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Published in: BMC Nephrology 1/2017

Open Access 01-12-2017 | Research article

A randomized cross-over study comparing the performance of HD integra™ central concentrate system versus pre-produced concentrate in hemodialysis

Authors: K. Fauziah, K. W. Go, A. Ghazali, M. Zaki, T. O. Lim

Published in: BMC Nephrology | Issue 1/2017

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Abstract

Background

Pre-produced bicarbonate concentrates (PPC) are still widely used in developing countries despite its cost and risk but Central Concentrate System (CCS) is lacking in data to support its wider adoption.

Methods

We conducted an 8-week randomized crossover study on 16 Hemodialysis machines to compare CCS versus PPC. Performance is assessed by solute concentrations while safety is assessed by microbial count, endotoxin level and adverse event reporting.

Results

Microbial counts and endotoxin levels were monitored on 48 occasions during the 8-week study for the CCS arm of the study. The levels were all below the action limit during the study. No patient reported any adverse events. Dialysate Sodium, Chloride and Bicarbonate concentrations were measured on a total of 128 occasions for each arm of the study. The relative deviations of Sodium, Chloride and Bicarbonate concentration were within ±5% of their nominal values for both. The 95% Confidence Intervals for the ratio of the mean solute concentrations on the CCS to PPC lie within the tolerance limit of ±5%.

Conclusion

Modern CCS is bacteriologically safe and its performance statistically equivalent to PPC.
Literature
1.
go back to reference Lim YN, Goh BL, Ong LM, editors. Twentieth report of the Malaysian dialysis and transplant 2012. Kuala Lumpur: National Renal Registry; 2013. Lim YN, Goh BL, Ong LM, editors. Twentieth report of the Malaysian dialysis and transplant 2012. Kuala Lumpur: National Renal Registry; 2013.
2.
go back to reference Gleick PH, Cooley HS. Energy implications of bottled water. Environ Res Lett. 2009;4:1–6.CrossRef Gleick PH, Cooley HS. Energy implications of bottled water. Environ Res Lett. 2009;4:1–6.CrossRef
3.
go back to reference Energy Commission. Malaysia Energy Statistics Handbook 2014. Kuala Lumpur: Energy Commission; 2015. Energy Commission. Malaysia Energy Statistics Handbook 2014. Kuala Lumpur: Energy Commission; 2015.
5.
go back to reference Department of Statistics. Compendium of environment statistics Malaysia. 2014. Department of Statistics. Compendium of environment statistics Malaysia. 2014.
8.
go back to reference Bland LA, et al. Potential bacteriologic and endotoxin hazards associated with liquid bicarbonate concentrate. Trans Am Soc Artif Int Organs. 1987;33:542–5. Bland LA, et al. Potential bacteriologic and endotoxin hazards associated with liquid bicarbonate concentrate. Trans Am Soc Artif Int Organs. 1987;33:542–5.
9.
go back to reference Ebben JP, Hirsch DN, Luehmann DA, Collins AJ, Keshaviah PR. Microbiological contamination of liquid bicarbonate concentrate for hemodialysis. Trans Am Soc Artif Intern Organs. 1987;33:269–72. Ebben JP, Hirsch DN, Luehmann DA, Collins AJ, Keshaviah PR. Microbiological contamination of liquid bicarbonate concentrate for hemodialysis. Trans Am Soc Artif Intern Organs. 1987;33:269–72.
10.
go back to reference Alter MJ, Favero MS, Miller JK, Moyer LA, Bland LA. National surveillance of dialysis-associated diseases in the United States, 1989. ASAIO Trans. 1991;37:97–109.PubMed Alter MJ, Favero MS, Miller JK, Moyer LA, Bland LA. National surveillance of dialysis-associated diseases in the United States, 1989. ASAIO Trans. 1991;37:97–109.PubMed
11.
go back to reference Ruderman MA, Yungbluth MM, del Greco F, Krumlovsky FA, Beske RG. Preparation of bacteriologically safe bicarbonate concentrate for hemodialysis. ASAIO Trans. 1988;34:606–7.PubMed Ruderman MA, Yungbluth MM, del Greco F, Krumlovsky FA, Beske RG. Preparation of bacteriologically safe bicarbonate concentrate for hemodialysis. ASAIO Trans. 1988;34:606–7.PubMed
13.
go back to reference Grimsrud L, Cole JJ, Lehman GA, Babb AL, Scribner BH. A central system for the continuous preparation and distribution of hemodialysis fluid. Trans Am Soc Artif Intern Organs. 1964;10:107–9.PubMed Grimsrud L, Cole JJ, Lehman GA, Babb AL, Scribner BH. A central system for the continuous preparation and distribution of hemodialysis fluid. Trans Am Soc Artif Intern Organs. 1964;10:107–9.PubMed
14.
go back to reference Friedman EA, Lundin AP. Dialysate delivery: historical, theoretical, and practical aspects. Kidney Int. 1980;18:s33–43. Friedman EA, Lundin AP. Dialysate delivery: historical, theoretical, and practical aspects. Kidney Int. 1980;18:s33–43.
15.
go back to reference Oettinger CW, Oliver JC. An economical new process for incenter bicarbonate dialysate production: comparison with acetate in a large dialysis population. Artif Organs. 1992;16:141–5.PubMed Oettinger CW, Oliver JC. An economical new process for incenter bicarbonate dialysate production: comparison with acetate in a large dialysis population. Artif Organs. 1992;16:141–5.PubMed
16.
go back to reference Rehmert N, Boecker T, Raidt H, Langer K, Graefe H. A new central supply system as alternative source for bicarbonate dialysate. Int J Artificial organ. 1992;15:339–42. Rehmert N, Boecker T, Raidt H, Langer K, Graefe H. A new central supply system as alternative source for bicarbonate dialysate. Int J Artificial organ. 1992;15:339–42.
17.
go back to reference De Vos JY, Marzougui H, Hombrouckx RO. Automated on-line bicarbonate concentrate production: microbiological, chemical and economic benefits. EDTNA ERCA J. 1996;22:5–6.PubMed De Vos JY, Marzougui H, Hombrouckx RO. Automated on-line bicarbonate concentrate production: microbiological, chemical and economic benefits. EDTNA ERCA J. 1996;22:5–6.PubMed
18.
go back to reference Stragier A, Wenderickx D. Bacterial growth prevention in liquid bicarbonate concentrate. EDTNA ERCA J. 1998;24(4):40–2.PubMed Stragier A, Wenderickx D. Bacterial growth prevention in liquid bicarbonate concentrate. EDTNA ERCA J. 1998;24(4):40–2.PubMed
19.
go back to reference Lebedo I. On-line preparation of solutions for dialysis: practical aspects versus safety and regulations. J Am Soc Nephrol. 2002;13:S78–83. Lebedo I. On-line preparation of solutions for dialysis: practical aspects versus safety and regulations. J Am Soc Nephrol. 2002;13:S78–83.
20.
go back to reference Han S-W, Yi JH, Kim HJ. Current status of central concentrate delivery system for hemodialysis in Korea. Blood Purif. 2009;27 suppl 1:70–3.CrossRefPubMed Han S-W, Yi JH, Kim HJ. Current status of central concentrate delivery system for hemodialysis in Korea. Blood Purif. 2009;27 suppl 1:70–3.CrossRefPubMed
21.
go back to reference Beige J, Lutter S, Martus P. On-site production of a dialysis bath from dry salts. Results of solute concentration control by routine clinical chemistry. Clin Kidney J. 2012;5:207–11.CrossRefPubMedPubMedCentral Beige J, Lutter S, Martus P. On-site production of a dialysis bath from dry salts. Results of solute concentration control by routine clinical chemistry. Clin Kidney J. 2012;5:207–11.CrossRefPubMedPubMedCentral
22.
go back to reference ANSI/AAMI/ISO. ISO 13958:2009. Concentrates for hemodialysis and related therapies. ANSI/AAMI/ISO. ISO 13958:2009. Concentrates for hemodialysis and related therapies.
23.
go back to reference ANSI/AAMI/ISO. ISO 11663:2009. Quality of dialysis fluid for haemodialysis and related therapies. ANSI/AAMI/ISO. ISO 11663:2009. Quality of dialysis fluid for haemodialysis and related therapies.
24.
go back to reference ANSI/AAMI/ISO. ISO 23500:2011. Guidance for the preparation and quality management of fluids for hemodialysis and related therapies. ANSI/AAMI/ISO. ISO 23500:2011. Guidance for the preparation and quality management of fluids for hemodialysis and related therapies.
25.
go back to reference Ministry of Health (MOH). Standards for HD, Mutu dan Piawaian. 2011. Ministry of Health (MOH). Standards for HD, Mutu dan Piawaian. 2011.
26.
go back to reference Note for guidance on the investigation of bioavailability and bioequivalence. The European Agency for the Evaluation of Medicinal Products, London, 17 December 1998. Note for guidance on the investigation of bioavailability and bioequivalence. The European Agency for the Evaluation of Medicinal Products, London, 17 December 1998.
27.
go back to reference Chapter 2320 Alkalinity. American Public Health Association, Standard Methods for the Examination of Water and Wastewater. 21st ed. Washington D.C.: APHA; 2005. Chapter 2320 Alkalinity. American Public Health Association, Standard Methods for the Examination of Water and Wastewater. 21st ed. Washington D.C.: APHA; 2005.
28.
go back to reference Canauda B, Bosc JY, Leray H, Morena M, Stec F. Microbiologic purity of dialysate: rationale and technical aspects. Blood Purif. 2000;18:200–13.CrossRef Canauda B, Bosc JY, Leray H, Morena M, Stec F. Microbiologic purity of dialysate: rationale and technical aspects. Blood Purif. 2000;18:200–13.CrossRef
Metadata
Title
A randomized cross-over study comparing the performance of HD integra™ central concentrate system versus pre-produced concentrate in hemodialysis
Authors
K. Fauziah
K. W. Go
A. Ghazali
M. Zaki
T. O. Lim
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2017
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-017-0537-2

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