| Abstract: | Survival of chronic hemodialysis patients is worse than that of many patients with cancers or severe infections. An important cause of chronic inflammation is impurities infused into patients during dialysis. Definitions of dialysis purity have been narrow and focused on metals in dialysate water and on bacterial contaminants. There is no standard for priming fluids or toxins released directly into blood from inside the extracorporeal circuit. We propose a much broader standard of dialysis purity that also includes phthalate metabolites, bisphenols, spalled particles, and other contaminants from dialysis machines, filters, and bloodlines. Standards must include new methods for measuring bacteriological contaminants in addition to colony‐forming units and endotoxin determinations. These include the sensitive silkworm larva plasma test that detects peptidoglycan that is missed by endotoxin tests and standards for newly detected small molecular bacterial detritus. Current levels for “standard” bacteriological contaminants are woefully inadequate and should be increased. New standards for contamination with plasticizers and spallation are also necessary. Studies with ultrapure dialysis have shown almost immediate patient benefits with increased well‐being and stabilization of the cardiovascular system during and between dialyses. Intermediate effects include lower C‐reactive protein levels, better response to erythropoietin, increased appetite, and improved nutrition. Over the years, amyloidosis and carpal tunnel syndrome have become less common and cardiovascular deaths have decreased. Standards for dialysis purity must be sharpened and expanded and this becomes even more urgent with daily and long nightly hemodialysis. All contaminants received by patients, whether biological, chemical, or physical, must be considered. |
