Twelve Years Experience in Management Evolution to Improve Dialysis Water Quality

Abstract

Methods: The present editorial attempts to illustrate the positive experience produced over a 20-year period on progressive optimization of materials and procedures in the production of dialysis water in five dialysis units in Sardinia. In fact a significative improvement was observed in microbiological quality of dialysis because of regular samples, ranging from using PVC distribution rings and mono-osmosis (SRO), since introduction of steel circuits INOX AISI 316L and/or PEX. Further fundamental steps have been: bacterial controls improvement, use of bi-osmosis (TRO), daily overnight heated disinfection, validate new protocols of microbiological culture methods as recommended by the most important guidelines. Conclusions: Today dialysis water mustn’t viewed by the Nephrologist like a simple good ultrapure water to perform high quality of dialysate/infusate but rather how a real drug exerting a demonstrable positive impact on micro-inflammation of hemodialysis patients. The use of PVC should be abandoned and ratio quality/costs is better using PEX piping than steel. By now it’s is mandatory the use of TRO devices. During this long time our actions result in a unexpected and sure quality improvements of hemodialysis and/or hemodiafiltration water.