Experience of using heat citric acid disinfection method in central dialysis fluid delivery system.

We applied the heat citric acid disinfection method in the main part of the central dialysis fluid delivery system (MPCDDS), which consists of a multiple-patient dialysis fluid supply unit, dialysis console units, and dialysis fluid piping. This disinfection method has been used for single-patient dialysis machines, but this is the first trial in the MPCDDS. We examined, by points of safety and disinfection effect, whether this disinfection method is comparable to conventional disinfection methods in Japan. The conventional disinfection method is a combination of two disinfectants, sodium hypochlorite and acetic acid, used separately for protein removal and decalcification. Consequently, total microbial counts and endotoxin concentrations fully satisfied the microbiological requirements for standard dialysis fluid of ISO 11663. From our results and discussion, this heat citric acid disinfection method is proved to be safe and reliable for MPCDDS. However, to satisfy the microbiological requirements for ultrapure dialysis fluid, further consideration for this method in MPCDDS including the reverse osmosis device composition and piping is necessary.

Polyester polymer alloy as a high-performance membrane.

Polyester polymer alloy (PEPA) membrane is developed as a synthetic polymermembrane. It consists of two polymers - polyethersulfone (PES) and polyarylate (PAR).The pore size in membrane can be controlled by a blend ratio of PES and PAR. One unique characteristic is that PEPA membrane has three layers of a skin layer on the inner surface, a porous layer in the membrane, and a skin layer on the outer surface, respectively. The permeability of water and substances is controlled by the skin layer on the inner surface. PEPA membrane dialyzer can be adequately considered as a high-performance dialyzer. Furthermore, the skin layer on the outer surface can block endotoxin from the dialysis fluid side. PEPA membrane can therefore be used as an endotoxin-retentive filter. The other unique characteristic is that each amount of albumin loss or ß2-microglobulin removal can be controlled by an additive amount of polyvinylpyrrolidone. This means that the PEPA dialyzer can be clinically used to meet the conditions of the patient.