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Effectiveness of combination of heat water disinfection, continuous water circulation, and minimalized dead space for dialysis piping in maintaining ultrapure dialysis fluid and preventing biofilm formation in a central dialysis fluid delivery system

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  • Artificial Kidney / Dialysis
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Abstract

Various benefits have been attached to purifying the dialysis fluid used for hemodialysis therapy. The central dialysis fluid delivery system can treat approximately 50 dialysis patients simultaneously and is convenient to operate. In contrast, the dialysis fluid supply piping is complicated, and bacterial growth can cause biofilms. This study aimed to develop sustainable cleaning strategies to solve the complicated dialysis fluid piping, which is a weakness of the central dialysis fluid delivery system, and provide ultrapure dialysis fluid for a long term. Combination of heat water disinfection, continuous water circulation, and minimalized dead space in the dialysis piping were designed for a central dialysis fluid delivery system and used in a clinic for 6 years. As an index of water purification, endotoxin concentrations and microbial colony counts in reverse osmosis water and dialysis fluid were measured. In addition, we performed scanning electron microscopy of the silicon tube surface that had been used for 5 years to confirm the presence or absence of biofilm formation. For 6 years, endotoxin concentrations and microbial colonies were not detected in reverse osmosis water and dialysis fluid using the multiple-patient dialysis fluid supply equipment. The purity of the dialysis fluid was maintained. No biofilm formation was observed by scanning electron microscopy. Combination of heat water disinfection, continuous water circulation, and minimalized dead space designs for dialysis piping can supply ultrapure dialysis fluid with minimal biofilm formation in the piping in the long term.

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Acknowledgements

We kindly acknowledge the clinical engineers at Makinose Urological Clinic for their support in achieving this study’s purpose.

Funding

This research has not received any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Sendai Makinose Urological Clinic, Kagoshima, Japan

    Fumiyo Ohno & Shinichi Makinose

  2. Graduate School of Health Sciences, Kyushu University of Health and Welfare, Nobeoka, Japan

    Yoshihiro Tange

Authors
  1. Fumiyo Ohno
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  2. Shinichi Makinose
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  3. Yoshihiro Tange
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Contributions

Fumiyo Ohno and Yoshihiro Tange contributed to the conception and design of the study, data analysis and interpretation, and drafting of the manuscript. Fumiyo Ohno and Shinichi Makinose contributed to the data collection. All authors are accountable for all aspects of the study; they worked on and approved the final version to be submitted.

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Correspondence to Fumiyo Ohno or Yoshihiro Tange.

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Ohno, F., Makinose, S. & Tange, Y. Effectiveness of combination of heat water disinfection, continuous water circulation, and minimalized dead space for dialysis piping in maintaining ultrapure dialysis fluid and preventing biofilm formation in a central dialysis fluid delivery system. J Artif Organs 26, 220–225 (2023). https://doi.org/10.1007/s10047-022-01362-z

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  • DOI: https://doi.org/10.1007/s10047-022-01362-z

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