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Water treatment for hemodialysis

  • P. Keshaviah
Part of the Developments in Nephrology book series (DINE, volume 39)

Abstract

According to an Italian proverb “Aqua torbido non lava” i.e. “Dirty water does not wash clean”. This can be most aptly applied to the water used for hemodialysis. If the water used for hemodialysis is “dirty”, the blood of the hemodialysis patient will not be “washed clean”. The hemodialysis patient is exposed to more water in one year than the normal population in 20 years. Further, the hemodialysis patient’s blood is exposed to this large quantity of water across a thin non-selective membrane that has none of the “wisdom” of the gastrointestinal tract of a normal individual. Also, the hemodialysis patient’s ability to excrete harmful toxins from such exposure is limited by compromised renal function. The combination of large volume of exposure, non-selective transport across the dialyzer membrane, and compromised renal function make for a situation that is potentially hazardous to the health and well-being of the patient on hemodialysis. Unless the water used for hemodialysis is analyzed periodically and subjected to appropriate treatment processes whose efficacy is monitored regularly, there may be serious risks to patient well-being that have been well documented in the dialysis literature.

Keywords

Product Water Reverse Osmosis Feed Water Free Chlorine Water Treatment Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 2.
    Alfrey AC, Mishell JM, Burks J, Contiguglia SR, Rudolph H, Lewin E et al. Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Intern Organs 1972; 18:257–61.PubMedGoogle Scholar
  2. 3.
    Alfrey AC. Dialysis encephalopathy syndrome. Ann Rev Med 1978; 29:93–8.PubMedCrossRefGoogle Scholar
  3. 4.
    Dunea G, Mahurkar SD, Mamdani B and Smith EC. Role of aluminium in dialysis dementia. Ann Intern Med. 1978; 88:502–4.PubMedGoogle Scholar
  4. 5.
    McDermott JR, Smith AI, Ward MK, Parkinson IS and Kerr DNS. Brain-aluminium concentration in dialysis encephalopathy. Lancet 1978; 1:901–3.PubMedCrossRefGoogle Scholar
  5. 6.
    Elliot HL, Dryburgh F, Fell GS, Sabet S and MacDougall AI. Aluminium toxicity during regular haemodialysis. Br Med J. 1978; 1:1101–3.Google Scholar
  6. 7.
    Pierides AM, Edwards WG, Cullum UX, McCall JT and Ellis HA. Hemodialysis encephalopathy with osteomalacic fractures and muscle weakness. Kidney Int 1980; 18:115–24.PubMedCrossRefGoogle Scholar
  7. 8.
    Short AI, Winney RJ and Robson JS. Reversible microcytic hypochromic anaemia in dialysis patients due to aluminium intoxication. Proc Eur Dial Transpl Assoc 1980; 17:226–33.Google Scholar
  8. 9.
    McGonigle RJS and Parsons V. Aluminium-induced anaemia in haemodialysis patients. Nephron 1985; 39:1–9.PubMedGoogle Scholar
  9. 10.
    Schreeder MT, Favero MS, Hughes JR, Petersen NJ, Bennett PH and Maynard JE. Dialysis encephalopathy and aluminium exposure: an epidemiological analysis. J Chronic Dis 1983; 36:581–93.PubMedCrossRefGoogle Scholar
  10. 11.
    Matter BJ, Pederson J, Psimenos G and Lindeman RD. Lethal copper intoxication in hemodialysis. Trans Am Soc Arfif Intern Organs 1969; 15:309–15.Google Scholar
  11. 12.
    Ivanovich P, Manzler A and Drake R. Acute hemolysis following hemodialysis. Trans Am Soc Artif Intern Organs 1969; 15:316–18.PubMedGoogle Scholar
  12. 13.
    Manzler AD and Schreiner AW. Copper-induced hemolytic anemia. A new complication of hemodialysis. Ann Intern Med. 1970; 73:409–12.Google Scholar
  13. 14.
    Gallery EDM, Blomfield J and Dixon SR. Acute zinc toxicity in haemodialysis. Br Med J 1972; 4:331–3.PubMedGoogle Scholar
  14. 15.
    Freeman RM, Lawton RL and Chamberlain MA. Hardwater syndrome. N Engl J Med 1967; 276:1113–18.PubMedCrossRefGoogle Scholar
  15. 16.
    Evans DB and Slapak M. Pancreatitis in the hard water syndrome. Br Med J 1975; 3:748.PubMedGoogle Scholar
  16. 17.
    Drukker W. The hard water syndrome: a potential hazard during regular dialysis treatment. Proc Eur Dial Transpl Assoc 1969:5:284–7.Google Scholar
  17. 18.
    Nickey WA, Chinitz VL, Kim KE, Onesti G and Swartz C. Hypernatremia from water softener malfunction during home dialysis (letter). J Am Med Assoc 1970; 214:915.CrossRefGoogle Scholar
  18. 19.
    Jowsey J, Johnson WJ, Taves DR and Kelly PJ. Effects of dialysate calcium and fluoride on bone disease during regular hemodialysis. J Lab Clin Med 1972; 79:204–14.PubMedGoogle Scholar
  19. 20.
    Lough J, Noonan R, Gagnon R and Kaye M. Effects of fluoride on bone in calcium renal failure. Arch Pathol 1975; 99:484–7.PubMedGoogle Scholar
  20. 21.
    Anderson R, Beard JH and Sorley D. Fluoride intoxication in a dialysis unit — Maryland. Morbid Mortal Wkly Rep 1980; 29:134–6.Google Scholar
  21. 22.
    Carlson DJ and Shapiro FL. Methemoglobinemia from well water nitrates: a complication of home dialysis. Ann Intern Med 1970; 73:757–9.PubMedGoogle Scholar
  22. 23.
    Salvadori M, Martinelli F, Comparini L, Bandini S and Sodi A. Nitrate induced anemia in home dialysis patients. Proc Eur Dial Transpl Assoc 1984; 21:321–5.Google Scholar
  23. 24.
    Compty C, Luehmann D, Wathen R and Shapiro F. Prescription water for chronic hemodialysis. Trans Am Soc Artif Intern Organs 1974; 20:189–96.Google Scholar
  24. 25.
    Yawata Y, Howe R and Jacob HS. Abnormal red cell metabolism causing hemolysis in uremia. A defect potentiated by tap water hemodialysis. Ann Intern Med 1973; 79:362–7.PubMedGoogle Scholar
  25. 26.
    Eaton JW, Kolpin CF, Swofford HS, Kjellstrand CM and Jacob HS. Chlorinated urban water: a cause of dialysisinduced hemolytic anemia. Sciences 1973; 181:463–4.Google Scholar
  26. 27.
    Kjellstrand CM, Eaton JW, Yawata Y, Swofford H, Kolpin CF, Buselmeier TJ et al. Hemolysis in dialyzed patients caused by chloramines. Nephron 1974; 13:427–33.PubMedGoogle Scholar
  27. 28.
    Botella J, Traver JA, Sanz-Guajardo D, Torres MT, Sanjuan I and Zabala P. Chloramines, an aggravating factor in the anemia of patients on regular dialysis treatment. Proc Eur Dial Transpl Assoc 1977; 14:192–9.Google Scholar
  28. 30.
    Favero MS, Petersen NJ, Carson LA, Bond WW and Hindman SH. Gram-negative water bacteria in hemodialysis systems. Health Lab Sci 1975; 12:321 34.PubMedGoogle Scholar
  29. 31.
    Lauer J, Streifel A, Kjellstrand C and DeRoos R. The bacteriological quality of hemodialysis solution as related to several environmental factors. Nephron 1975; 15:87–97.PubMedGoogle Scholar
  30. 32.
    Blagg CR, Tenckhoff H. Microbial contamination of water used for hemodialysis. Nephron 1975; 15:81–6.PubMedCrossRefGoogle Scholar
  31. 33.
    Robinson PJA and Rosen SM. Pyrexial reactions during haemodialysis. Br Med J 1971; 1:528–30.PubMedGoogle Scholar
  32. 34.
    Stacha JA and Pontius FW. An overview of water treatment practices in the United States. J Am Water Works Assoc 1984; 76:73–85.Google Scholar
  33. 37.
    Keshaviah P, Luehmann D, Shapiro F and Comty C. Investigation of the risks and hazards associated with hemodialysis systems. (Technical Report, Contract 223-78-5046). U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Bureau of Medical Devices, Silver Spring, MD, June 1980.Google Scholar
  34. 38.
    Favero MS, Carson LA, Bond WW and Petersen NJ. Factors that influence microbial contamination of fluids associated with hemodialysis machines. Appl Microbiol 1974; 28:822–30.PubMedGoogle Scholar
  35. 39.
    Favero MS and Petersen NJ. Microbiological guidelines for hemodialysis systems. Dial Transplant 1977; 6:34.Google Scholar
  36. 40.
    Man NK, Ciancioni C, Faivre JM, Diab N, London G, Maret J et al. Dialysis-associated adverse reactions with high-flux membranes and microbial contamination of liquid bicarbonate concentrate. Contr Nephrol 1988; 62:24–34.Google Scholar
  37. 41.
    Klinkman H, Falkenhagen D and Smollich BP. Investigation of the permeability of highly permeable polysulfone membranes for pyrogens. Contr Nephrol 1985; 46:174–83,185.Google Scholar
  38. 42.
    Dinarello C. The biology of interleukin 1 and its relevance to hemodialysis. Blood Purif 1983; 1:197–224.CrossRefGoogle Scholar
  39. 43.
    Lonnemann G, Koch KM and Shaldon S. Induction of interleukin 1 from human monocytes adhering to hemodialysis membranes. Kidney Int 1987; 31:238.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

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  • P. Keshaviah

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