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  • Review Article
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Water quality in conventional and home haemodialysis

Nature Reviews Nephrology volume 8, pages 725–734 (2012)Cite this article

Abstract

Dialysis water can be contaminated by chemical and microbiological factors, all of which are potentially hazardous to patients on haemodialysis. The quality of dialysis water has seen incremental improvements over the years, with advances in water preparation, monitoring and disinfection methods, and high standards are now readily achievable in clinical practice. Advances in dialysis membrane technology have refocused attention on water quality and its potential role in the bioincompatibility of haemodialysis circuits and adverse patient outcomes. The role of ultrapure dialysate is increasingly being advocated, given its proposed clinical benefits and relative ease of production as a result of the widespread use of reverse osmosis and ultrafiltration. Many of the issues pertaining to water quality in hospital-based dialysis units are also pertinent to haemodialysis in the home. Furthermore, an increased awareness of the environmental and financial consequences of home haemodialysis has resulted in the development of automated and more efficient dialysis machines. These new machines have an increased emphasis on water conservation and recycling along with a decreased need for a complex infrastructure for water purification and maintenance.

Key Points

  • High-quality dialysis water is an essential part of the provision of conventional haemodialysis and home haemodialysis

  • Dialysis water can be contaminated by various chemical and bacterial factors, which have the potential to cause morbidity and—in severe cases—mortality

  • High-quality dialysis fluid standards are now readily achievable with existing infrastructure and current dialysis fluid guidelines

  • Bacterial fragments and endotoxins have been implicated in adverse patient outcomes and the use of ultrapure dialysate has been linked to improved clinical outcomes, but further evaluation is needed

  • New technologies and materials will enable the dialysis water infrastructure to be more compatible with newer and more effective disinfection agents

  • Home haemodialysis places additional challenges in our ability to translate the existing water purification infrastructure into the home setting, but new developments will allow for simplified and integrated dialysis infrastructure

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Figure 1: Typical water purification system for a haemodialysis system.

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Article 07 February 2020

Katherine A. Barraclough & John W. M. Agar

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  1. Department of Nephrology, Monash Medical Centre, Locked Bag 29, Clayton, 3168, VIC, Australia

    Matthew J. Damasiewicz, Kevan R. Polkinghorne & Peter G. Kerr

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P. G. Kerr declares associations with the following companies: Baxter (consultant), Fresenius Australia (consultant). The other authors declare no competing interests.

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Damasiewicz, M., Polkinghorne, K. & Kerr, P. Water quality in conventional and home haemodialysis. Nat Rev Nephrol 8, 725–734 (2012). https://doi.org/10.1038/nrneph.2012.241

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