Abstract
“On-line Hemodiafiltration (on-line HDF)” is now listed on the medical fee schedule, which was dramatically changed in 2012 by the Ministry of Health, Labour and Welfare. Consequently, the Ministry approved the use of dialysis machines and the central monitoring system for on-line HDF ; these were provided by various manufactures. On the other hand, standard product water, which is provided by the reverse osmosis (RO) systems for single use (commonly called RO water), is used for the Individual Dialysate Delivery System (IDDS) in the field of acute blood purification and home hemodialysis (HHD). These IDDSs are commonly known as “Individual Dialysis System” in Japan. Unlike the Central Dialysate Delivery System (CDDS), an automated disinfection and cleaning system in the pipeline between the RO machine and the personal dialysis machine is not available for IDDSs. Therefore, there is difficult to adopt on-line HDF into IDDS. Recently, on-line HDF treatment has become popular in Japan, and instead of physiological saline, the ultrapure dialysate is used for the automated priming and blood return process in CDDS. It is clear that without the central monitoring system, the automated disinfection and cleaning systems are unusable, thereby making safe on-line HDF (included the automated priming and blood return process) un-available for IDDS. Therefore, in collaboration with Nipro Corporation, we decided to develop a new system for on-line HDF in IDDSs. Finally, an RO machine for single use called “NCR×eco Ao” was developed. Using NCV-10 (personal dialysis machine), we assessed and reviewed the quality of water produced. We found that NCR×eco Ao allows IDDS to safely perform on-line HDF because the water quality is ultrapure and meets the standards of the guidelines in Japan.
