Lucena Rui, Feurle Juliane, Gil Célia, Ferreira Aníbal, Ponce Pedro, Canaud Bernard
Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany.
Unidade Local de Saúde Lisboa Ocidental, Hospital Santa Cruz (Nephrology Department); Medical Director Nephrocare Alverca Dialysis Clinic, Portugal, NephroCare Alverca, Lisbon, Portugal.
Sci Rep. 2025 Apr 14;15(1):12809. doi: 10.1038/s41598-025-96597-0.
Water is an essential component of renal replacement therapy by dialysis. Haemodialysis patients undergoing 4-hour dialysis sessions, thrice weekly, may be exposed to more than 360 L of dialysis fluid per week. Dialysis water and ultrapure dialysis fluids have been established as a prerequisite for online convective therapies (namely haemodiafiltration), to improve biocompatibility of the dialysis system and to reduce inflammation profile of the dialysis patients. The microbial quality of dialysis water should be monitored regularly to demonstrate the effectiveness of the disinfection protocol. Current water and dialysis fluids microbial quality assessment is typically done via heterotrophic plate counts (HPC) and endotoxins analysis. Plate counts methodology provides information on the microbial content of the water only after a considerable incubation time (typically 7 days). Flow cytometry (FCM), as a rapid alternative method, provides the possibility of real-time corrective actions and greater patient safety. In this study, we compared the outcomes of dialysis water microbial quality in an existing dialysis clinic, using two different measurement methods, HPC and FCM, to test the possible benefits of applying FCM as a valid alternative method for dialysis water microbial monitoring. We conclude that FCM offers higher sensitivity than HPC for microbial monitoring of dialysis water, potentially enabling earlier corrective actions. More extensive and larger studies are needed, namely, to evaluate the possible added value of FCM method in dialysis fluids monitoring. If the FCM method is confirmed, it will be necessary to establish maximum allowable levels and typical action levels for dialysis water and dialysis fluids quality when using FCM.
水是透析肾替代治疗的重要组成部分。每周进行三次、每次4小时透析治疗的血液透析患者，每周接触的透析液可能超过360升。透析用水和超纯透析液已被确定为在线对流治疗（即血液透析滤过）的前提条件，以提高透析系统的生物相容性，并降低透析患者的炎症反应。应定期监测透析用水的微生物质量，以证明消毒方案的有效性。目前对水和透析液微生物质量的评估通常通过异养平板计数（HPC）和内毒素分析来进行。平板计数法只有在经过相当长的培养时间（通常为7天）后才能提供有关水中微生物含量的信息。流式细胞术（FCM）作为一种快速替代方法，提供了采取实时纠正措施的可能性，并提高了患者的安全性。在本研究中，我们在一家现有的透析诊所使用两种不同的测量方法（HPC和FCM）比较了透析用水微生物质量的检测结果，以测试应用FCM作为透析用水微生物监测有效替代方法的潜在益处。我们得出结论，FCM在透析用水微生物监测方面比HPC具有更高的灵敏度，有可能实现更早的纠正措施。需要进行更广泛、更大规模的研究，即评估FCM方法在透析液监测中的可能附加值。如果FCM方法得到证实，在使用FCM时，有必要确定透析用水和透析液质量的最大允许水平和典型行动水平。
