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Abstract The estimated water intake of a healthy individual is 2 L per day or 14 L per week. By comparison, a hemodialysis patient may be exposed to 350 to 500 L of water per week. Hemodialysis patients are particularly vulnerable to contaminants in the water used to prepare concentrate and dialysate, or in water used for reprocessing dialyzers,All dialysis facilities therefore require a properly designed and maintained water treatment system to safeguard patients. To maintain acceptable water quality, a dialysis facility must institute a formal program to monitor and maintain its water treatment and distribution system. Monitoring should encompass measurement of physical, chemical and microbiological parameters that allow both water quality and equipment performance to be assessed. It is important to effectively monitor the specific purification processes. These processes include the reverse osmosis system, deionizers, carbon, softeners, and filters.The chemical and bacteriological purity of thedialysis water must be monitored routinely and regularly and the results should be documented. There should be documented procedures, which come into effect once these limits are exceeded. These procedures will include temporary closure of the dialysis unit when the safe limits for contaminants are exceeded. In most outpatient centers the dialysate is prepared centrally such that the composition of the dialysate is the same for all patients. When delivered in this manner most patients tolerate the procedure well. However, there are patients who tolerate the procedure poorly. Dialysate composition and preparation along with dialysate use is probably one of the most fascinating topics in nephrology, where the possibilities for innovative tinkering and improvements are plentiful. With older and increasingly complex patients, the potentialbenefits of individual prescription of dialysate have gained more relevance. Individual dialysate prescription may involve setting concentration of each solute at the start of dialysis and adjustment of the concentration of some solutes throughout the dialyticperiod, so-called modelling or profiling of the dialysate. The need to improve both intradialytic and interdialytic morbidities and long-term outcomes has driven the use of individualized prescription. |