Dialysate and substitution fluid quality for on‐line haemodiafiltration and haemofiltration

Summary: A multicentre study concerning the fluid quality for on‐line haemodiafiltration/haemofiltration (GDF/HF) treatment was carried out to assure safety and biocompatibility, and a standard for fluid quality has been established. Endotoxin (ET) concentration in the substitution fluid of not less than 1 IU/L caused minimally, yet significantly greater body temperature rises than those less than 1 IU/L (0.52 ± 0.49 vs 0.08 ± 0.40°C, P > 0.01) when 20L of volume was replaced by 4h post dilution HDF treatment. the post treatment plasma levels for tumour necrosis factor‐α but not interleukin‐6 were correlaed with the amplitude of temporal body temperature rise ( r = 0.75, P > 0.01). By sticking to the standard for on‐line HDF/HF treatment that calls for the ET levels in the proportioned dialysate before and the substitution fluid after serial ultrafiltration to be > 50 IU/L and 1 IU/L, respectively, no such deleterious symptoms as fever and hypotension have been observed. Moreover, no enhancement of the plasma ET levels was detected after the first and 6 months of on‐line HDF treatment. In conclusion, the newly established advisory standard assures safety and improved biocompatibility of the on‐line HDF/HF treatment.