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Nefrología (Madrid)

versión On-line ISSN 1989-2284versión impresa ISSN 0211-6995

Resumen

PEREZ-GARCIA, Rafael  y  COMISION DE EXPERTOS DE LA SOCIEDAD ESPANOLA DE NEFROLOGIA PARA LA CREACION DE LA SEGUNDA EDICION DE LA GUIA DE GESTION DE CALIDAD DEL LIQUIDO DE DIALISIS et al. Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015). Nefrología (Madr.) [online]. 2016, vol.36, n.3, pp.e1-e52. ISSN 1989-2284.  http://dx.doi.org/10.1016/j.nefro.2016.01.003.

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 hemodialysis proportioning systems. This Guideline is based on the ISO13959, 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 hemodialysis 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):

Microbial (CFU/ml) Endotoxins LAL test (EU/ml) Purified water ≤ 100 CFU/ml ≤ 0,25 High purified water ≤ 10 CFU/100 ml ≤ 0,03 Ultra pure dialysate ≤ 10 CFU/100 ml ≤ 0,03

Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (anexos). 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 hemodialysis has the ultimate responsibility for dialysate quality.

All suggestions and questions about this Guideline are wellcome to www.senefro.org.

Palabras clave : Dialysate; Water treatment for dialysis fluid; Hemodialysis; Concentrate; Endotoxins.

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