Water Treatment and Dialysate Production in the Home

The ability to deliver hemodialysis in the patient’s home is predicated upon producing water from the home that meets the acceptable standards of purification and combining that water with an appropriate concentration of solutes that will provide metabolic homeostasis. The large-scale installations currently utilized in outpatient dialysis centers cannot be replicated on an individual basis in the home, and different strategies must be utilized. This chapter will review the history of dialysate production in the home setting including many of the pitfalls, techniques that meet the American Association of Medical Instrumentation (AAMI) water guidelines for hemodialysis, the differences between the home and outpatient center-based settings, and the financial and environmental implications of different home water production methods.