Ultrapure dialysis fluid

Q: What is ultrapure dialysis fluid?

Answer: This may be shocking to know that standard dialysis fluid is generally not sterile and may contain a wide range of microorganisms and bacterial products. Moreover, some microbial contamination of the dialysis fluid is considered acceptable. 

Historically and conventionally, it was believed that dialyzer membranes can effectively remove bacterial products. Some even argued that low level of contamination stimulates immune system and heightens the inflammatory state of dialysis patients. All these assumptions proved to be either wrong or partially true. Over time manufacturers built dialysis machines that can filter most of the contamination. This also leads to the quest for creation of ultrapure dialysis fluid.

Ultrapure dialysis fluid is created by filtering standard dialysis fluid via bacterial- and endotoxin-retentive ultrafilters in vivo. This is still not ultrapure at 100 percent, as some bacterial DNA segments may stay back.

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References:

1. Canaud B, Lertdumrongluk P. Ultrapure dialysis fluid: a new standard for contemporary hemodialysis. Nephrourol Mon. 2012 Summer;4(3):519-23. doi: 10.5812/numonthly.3060. Epub 2012 Jun 20. PMID: 23573478; PMCID: PMC3614300.

2. Ledebo I. Ultrapure dialysis fluid--direct and indirect benefits in dialysis therapy. Blood Purif. 2004;22 Suppl 2:20-5. doi: 10.1159/000081869. PMID: 15655318.

3. Ledebo I. Ultrapure dialysis fluid--how pure is it and do we need it? Nephrol Dial Transplant. 2007 Jan;22(1):20-3. doi: 10.1093/ndt/gfl574. Epub 2006 Oct 11. PMID: 17035373.