Ultrapure versus standard dialysate: A cost‐benefit analysis

Abstract

Low-level bacterial and endotoxin contamination of water used to generate dialysate propagates chronic inflammation in patients with a wide-range of potential adverse consequences, including erythropoietin hyporesponsiveness. Advancements in hemodialysis systems now allow for the generation of ultrapure dialysate that has lower bacterial and endotoxin levels than the standard dialysate. The cost associated with ultrapure dialysate is thought to be a major barrier to its widespread adoption. In this report, we conduct a cost-benefit analysis examining the excess cost of generating ultrapure dialysate and the potential cost saving from a lower erythropoietin dose requirement. Our analysis suggests a potential cost saving of approximately $371 to $425 million per year with full adoption of ultrapure dialysate in the United States.

Dialysis Water Quality and Its Impact on Maintenance for the Hemodialysis Community

“…It can help to reduce the incidence of carpal tunnel syndrome, reduce the need for erythropoietin, help to maintain good nutritional status, and will help to preserve residual renal function. The use of ultrapure dialysis fluid combined with less complement activation membrane will help to increase the biocompatibility of the dialysis procedure [18,19].…”

Introductory Chapter

“…The advancement technology of HD machines was accompanied by significant improvement in dialyzers compatibility and membrane permeability (including pore size, density and distribution, length of fibers and its reduced inner diameter), which include high-flux and medium-to-high cut-off membranes [19]. These innovations, together with the ability to provide ultrapure and online treated water by modern water treatment plants, did not only reduce inflammation, erythropoietin resistance and cost reductions [20], but also allowed the implementation of online hemofiltration (HF) and hemodiafiltration (HDF) treatments [21,25] and the use of high-flux dialyzers. For example, middle size uremic toxins such Sodium (23) Phosphorus (31) Potassium (35) Urea (60) Creatinine (113) Uric acid (168) Glucose (180) Vitamin B12 (1355) Vancomycin (1448) ANP (3100) Endothelin (4300) Insulin (5200) PTH (9225) Abbreviations: ANP, atrial natriuretic peptide; PTH, parathyroid hormone; FLC, free light chains immunoglobulin; FGF-23; fibroblast growth factor-23; AOP, advanced oxidation products; AGEP, advanced glycation end products.…”