Skip to main content
Log in

Purification of central dialysis fluid delivery system for hemodialysis: practical training on the east kyushu medical valley project

  • Original Paper
  • Published:
Health and Technology Aims and scope Submit manuscript

Abstract

Purpose

The number of patients receiving renal replacement therapy in Japan is extremely high. However, high-quality hemodialysis therapy, especially dialysate purification, is made possible by clinical engineers who possess medical qualifications that exist only in Japan. In this study, water purification techniques for dialysate delivery systems were developed through a project aimed at improving the human resource development of biomedical engineers in Thailand over the past 10 years (2013–2023).

Methods

The central dialysis fluid delivery system, which delivers a large amount of dialysate to multiple dialysis machines, needs to be endotoxin free. The selection of a disinfectant and endotoxin retentive filter is essential to provide high-quality dialysate for patients undergoing hemodialysis.

Results

Using a high concentration of sodium hypochlorite and peracetic acid could reduce the endotoxin concentration in the dialysate delivery system; however, these disinfectants affected the water flux through the membrane pores of the endotoxin retentive filters.

Conclusion

In this study, we describe the purification of a dialysate delivery system with a focus on overseas healthcare specialists, including biomedical engineers, for simultaneous application to multiple patients receiving hemodialysis therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Naramura T. The role of clinical engineers in dialysis therapy in Japan. Blood Purif. 2018;46:134–5. https://doi.org/10.1159/000489199.

    Article  Google Scholar 

  2. Shibata M. Safety Management of Dialysis Fluid in Japan: important duties and responsibilities of clinical engineers. Blood Purif. 2023;52:401–6. https://doi.org/10.1159/000512349.

    Article  Google Scholar 

  3. Bolasco P, Contu A, Meloni P, Vacca D, Murtas S. The evolution of technological strategies in the prevention of dialysis water pollution: sixteen years’ experience. Blood Purif. 2012;34:238–45. https://doi.org/10.1159/000343127.

    Article  Google Scholar 

  4. Mineshima M, Kawanishi H, Ase T, Kawasaki T, Tomo T, Nakamoto H. 2016 update Japanese Society for Dialysis Therapy Standard of fluids for hemodialysis and related therapies. Ren Replace Ther. 2018;4:1–4. https://doi.org/10.1186/s41100-018-0155-x.

    Article  Google Scholar 

  5. Beasley AS, Cotter RJ, Vogel SN, Inzana TJ, Qureshi AA, Qureshi N. A variety of novel lipid a structures obtained from Francisella tularensis live vaccine strain. Innate Immun. 2012;18:268–78. https://doi.org/10.1177/1753425911401054.

    Article  Google Scholar 

  6. Glorieux G, Neirynck N, Veys N, Vanholder R. Dialysis water and fluid purity: more than endotoxin. Nephrol Dial Transpl. 2012;27:4010–21. https://doi.org/10.1093/ndt/gfs306.

    Article  Google Scholar 

  7. Schiffl H, Lang SM, Bergner A. Ultrapure dialysate reduces dose of recombinant human erythropoietin. Nephron. 1999;83:278–9. https://doi.org/10.1159/000045525.

    Article  Google Scholar 

  8. Matsuhashi N, Yoshioka T. Endotoxin-free dialysate improves response to erythropoietin in hemodialysis patients. Nephron. 2002;92:601–4. https://doi.org/10.1159/000064087.

    Article  Google Scholar 

  9. Kwan BC, Chow KM, Ma TK, Cheng PM, Leung CB, Li PK, Szeto CC. Effect of using ultrapure dialysate for hemodialysis on the level of circulating bacterial fragment in renal failure patients. Nephron Clin Pract. 2013;123:246–53. https://doi.org/10.1159/000354714.

    Article  Google Scholar 

  10. Susantitaphong P, Riella C, Jaber BL. Effect of ultrapure dialysate on markers of inflammation, oxidative stress, nutrition and anemia parameters: a meta-analysis. Nephrol Dial Transpl. 2013;28:438–46. https://doi.org/10.1093/ndt/gfs514.

    Article  Google Scholar 

  11. Di Iorio B, Di Micco L, Bruzzese D, Nardone L, Russo L, Formisano P, D’Esposito V, Russo D. Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis. J Nephrol. 2017;30:795–801. https://doi.org/10.1007/s40620-017-0422-x.

    Article  Google Scholar 

  12. Upadhyay A, Susantitaphong P, Jaber BL. Ultrapure versus standard dialysate: a cost-benefit analysis. Semin Dial. 2017;30:398–402. https://doi.org/10.1111/sdi.12618.

    Article  Google Scholar 

  13. Di Iorio BR, Di Micco L, Russo L, Nardone L, De Simone E, Sirico ML, Di Natale G, Russo D. A strategy to reduce inflammation and anemia treatment’s related costs in dialysis patients. G Ital Nefrol. 2018;35:2018–vol1.

    Google Scholar 

  14. Nozaki H, Tange Y, Inada Y, Uchino T, Azuma N. Leakage of endotoxins through the endotoxin retentive filter: an in vitro study. Blood Purif. 2022;51:831–9. https://doi.org/10.1159/000520792.

    Article  Google Scholar 

  15. Kikuchi K, Hamano T, Wada A, Nakai S, Masakane I. Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis. Kidney Int. 2019;95:929–38. https://doi.org/10.1016/j.kint.2018.10.036.

  16. Okada K, Michiwaki H, Tashiro M, Inoue T, Shima H, Minakuchi J, Kawashima S. Effects of Japanese-style online hemodiafiltration on survival and cardiovascular events. Ren Replace Ther. 2021;7:1–10. https://doi.org/10.1186/s41100-021-00385-1.

  17. Koda Y, Mineshima M. Advances and advantages in recent central dialysis fluid delivery system. Blood Purif. 2009;27(Suppl 1):23–7. https://doi.org/10.1159/000213494.

    Article  Google Scholar 

  18. Hassan MS, Hebah HA, Mourad TAH, El-Sharabasy RM. Impact of water treatment on anemia in hemodialysis patients. Ind J Nephrol. 2023;33:183–7. https://doi.org/10.4103/ijn.ijn_300_21.

    Article  Google Scholar 

  19. Hasan M, Sutradhar I, Gupta RD, Sarker M. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol. 2018;19:291. https://doi.org/10.1186/s12882-018-1072-5.

    Article  Google Scholar 

  20. Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nat Rev Nephrol. 2020;16:573–85. https://doi.org/10.1038/s41581-020-0315-4.

    Article  Google Scholar 

  21. Naramura T, Hyodo T, Kokubo K, Matsubara H, Wakai H, Nakajima F, Shibahara N, Yoshida K, Komaru Y, Kawanishi H, Kawamura A, Hidai H, Takesawa S. Dialysis and quality of dialysate in southeast Asian developing countries. Nephron Extra. 2014;4:64–9. https://doi.org/10.1159/000362454.

    Article  Google Scholar 

  22. THAILAND RENAL REPLACEMENT, THERAPY. 2020 https://www.nephrothai.org/wp-content/uploads/2022/06/Final-TRT-report-2020.pdf (accessed on 12 Nov 2023).

  23. Nitta K, Goto S, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, Nakai S, Wada A, Hamano T, Hoshino J, Joki N. incidence, prevalence, and mortality. Ren Replace Ther. 2020;6:1–8. https://doi.org/10.1186/s41100-020-00286-9. Annual dialysis data report for 2018, JSDT Renal Data Registry: survey methods, facility data,.

  24. Tange Y, Takesawa S, Yoshitake S. Asymmetric triacetate membrane keeps high water flux during ultrafiltration: in vitro study. J Artif Organs. 2017;20:399–402. https://doi.org/10.1007/s10047-017-0971-8.

    Article  Google Scholar 

  25. 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. 2023;26:220–5. https://doi.org/10.1007/s10047-022-01362-z.

    Article  Google Scholar 

  26. Naramura T, Kokubo K, Kojima M, Wakai H, Hyodo T, Kawanishi H. Japan’s support of Hemodialysis in Southeast Asia. Contrib Nephrol. 2017;189:102–9. https://doi.org/10.1159/000452076.

    Article  Google Scholar 

  27. Kokubo K, Kobayashi K, Urabe S, Matsubara H, Naramura T, Wakai H, Naganuma T, Nakajima F, Shibahara N, Hyodo T, Matsuda K, Yoshida K, Yamashita AC, Kawanishi H. Support for dialysis therapy in Vietnam, Cambodia, and Myanmar by Japanese societies in the field of blood purification. Blood Purif. 2017;44(Suppl 1):55–61. https://doi.org/10.1159/000479621.

    Article  Google Scholar 

  28. Hyodo T, Hirawa N, Isaka Y, Nakamoto H, Thim P, Phon E, Hy C, Chan S, Kokubo K, Matsubara H, Wakai H, Yamashita AC, Kawanishi H. Current status of renal replacement therapy in Cambodia and Japanese support activities in developing countries in East and Southeast Asia: a report as of June 2018 from the Non-Western World Countries Symposium at the 63rd Annual Meeting of the Japanese Society for Dialysis Therapy. Ren Replace Ther. 2022;8:9. https://doi.org/10.1186/s41100-022-00398-4.

Download references

Acknowledgements

The authors have no acknowledgments to declare.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yoshihiro Tange, and Shingo Takesawa. The first draft of the manuscript was written by Yoshihiro Tange and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yoshihiro Tange.

Ethics declarations

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

All authors agreed with the content for publication.

Competing interests

The authors declare no potential conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tange, Y., Takesawa, S. Purification of central dialysis fluid delivery system for hemodialysis: practical training on the east kyushu medical valley project. Health Technol. (2024). https://doi.org/10.1007/s12553-024-00854-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12553-024-00854-7

Keywords

Navigation