Ensuring the chemical and microbiological safety of water for hemodialysis or hemodiafiltration: Adapted clinical guidelines of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists

Abstract

The purpose of these recommendations is to provide information on regulations, the required scope of action, and forms for recording measures to ensure the chemical and microbiological safety of water used in hemodialysis and hemofiltration.

For patients with chronic kidney disease stage VI, the quality of water is just as vital as treatment itself, since water makes up 98% of the dialysis solution.

Safe and effective hemodialysis can be carried out only after multi-stage water purification, especially given that the centralized water supply in Ukraine does not meet the required standards.

The use of low-quality water is associated with an increased risk of cardiovascular diseases, mortality in dialysis patients, and adverse effects on indicators of oxidative stress and inflammation, as well as decreased immune function and bone integrity.

It is necessary to ensure compliance with ISO standards to guarantee the chemical and microbiological safety of water through continuous monitoring, both internal and external, with the involvement of health care institutions and dialysis centers.

Standard operating procedures (SOPs) regarding technical, chemical, and microbiological monitoring of water quality for HD/HF define the frequency of testing and the responsible personnel for ensuring compliance.

If the water quality does not meet the required parameters for hemodialysis, dialysis is not carried out, and appropriate corrective actions are taken to eliminate the cause.