Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015)

Abstract

A Best Practice Guideline about Dialysis fluid purity was developed under the leadership of the Spanish Society of Nephrology in 2004. The second edition revised Guideline considered new evidences and International Standard. The guideline has established recommendations for standards for preparing dialysate: water, concentrates and haemodialysis proportioning systems. This guideline is based on the ISO 13959, European Pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis, literature reviews, according to their level of evidence, and the opinion of the expert Spanish group. Two levels of quality of water were defined: purified water and high purified water (ultra pure) and for dialysate: ultra pure dialysate. Regular use of ultra pure dialysate is recommended for all type of haemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anaemia and amiloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (4.1.2), conductivity, microbial and endotoxins (4.1.1): Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in Appendix. For microbiological monitoring, R2A medium is recommended, incubated during 7–14 days at a temperature of 17–23 °C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of haemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are welcome to www.senefro.org.

Keywords

• Dialysate
• Water treatment for dialysis fluid
• Haemodialysis
• Concentrate
• Endotoxins