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A key step towards good dialysis practice

• Produces ultrapure dialysis fluid
• Provides sterile and non-pyrogenic substitution fluid 

* When used with two Diasafe plus in series (for Online therapies) 

Key features

 

Dialysis fluid purity

The quality and purity of dialysis fluids are of major concern in modern renal replacement therapies as large volumes of dialysis fluid come into contact with the patient’s bloodstream. Dialysis fluids may contain microbial impurities such as endotoxins derived from bacterial fragments. Endotoxin fragments may have molecular weights well below 2000Da - small enough to pass across both low and high flux membranes (Figure 1). Endotoxins are known to cause acute adverse reactions and promote long-term complications in hemodialysis patients1,2.

In order to avoid endotoxin related complications during routine hemodialysis, the European Best Practice Guidelines for Hemodialysis (EBPG)3 strongly recommend the usage of ultrapure water. Ultrapure water or dialysis fluid can easily be achieved through the application of special dialysis fluid filters – such as Diasafe plus. 

Chronic inflammation

Endotoxins can activate immune component cells in a number of ways, thereby contributing to chronic inflammation that is present in all hemodialysis patients4. Evidence demonstrates that chronic inflammation is a major risk factor for progressive atherosclerotic cardiovascular disease (CVD)5.

 

The usage of ultrapure dialysis fluid has been shown to reduce markers of chronic inflammation in hemodialysis patients6, therefore it is suggestive that ultrapure dialysis fluid has a beneficial effect on inflammatory diseases such as atherosclerotic CVD7.

Oxidative stress

Several treatment related stimuli, including bacterial endotoxins derived from dialysis fluid8,9 can increase oxidative stress — a situation in which the normal balance between production of reactive oxygen species (ROS) and antioxidant activity is tilted in favour of ROS. As oxidative stress is associated with the progression of malnutrition, anemia and inflammatory diseases such as atherosclerosis, the usage of ultrapure dialysis fluid to reduce dialysis induced oxidative mechanisms appears desirable8,9.

Advanced Glycation End Products (AGE)

The importance of ultrapure dialysis fluid in routine hemodialysis treatments is emphasized by the finding that endotoxins act in synergy with advanced glycation end products (AGE), which enhance inflammation and oxidative stress10. The use of ultrapure dialysis fluid has further been shown to reduce the plasma levels of the AGE compound pentosidine11.

Anemia treatment

 

Ultrapure dialysis fluid has been shown to improve iron utilization and the response to erythropoietin, meaning it could be beneficial in anemia treatment by allowing for a reduced erythropoietin dosage while maintaining optimal hemoglobin levels12,13.


Disinfection

Puristeril 340 or Puristeril plus (peracetic acid)
Diasteril (hydroxyacetic acid) or Citrosteril (citric acid)
Sporotal100 (sodium hypochlorite) max. 11 times