title: We Use Impure Water to Make Dialysate for Hemodialysis.
abstract: Patients receiving hemodialysis are exposed to a large volume of water, used to prepare dialysate for each treatment session. Technological advancements now make it possible to generate ultrapure dialysate that has substantially lower bacterial and endotoxin counts than the standard dialysate used in the United States. Low-level water contamination is thought to propagate a state of chronic inflammation seen in hemodialysis patients, and a number of studies demonstrate that the use of ultrapure dialysate has a favorable effect on laboratory parameters of inflammation, nutrition, erythropoietin responsiveness, dialysis-associated amyloidosis, and atherosclerosis. Few studies even suggest a direct clinical benefit of adopting ultrapure dialysate. As there is no proven harm with use of ultrapure dialysate and the economic implication appears to be minimal when using modern dialysis machines, it is imperative for regulatory agencies and the dialysis community to ensure that our vulnerable patients are no longer exposed to impure water during their hemodialysis treatments.
authors.affiliation: Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ashish
authors.initials: A
authors.lastname: Upadhyay
authors.affiliation: Division of Nephrology, Department of Medicine, Steward St. Elizabeth's Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D015314:Dialysis Solutions / Q000737:chemistry*; D004731:Endotoxins / Q000302:isolation & purification; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009398:Nephrology / Q000379:methods*; D006435:Renal Dialysis; D014867:Water / Q000737:chemistry*
chemical_list: D015314:Dialysis Solutions; D004731:Endotoxins; D014867:Water