Dialysis Water Treatment Systems: From past to Present

Abstract

In the past dialysis was associated with typical syndromes, such as “hard water syndrome”, aluminium-linked encephalopathy and osteomalacia, and pyrogenic reactions. With time it was recognized that water required treatment before being used for haemodialysis. With experience, the type of water for haemodialysis changed from tap to decalcified, then to demineralised, next to osmosis and finally ultra-pure water, the current gold standard. At present, water treatment systems involve pre-treatment, real treatment and a hydraulic circuit. The pre-treatment process removes suspended particles which would damage the osmotic membranes. Real treatment prepares water for haemodialysis by using reverse osmosis. The hydraulic circuit distributes osmotic water to the dialysis room and into each machine. The water treatment systems considered were supplied by Fresenius, Gambro and Farmacastelli. They differ from one another in treatment protocols, construction and disinfection systems.