Renal Replacement Therapy (Mar 2018)

2016 update Japanese Society for Dialysis Therapy Standard of fluids for hemodialysis and related therapies

  • Michio Mineshima,
  • Hideki Kawanishi,
  • Tomonobu Ase,
  • Tadayuki Kawasaki,
  • Tadashi Tomo,
  • Hidetomo Nakamoto,
  • on behalf of the Subcommittee on the Function and Efficacy of Blood Purification Therapy, the Scientific Academic Committee of the Japanese Society for Dialysis Therapy

DOI
https://doi.org/10.1186/s41100-018-0155-x
Journal volume & issue
Vol. 4, no. 1
pp. 1 – 14

Abstract

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Abstract The necessity of purification of dialysis fluids has been discussed since the 1980s. The Japanese Society for Dialysis Therapy (JSDT) presented a standard for dialysis fluid purification in 1995 and revised three times after that. Lastly, JSDT presented a new standard on microbiological management of fluids for Hemodialysis and related therapies in 2008 (the 2008 JSDT standard). It, however, specifies biological contaminants (ET and bacteria) alone. The society further revised the 2008 JSDT standard with the addition of the water quality standard for chemical contaminants and management standard for water treatment equipment in 2016 (the 2016 JSDT standard). This article describes the 2016 JSDT. Chapter 1 describes the water quality standard for biological contaminants without any modification of the standard values in the 2008 JSDT standard because the ultrapure dialysis fluid standard was met at 66.4% of all responder facilities in a 2014 survey conducted by the JSDT. Chapter 2 describes the water quality standard for chemical contaminants. Twelve items are specified in the standard, inasmuch as the toxic potentials of these chemicals have been verified, or are suspected. When the water treatment equipment is operated appropriately, chemical contaminants are appropriately removed from raw water and safe dialysis water is supplied to dialysis machines. However, chemical contaminants in raw water should be confirmed at least before installation of the water treatment equipment. In the daily management, water quality data on the source of raw water must be confirmed in each season of the year. If some chemical contaminants in source of raw water do not meet the water quality standard, the relevant chemical contaminants in dialysis water should be measured at least once a year. Chapter 3 describes the measurement of the residual chlorine. The concentration of total residual chlorine (total chlorine) in dialysis water should be less than 0.1 mg/L. The management standard for water treatment equipment is proposed in Chapter 4. Chapter 5 describes in detail the management.

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