google Scholar
  42. 42.
    Flendring JA, Kruis H, Das HA: Aluminium intoxication: the cause of dialysis dementia? Proc Eur Dial Transplant Assoc 13: 355, 1976Google Scholar
  43. 43.
    Alfrey AC, Legendre GR, Kaehny WD: Dialysis encephalopathy syndrome. N Eng J Med 294: 184, 1976CrossRefGoogle Scholar
  44. 44.
    Salvadeo A, Minoia C, Segagni S, Villa G: Trace metal changes in dialysis fluid and blood of patients on hemodialysis. Int J Artif Organs 2: 17, 1979PubMedGoogle Scholar
  45. 45.
    Platts MM, Owen G, Smith S: Water purification and the incidence of fractures in patients receiving home haemodialysis supervised by a single centre: evidence for’ safe’ upper limit of aluminium in water. Br Med J 288: 969, 1984CrossRefGoogle Scholar
  46. 46.
    Abreo K, Brown ST, Sella ML: Correction of microcytosis following elimination of an occult source of aluminium contamination of dialysate. Am J Kidney Dis 13: 465, 1989PubMedGoogle Scholar
  47. 47.
    Kabei N, Kolff WJ, Foux A: Evaluation of hollow-fiber osmosis permeator for use in peritoneal dialysis. Dial Transplant 6: 59, 1977Google Scholar
  48. 48.
    Wathen RL, Burcham CW: Reverse osmosis technology: its applications in water treatment for hemodialysis. Contemp Dial Nephrol 13: 28, 1992Google Scholar
  49. 49.
    Petrie JJB, Fleming R, McKinnon P, Winney RJ, Cowie J: The use of ion exchange to remove aluminium from water used in hemodialysis. Am J Kidney Dis 4: 69, 1984PubMedGoogle Scholar
  50. 50.
    Bernick JJ, Port FK, Favero MS: In vivo studies of dialysis-related endotoxemia and bacteremia. Nephron 27: 307, 1981PubMedGoogle Scholar
  51. 51.
    Du Moulin GC, Coleman EC, Hedley-Whyte J: Bacterial colonization and endotoxin content of a new renal dialysis water system composed of acrylonitrile butadiene styrene. Appl Environ Microbiol 53: 1322, 1987PubMedGoogle Scholar
  52. 52.
    Clements MC: Why validate? Contemp Dial Nephrol 12: 37, 1991Google Scholar
  53. 53.
    Arduino MJ, Bland LA, Favero MS: Adverse patient reactions due to chemical contamination of hemodialysis fluids. Dial Transplant 18: 655, 1989Google Scholar
  54. 54.
    Kroneld R, Reunanen: Volatile halocarbons in haemodialysis therapy. Bull Environ Contam Toxicol 35: 583, 1985PubMedGoogle Scholar
  55. 55.
    Villforth JC, FDA Issues Safety Alert: Chloramine contamination of hemodialysis water supplies (Letter). Am J Kidney Dis 11: 447, 1988PubMedGoogle Scholar
  56. 56.
    Carson LA, Bland LA, Cusick LB, Favero MS, Bolan GA, Reingold AL, Good RC: Prevalence of nontuberculous Mycobacteria in water supplies of hemodialysis centers. Appl Environ Microbiol 54: 3122, 1988PubMedGoogle Scholar
  57. 57.
    Becker FF, Janowsky U, Overath H, Stetter D: Removability of pesticides during the production of dialysis water (Part 1). Biomed Tech 34: 139, 1989Google Scholar
  58. 58.
    Becker FF, Janowsky U, Overath H, Stetter D: Removability of pesticides during the production of dialysis water (Part 2). Biomed Tech 34: 215, 1989CrossRefGoogle Scholar
  59. 59.
    Hopfer SM, Fay WP, Sunderman FW: Serum nickel concentrations in hemodialysis patients with environmental exposure. Ann Clin Lab Sci 19: 161, 1989PubMedGoogle Scholar
  60. 60.
    Davenport A, Roberts NB: Accumulation of aluminium in patients with acute renal failure. Nephron 52: 253, 1989PubMedCrossRefGoogle Scholar
  61. 61.
    Piccoli A, Andriani M, Mattiello G, Nordio M, Modena F, Dalla Rosa C: Serum aluminium level in the veneto chronic haemodialysis population: cross-sectional study on 1026 patients. Nephron 51: 482, 1989PubMedGoogle Scholar
  62. 62.
    Chazan JA, Abuelo JG, Blonsky SL: Plasma aluminum levels (unstimulated and stimulated): clinical and biochemical findings in 185 patients undergoing chronic hemodialysis for 4 to 95 months. Am J Kidney Dis 13: 284, 1989PubMedGoogle Scholar
  63. 63.
    Brem AS, Di Mario C, Levy DL: Perceived aluminum-related disease in a dialysis population. A report from the End-Stage Renal Disease Network 28. Arch Intern Med 149:2541, 1989PubMedGoogle Scholar
  64. 64.
    Tsukamoto Y, Saka S, Kumano K, Iwanami S, Ishida O, Marumo F: Abnormal accumulation of vanadium in patients on chronic hemodialysis. Nephron 56: 368, 1990PubMedGoogle Scholar
  65. 65.
    Gordon SM, Drachman J, Bland LA, Reid MH, Favero M, Jarvis WR: Epidemic hypotension in a dialysis center caused by sodium azide. Kidney Int 37: 110, 1990PubMedGoogle Scholar
  66. 66.
    Gordon SM, Bland LA, Alexander SR, Newman HF, Arduino MJ, Jarvis WR: Hemolysis associated with hydrogen peroxide at a pediatric dialysis center. Am J Nephrol 10: 123, 1990PubMedCrossRefGoogle Scholar
  67. 67.
    Bello VA, Gitelman HJ: High fluoride exposure in hemodialysis patients. Am J Kidney Dis 15: 320, 1990PubMedGoogle Scholar
  68. 68.
    Smith RP, Willhite CC: Chlorine dioxide and hemodialysis. Regul Toxicol Pharmac 11: 42, 1990Google Scholar
  69. 69.
    Tipple MA, Shusterman N, Bland LA, McCarthy MA, Favero MS, Arduino MJ, Reid MH, Jarvis WR: Illness in hemodialysis patients after exposure to chloramine contaminated dialysate. Trans Am Soc Artif Intern Organs 37: 588, 1991Google Scholar
  70. 70.
    Montagnac R, Schillinger F, Roquebert MF, Croix JC, Eloy C: Contamination par des champignons d’un circuit de traitement d’eau en autodialyse. Néphrologie 7: 27, 1991Google Scholar
  71. 71.
    Petersen MD, Thomas SB: The new EPA lead and copper rule. Contemp Dial Nephrol 12: 26, 1991Google Scholar
  72. 72.
    Gitelman HJ, Alderman FR, Perry SJ: Silicon accumulation in dialysis patients. Am J Kidney Dis 19: 140, 1992PubMedGoogle Scholar
  73. 73.
    FDA Issues Safety Alert: Dialysis patients in Chicago die from fluoride poisoning. Contemp Dial Nephrol 14: 10, 1993Google Scholar
  74. 74.
    Steinbergs CZ: Removal of by-products of chlorine and chlorine dioxide at a hemodialysis center. Res Technol (Journal AWWA): 94, 1986Google Scholar
  75. 75.
    Weiss LG, Danielson BG, Fellstrom B, Wikstrom B: Aluminum removal with hemodialysis, hemofiltration and charcoal hemoperfusion in uremic patients after desferrioxamine infusion. A comparison of efficiency. Nephron 54: 179, 1990Google Scholar
  76. 76.
    Jourdan JL, Maingourd C, Meguin C, Nivet H, Martin C, Moulier MC: Possible aluminium release from activated charcoal filters used in home hemodialysis. Néphrologie 4: 153, 1986Google Scholar
  77. 77.
    Petersen NJ, Carson LA, Favero MS, Marshall JH, Aguero SM: Removal of bacteria and bacterial endotoxin from dialysis fluids by sorbents. ASAIO J 3: 6, 1979Google Scholar
  78. 78.
    Muirhead N, Mitton R: Use of bone char as an adsorbent in preparation of water for dialysis. ASAIO J 38: M334, 1992PubMedGoogle Scholar
  79. 79.
    Perlmuter BA: Principles of Filtration. Pall Well Technology Corporation — Technical Notes, 1982Google Scholar
  80. 80.
    Sweadner KJ, Forte M, Nelsen LL: Filtration removal of endotoxin (pyrogens) in solution in different states of aggregation. Appl Envir Microbiol 34: 382, 1977Google Scholar
  81. 81.
    Howard G, Duberstein R: A case of penetration of 0.2 µm rated membrane filters by bacteria. J Parenter Drug Assoc 34: 95, 1980PubMedGoogle Scholar
  82. 82.
    Hou K, Gerba CP, Goyal SM, Zerda KS: Capture of latex beads, bacteria, endotoxins, and viruses by chargemodified filters. Appl Environ Microbiol 40: 892, 1980PubMedGoogle Scholar
  83. 83.
    Gerba CP, Hou KC, Babineau RA, Fiore JV: Pyrogen control by depth filtration. Pharm Technol 5: 32, 1980Google Scholar
  84. 84.
    Pall DB, Kirnbauer EA, Allen BT: Paniculate retention by bacteria retentive membrane filters. Colloids and Surfaces 1: 235, 1980Google Scholar
  85. 85.
    Carazzone M, Arecco D, Fava M, Sancin: A new type of positively charged filter: preliminary test results. J Parenter Sci Technol 39: 69, 1985PubMedGoogle Scholar
  86. 86.
    Gerba CP, Hou KC, Babineau RA: Pyrogen control by charge-modified filters. Pharm Enginr 6: 32, 1981Google Scholar
  87. 87.
    Cradock JC, Guder LA, Francis DL, Morgan SL: Reduction of pyrogens: applications of molecular filtration. J Pharm Pharmac 30: 198, 1978Google Scholar
  88. 88.
    Abramson D, Butler LD, Chrai S: Depyrogenation of a parenteral solution by ultrafiltration. J Parenter Sci Technol 35: 3, 1981PubMedGoogle Scholar
  89. 89.
    Nelsen LL: Removal of pyrogens from parenteral solutions by Ultrafiltration. Pharm Technol 8: 30, 1978Google Scholar
  90. 90.
    Rechen HC: The role of ultrafiltration in the production of pyrogen-free purified water. Pharm Manu 10: 29, 1984Google Scholar
  91. 91.
    Klinkmann H, Falkenhagen D, Smollich BP: Investigation of the permeability of highly permeable polysulfone membranes for pyrogen. Contrib Nephrol 46: 174, 1985PubMedGoogle Scholar
  92. 92.
    Kumano K, Yokota S, Nanbu M, Sakai T: Methods of minimizing endotoxin level in dialysate. Dial Transplant 22: 147, 1993Google Scholar
  93. 93.
    Di Felice A, Cappelli G, Facchini F, Tetta C, Cornia F, Aimo G, Lusvarghi E: Ultrafiltration and endotoxin removal from dialysis fluids. Kidney Int 43: 201, 1991Google Scholar
  94. 94.
    Cappelli G, Tetta C, Cornia F, Di Felice A, Facchini F, Neri R, Lucchi L, Lusvarghi E: Removal of limulus reactivity and cytokine-inducing capacity from bicarbonate dialysis fluids by ultrafiltration. Nephrol Dial Transplant 8: 1133, 1993PubMedGoogle Scholar
  95. 95.
    Kumano K, Yokota S, Nanbu M, Sakai T: Do cytokine-inducing substances penetrate through dialysis membranes and stimulate monocytes? Kidney Int 41(Suppl): S205, 1993Google Scholar
  96. 96.
    White D, Layman R: Reverse osmosis element design evolution and its effects. Contemp Dial Nephrol 12: 20, 1991Google Scholar
  97. 97.
    Williamson J: Getting comfortable with your reverse osmosis machine. Contemp Dial Nephrol 13: 52, 1992Google Scholar
  98. 98.
    Layman-Amato R: How to maintain your reverse osmosis system. Contemp Dial Nephrol 13: 54, 1992Google Scholar
  99. 99.
    Healey RJ: Reverse osmosis and distribution. Contemp Dial Nephrol 13: 24, 1992Google Scholar
  100. 100.
    Chapman WF, Williamson JL: Recordkeeping for reverse osmosis performance analysis. Contemp Dial Nephrol 14: 24, 1993Google Scholar
  101. 101.
    Schwarzbeck A, Wagner L, Squarr HU, Straugh M: Clotting in dialyzers due to low pH dialysis fluid. Clin Nephrol 7: 125, 1977PubMedGoogle Scholar
  102. 102.
    Ganzi GC, Egozy Y, Giuffrida AJ, Jha AD: High purity water by electrodeionization: performance of Ionpure® continuous deionization system. Ultrapure Water 4: 3, 1987Google Scholar
  103. 103.
    Ganzi GC: Electrodeionization for high purity water production. AIChE Symposium Series. in New Membrane Materials and Processes for Separation, edited by Sirkar KK, Lloyd DR, New York, AIChE, 1988, p 73Google Scholar
  104. 104.
    Parise PL, Parekh BS, Waddington G: The use of Ionpure® continuous deionization for the production of pharmaceutical and semiconductor grades of water. Ultrapure Water Expo’ 90, 1990, p 63Google Scholar
  105. 105.
    Hudson MV: What role do dialysis professionals play in the design and operation of water-treatment systems? Contemp Dial Nephrol 13: 26, 1992Google Scholar
  106. 106.
    Schultze N, Morelle C, Egly JC: Les traitements de l’eau destinée au laboratoire. Biofutur 55: 117, 1992Google Scholar
  107. 107.
    Cartwright PS: Hemodialysis water treatment: a consultant’s perspective. Dial Transplant 21: 130, 1992Google Scholar
  108. 108.
    Healey RJ, Nicol CW: Economical operation of a dialysis water purification system. Contemp Dial Nephrol 12: 16, 1991Google Scholar
  109. 109.
    Grabow WOK, Gauss-Müller V, Prozesky OW, Deinhardt F: Inactivation of hepatitis A virus and indicator organisms in water by free chlorine residuals. Appl Environ Microbiol 46: 619, 1983PubMedGoogle Scholar
  110. 110.
    Klein E: Effects of disinfectants in renal dialysis patients. Environmental Health Perspectives 69: 45, 1986PubMedGoogle Scholar
  111. 111.
    Besarab A, DeLuca T, Picarello D, Jungkind D: Formaldehyde, sodium hypochlorite and metabisulphite are equally effective as sterilants for central delivery systems. ASAIO J (Abstract) 39: 82, 1993Google Scholar
  112. 112.
    Matsushima H, Sakurai N: A selected ion monitoring assay for chlorhexidine in medical waste water. Biomed Mass Spectrometry 11: 203, 1984Google Scholar
  113. 113.
    Mayr HU, Stec F, Canaud B, Mion CM, Shaldon S: Microbiological aspects of the batch preparation of replacement fluid for hemofiltration. Blood Purif 2: 158, 1985Google Scholar
  114. 114.
    Sifontes JR, Block S: Preservation of metals from microbial corrosion. in Disinfection, Sterilization and Preservation, edited by Block SS, Philadelphia, London, Lea & Febiger, 1991, p 948Google Scholar
  115. 115.
    Meeks JN: Water quality monitoring and the AAMI hemodialysis standards. Contemp Dial Nephrol 10: 41, 1989Google Scholar
  116. 116.
    Bernick JJ, Port FK, Favero MS, Brown DG: Bacterial and endotoxin permeability of hemodialysis membranes. Kidney Int 16: 491, 1979PubMedGoogle Scholar
  117. 117.
    Vos T, Roodvoets AP, Staal J: Bacterial proliferation in dialysis fluid. Clin Nephrol 2: 235, 1974PubMedGoogle Scholar
  118. 118.
    Dawids SG, Vejlsgaard R: Bacterial and clinical evaluation of different dialysate delivery systems. Acta Med Scand 199: 151, 1976PubMedCrossRefGoogle Scholar
  119. 119.
    Sladek KJ, Suslavitch RV, Sohn BI, Dawson FW: Optimum membrane structures for growth of coliform and fecal coliform organisms. Appl Environ Microbiol 30: 685, 1975Google Scholar
  120. 120.
    Tobin RS, Dutka BJ: Comparison of the surface structure, metal binding, and fecal coliform recoveries of nine membrane filters. Appl Environ Microbiol 34: 69, 1977PubMedGoogle Scholar
  121. 121.
    Logan KB, Rees GE, Seeley ND, Primrose SB: Rapid concentration of bacteriophages from large volumes of fresh water: evaluation of positively charged, microporous niters. J Virol Methods 1: 87, 1980PubMedGoogle Scholar
  122. 122.
    Harding GB, Pass T, Million C, Wright R, Delarnette J, Klein E: Bacterial contamination of hemodialysis center water and dialysate: are current assays adequate? Artif Organs 13: 155, 1989PubMedGoogle Scholar
  123. 123.
    Clements MC: Investigation of microbial contamination of hemodialysis water systems. Contemp Dial Nephrol 37, 1989Google Scholar
  124. 124.
    Ward RA, Luehmann DA, Klein E: Are current standards for the microbiological purity of hemodialysis adequate? Semin Dial 2: 69, 1989Google Scholar
  125. 125.
    Tominaga H, Tanaka S, Tominaga N: Endotoxin level of sterile injection solutions and substitution fluid for hemofiltration in Japan and Australia. Nephron 42: 128, 1986PubMedGoogle Scholar
  126. 126.
    Harding GB, Klein E, Pass T, Million C: Endotoxin and bacterial contamination of dialysis center water and dialysate; a cross sectional survey. Int J Artif Organs 13: 39, 1990PubMedGoogle Scholar
  127. 127.
    Klein E, Pass T, Harding GB, Wright R, Million C: Microbial and endotoxin contamination in water and dialysate in the Central United States. Artif Organs 14: 85, 1990PubMedCrossRefGoogle Scholar
  128. 128.
    Gaynes R, Friedman C, McLaren C, Swartz R: Hemodialysis-associated febrile episodes: surveillance before and after major alteration in the water treatment system. Int J Artif Organs 13: 482, 1990PubMedGoogle Scholar
  129. 129.
    Wathen RL: High-flux dialysis and pyrogenic reactions. Semin Dial 3: 193, 1990Google Scholar
  130. 130.
    Umeda M, Niwa M, Yamagami S, Kishimoto T, Maekawa M, Sawada Y: Novel endotoxin materials, polymyxin-sepharose and polyethylene membrane for removal of endotoxin from dialysis systems. Biomater Artif Cells Artif Organs 18:491, 1990PubMedGoogle Scholar
  131. 131.
    Canaud B, Imbert E, Kaaki M, Assounga A, Nguyen QV, Stec F, Garred LJ, Bostroem M, Mion C: Clinical and microbiological evaluation of a post-dilutional hemofiltration system with in-line production of substitution fluid. Blood Purif 8: 160, 1990PubMedGoogle Scholar
  132. 132.
    Arduino MJ, Bland LA, Aguero SM, Carson L, Ridgeway M, Favero M: Comparison of microbiologic assay methods for hemodialysis fluids. J Clin Microbiol 29: 592, 1991PubMedGoogle Scholar
  133. 133.
    Arduino MJ, Bland LA, Aguero SM, Favero MS: Effects of incubation time and temperature on microbiologic sampling procedures for hemodialysis fluids. J Clin Microbiol 29: 1462, 1991PubMedGoogle Scholar
  134. 134.
    Murray J: The merits of LAL testing: Contemp Dial Nephrol 12: 32, 1991Google Scholar
  135. 135.
    Gould MJ, Novitsky TJ: Endotoxin as a measure of water quality for hemodialysis. Contemp Dial Nephrol 13: 48, 1992Google Scholar
  136. 136.
    Harding GB, Pass T, Wright R: Bacteriology of hemodialysis fluids: are current methodologies meaningful? Artif Organs 16: 448, 1992PubMedCrossRefGoogle Scholar
  137. 137.
    Pollak VE, Kant S, Pesce A, Cathey M: Continuous quality improvement in chronic disease: early detection of a mini-cluster of pyrogenic reactions during hemodialysis and effect of on-line monitoring. Dial Transpl 21: 330, 1992Google Scholar
  138. 138.
    Harding GB, Sharp W: Possible risks to dialysis patients by 48-hour 37°C bacterial culturing of fluids. Blood Purif (Abstract) 10: 78, 1992Google Scholar
  139. 139.
    Layman-Amato R: Taking the ‘bugs’ out of bacterial monitoring. Contemp Dial Nephrol 14: 29, 1993Google Scholar
  140. 140.
    Mion CM, Canaud B, Garred LJ, Stec F, Nguyen QV: Sterile and pyrogen-free bicarbonate dialysate: a necessity for hemodialysis today. Adv Nephrol 19: 275, 1990Google Scholar
  141. 141.
    Bambauer R, Meyer S, Jung H, Goehl H, Nystrand R: Sterile versus non-sterile dialysis fluid in chronic hemodialysis treatment. Trans Am Soc Artif Intern Organs 3: M317, 1990Google Scholar
  142. 142.
    Bambauer R, Schmidt R, Falkenhagen D, Walther J, Jung WK: Sterile and endotoxin free dialysis fluid for hemodialysis. Biomater Artif Cells Immob Biotech 19: 71, 1991Google Scholar
  143. 143.
    Baz M, Durand C, Ragon A, Jaber K, Andrieu D, Merzouk T, Purgus R, Olmer M, Reynier JP, Berland Y: Using ultrapure water in hemodialysis delays carpal tunnel syndrome. Int J Artif Organs 14: 681, 1991PubMedGoogle Scholar
  144. 144.
    Gunderson RW, Concannon MF: Five years of experience with a pure water system designed for hemodialysis. Contemp Dial Nephrol 12: 40, 1991Google Scholar
  145. 145.
    Bambauer R, Schauer M, Vienken J: Contamination of dialysis water and dialysate. A survey of 30 centers. Blood Purif (Abstract) 9: 32, 1991Google Scholar
  146. 146.
    Oliver JC, Bland LA, Oettinger CW, Arduino MJ, Garrard M, Pegues DA, McAllister S, Moone T, Aguero S, Favero MS: Bacteria and endotoxin removal from bicarbonate dialysis fluids for use in conventional, high efficiency, and high-flux hemodialysis. Artif Organs 16: 141, 1992PubMedCrossRefGoogle Scholar
  147. 147.
    Gault MH, Duffett AL, Murphy JF, Purchase LH: In search of sterile, endotoxin-free dialysate. ASAIO J 431, 1992Google Scholar
  148. 148.
    Henderson L, Ward RA, Mion CA, Canaud B, Bosch JP, Charytan C, Spinowitz BS, Gupta BK, Maindel N, Bland LA, Favero MS, Arduino MJ: Should hemodialysis fluid be sterile? Semin Dial 6: 26, 1993Google Scholar
  149. 149.
    Berland Y, Brunet P, Ragon A, Frenkian G, Crevat A: Dialysate Biocompatibility: Evaluation and Expectations, Contrib Nephrol, Vol 103, Basel, Karger, 1993, p 76Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Bernard J. M. Canaud
    • 1
  • Charles M. Mion
    • 2
  1. 1.Division of NephrologyLapeyronie University HospitalMontpellierFrance
  2. 2.Division of NephrologyLapeyronie University HospitalMontpellier CédexFrance

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