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Nefrologia. 2016 May-Jun;36(3):e1-e52. doi: 10.1016/j.nefro.2016.01.003. Epub 2016 Mar 14.

Guideline for dialysate quality of Spanish Society of Nephrology (second edition, 2015).

[Article in English, Spanish]

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Hospital Universitario Infanta Leonor, Madrid, España. Electronic address:
Junta Directiva de la SEN, Hospital de Manises, Manises, Valencia, España.
Fundación Jimemez Díaz, Madrid, España.
Hospital Universitario de Navarra, Pamplona, España.
Departmento de Biología de Sistemas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
Hospital Universitario General Gregorio Marañón, Madrid, España.
Hospital Universitario de la Princesa, Madrid, España.
FSE Medical Devices, Tekogal Electromedicina S.L., Vigo, Pontevedra, España.
Fresenius Medical Care España, Madrid, España.
Tratamientos de Agua, Baxter Gambro Iberia, Madrid, España.
Diaverum España, Madrid, España.


A Best Practice Guideline about Dialysis fluid purity was developed under the leadership of the Spanish Society of Nephrology in 2004. The second edition revised Guideline considered new evidences and International Standard. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. This Guideline is based on the ISO13959, European Pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis, literature reviews, according to their level of evidence, and the opinion of the expert Spanish group. Two levels of quality of water were defined: purified water and high purified water (ultra pure) and for dialysate: ultra pure dialysate. Regular use of ultra pure dialysate is recommended for all type of hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anaemia and amiloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (4.1.2), conductivity, microbial and endotoxins (4.1.1): Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (anexos). For microbiological monitoring, R2A medium is recommended, incubated during 7-14 days at a temperature of 17-23°C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to


Concentrado; Concentrate; Dialysate; Endotoxinas; Endotoxins; Hemodialysis; Hemodiálisis; Líquido de diálisis; Tratamiento de agua para hemodiálisis; Water treatment for dialysis fluid

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