title: Microbiological quality and quality control of purified water and ultrapure dialysis fluids for online hemodiafiltration in routine clinical practice.
abstract: During online hemodiafiltration, patients are directly infused with sterile substitution solutions to maintain fluid balance. Adequate water treatment and a well-organized quality control process are essential to provide non-pyrogenic fluids with consistent optimal quality. We sought to assess water quality, the water treatment system, and the methods for surveillance of microbiological water quality in 10 Dutch dialysis centers that routinely treat patients with hemodiafiltration. Microbiological monitoring results (micro-organisms and endotoxins) were collected over a 1-year period representing 11,258 hemodiafiltration sessions covering 97 patients. In all centers, water purification was based on a reverse osmosis module in combination with a second reverse osmosis and/or an electrodeionizer. All centers regularly and routinely monitored the microbiological purity of the dialysis water with adequate analytical methods but with variable monitoring frequency. Microbiological assessments were compliant with reference quality levels in 3923 of 3961 samples. Our study suggests that non-pyrogenic substitution fluids can be produced online for a prolonged period of time. It is likely that the current Dutch Quality of Care Guideline has contributed to high-quality water treatment and a well-organized control process.
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E Lars
authors.initials: EL
authors.lastname: Penne
authors.forename: Linda
authors.initials: L
authors.lastname: Visser
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
authors.forename: Neelke C
authors.initials: NC
authors.lastname: van der Weerd
authors.forename: Albert H A
authors.initials: AH
authors.lastname: Mazairac
authors.forename: Brigit C
authors.initials: BC
authors.lastname: van Jaarsveld
authors.forename: Marion G
authors.initials: MG
authors.lastname: Koopman
authors.forename: Pieter
authors.initials: P
authors.lastname: Vos
authors.forename: Geert W
authors.initials: GW
authors.lastname: Feith
authors.forename: Ton K
authors.initials: TK
authors.lastname: Kremer Hovinga
authors.forename: Henk W
authors.initials: HW
authors.lastname: van Hamersvelt
authors.forename: Inge M
authors.initials: IM
authors.lastname: Wauters
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.forename: Piet M
authors.initials: PM
authors.lastname: Ter Wee
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
mesh_terms: D015314:Dialysis Solutions / Q000592:standards*; D017583:Hemodiafiltration / Q000592:standards*; D006801:Humans; D011786:Quality Control; D014871:Water Microbiology; D018508:Water Purification
chemical_list: D015314:Dialysis Solutions