Water Quality In Dialysis Matters - A life saver but poor quality can kill you too !

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Dialyzers, which are also known as Artificial Kidneys are the most important component of Hemodialysis. In simple words Dialyzers are filters which are used to filter blood and remove waste products, excess fluid and toxins from the body during dialysis.

Key Points

1. Dialyzer Surface Area -
   1. Dialyzer surface area is measured in Square Meters or generally you will se dialyzers size written as 1.3, 1.5 or 1.8. This 1.3 or 1.8 means that the dialyzer's surface area is 1.3 sqmt or 1.8 sqmt. The more the better. However decision on surface area shall be made in consultation with your treating Nephrologist.
2. Dialyzer Flux
   1. As we had told you that dialyzer has membranes which have microscopic holes. The size of these holes decide which all molecules can come out of blood.
   2. Its a two way process - Higher the dialyzer flux - it can remove larger molecules from body (eg. Beta2M). However, with high flux dialysers there is always a risk of water/dialysate entering into the blood stream. Thus its very important to ensure water quality is as per required standards.
3. Single use Vs. Re-use of Dialyzer
   1. Single Use or Re-Use - Understanding this is very simple. Dialyzers are either used only once and then discarded or its re-used.
   2. Obviously single use dialysis is going to be costly as a new dialyzer is tobe used in every dialysis procedure. In India due to cost considerations most of the patients are dialyzed by reusing dialyzers.
   3. When it comes to re-usage of dialyzers its important to understand that after every dialysis few of these hollow fibers get clogged or closed. Thus overall efficiency of Dialyzer gets reduced. And its essential to ensure dialyzers are not re-used once they fall below a certain efficiency. This is measured with term Fibre bundle volume in technical term.
   4. Considering that there is no manual way of checking fibre bundle volume there are Dialyzer re-processing machines which are used to not only clean and disinfect the dialyzers but also check if the efficiency of dialyzer and cases of damage.
   5. Patients shall be alarmed if they want to take dialysis in clinics where dialyzers are reused and the clinic does not have Automatic Dialyzer Reprocessing machine. And try not to take dialysis in clinics which do reuse of dialyzers and do not have a automatic dialyzer reprocessor machine. In case you can't avoid taking dialysis in such clinics then try and keep the no. of times a dialyzer is re-used to minimum.
   6. Number of reuse - This is one of the very interesting discussions I have had with patients and doctors both. How many times do we re-use dialyzers ? So we all need to understand - if a dialyzer is declared fit to be reused by the automatic reprocessing machine it shall be treated as good to be reused and else not. It can be 3rd time or 10th time. Considering the process is automated without any human intervention it eliminates chances of error or miscalculation.
4. Company / Brand of Dialyzers :- Government of India has fairly stringent norms for dialyse registration & thus for patients dialyzer brand shall not be a major concern. So, if you are asked to pay more for a particular brand of dialyzer then its better to save the money and use it in getting 1 extra dialysis a month or proper medication etc. Again a very personal choice and there is no wrong decision here.

At the end once you are equipped with information around 'Dialyzers' please do talk to your Nephrologist before changing anything or any protocol.

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