الفهرس 
Safety of water treatment for HemodialysisOnly 14 pages are availabe for public view
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Abstract
The estimated water intake of a healthy individual is 2 L
per day or 14 L per week. By comparison, a hemodialysis
patient may be exposed to 350 to 500 L of water per week.
Hemodialysis patients are particularly vulnerable to
contaminants in the water used to prepare concentrate and
dialysate, or in water used for reprocessing dialyzers,All
dialysis facilities therefore require a properly designed and
maintained water treatment system to safeguard patients.
To maintain acceptable water quality, a dialysis facility
must institute a formal program to monitor and maintain its
water treatment and distribution system. Monitoring should
encompass measurement of physical, chemical and
microbiological parameters that allow both water quality and
equipment performance to be assessed. It is important to
effectively monitor the specific purification processes.
These processes include the reverse osmosis system,
deionizers, carbon, softeners, and filters.The chemical and
bacteriological purity of thedialysis water must be monitored
routinely and regularly and the results should be documented.
There should be documented procedures, which come into
effect once these limits are exceeded. These procedures will
include temporary closure of the dialysis unit when the safe
limits for contaminants are exceeded. In most outpatient centers the dialysate is prepared
centrally such that the composition of the dialysate is the same
for all patients. When delivered in this manner most patients
tolerate the procedure well. However, there are patients who
tolerate the procedure poorly.
Dialysate composition and preparation along with
dialysate use is probably one of the most fascinating topics in
nephrology, where the possibilities for innovative tinkering and
improvements are plentiful.
With older and increasingly complex patients, the
potentialbenefits of individual prescription of dialysate have
gained more relevance. Individual dialysate prescription may
involve setting concentration of each solute at the start of
dialysis and adjustment of the concentration of some solutes
throughout the dialyticperiod, so-called modelling or profiling
of the dialysate.
The need to improve both intradialytic and interdialytic
morbidities and long-term outcomes has driven the use of
individualized prescription.