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Background: The risks connected with dialysis fluid contamination are well established. Epidemiological studies have demonstrated just how difficult it is to obtain permanently satisfactory quality standards. Therefore, dialysis centers must have effective and regular quality control programs, particularly with the growing and widespread use of online convective dialysis treatments. Considering this, we conducted a national survey of water treatment systems and monitoring in Italian dialysis centers., Methods: Two independent questionnaires were prepared and distributed in 1999 and 2001. The questions were designed to acquire information on structural and procedural elements. Responses to similar questions from both questionnaires were analyzed together., Results: Responses to questionnaires were received from 148 centers (17% of dialysis centers in Italy). In accordance with the European Best Practice Guidelines (EBPG) published recently concerning dialysis fluid purity, in the majority of centers (97%) the water treatment system consisted of at least pre-treatment and reverse osmosis (RO) modules. However, only one stage RO module was implemented (71%), there was a water storage tank (65%) and water pipe distribution loop was made of sanitary polyvinyl chloride (85%). Analysis of procedural elements--the timing and type of disinfection procedures used for the waterline system and monitors, the timing and type of water treatment quality control procedures--revealed a striking variability among centers in terms of the types and frequency of checks performed., Conclusions: Taking into account the EBPG, this survey revealed both bright and dark spots, calling for a national initiative aimed at defining a standard periodicity of loop disinfection, points in the water pipe line to be tested, and the frequency and type of tests.

Many studies have demonstrated that left ventricular hypertrophy is the most frequent cardiac alteration in patients on chronic hemodialysis. Autopsy studies have shown that hypertrophic hearts of uremic patients have peculiar characteristics, namely deposition of calcium salts, intermyocytic fibrosis, sometimes amyloid. None of the parameters obtainable from conventional echocardiografic images provides information on myocardial tissue structure. Analysis of "texture" originated as analysis of images sent by satellites for military or agricultural purposes and subsequently was applied to medicine for studying various organs like mainly and widely heart. Videodensitometry is a method for in vivo analysis of myocardial structure using computer-assisted quantitative assessment of grey levels of conventional echocardiographic images. In dialysis patients quantitative ultrasonic analysis of myocardial texture appears a promising technique for an observer-independent assessment of myocardial tissue characteristics. Although it may be hampered by many potentially confounding factors, quantitative echocardiography may offer useful parameters for the follow-up of myocardial structural changes in chronic uremia. Further studies are ongoing to completely understand the prognostic significance of myocardial ultrasonic textural alterations in dialysis population.