Water treatment for contemporary hemodialysis
Chronic hemodialysis treatment became an accepted mode of therapy in the 1960s, and since then the use of inadequately purified water was recognized as being responsible for many documented patients’ injuries and deaths (Table 1) (1–6). It is estimated that many more incidences go unreported since, unless a patient exhibits an acute or subacute reaction, chronic side-effects are usually related to uremia or to the treatment itself. Water represents more than 95% of dialysate, and a dialysis patient is exposed to a mean of 300–400 L of water a week, in contrast to a normal person ingesting 14 L/week. In healthy individuals gastrointestinal mucosa represents an active membrane which regulates transport of a potential toxin into the blood stream and, once entered, contaminants have ready means of excretion.
KeywordsMagnesium Hepatitis Cadmium Manganese Iodine
Unable to display preview. Download preview PDF.
- 4.Ward DM. Water disasters: pitfalls and precautions. Contemp Dial Nephrol Mag. 1999; 12. New York: Ashlee.Google Scholar
- 9.Cappelli G. Dialysate contribution to bio-incompatibility in hemodialysis. Contemp Dial Nephrol. 1991;12:20–2.Google Scholar
- 11.ANSI/AAMI. Water treatment equipment for hemodialysis applications (RD62:2001). Arlington, VA: AAMI, 2001.Google Scholar
- 12.European Pharmacopoeia, 3rd edn (Supplement). Haemodialysis solutions, concentrated, water for diluting. Monograph 1997:1167 corrected 2000. Strasbourg: Council of Europe, 2001.Google Scholar
- 19.Lonnemann G, Endres S, van der Meer JW, Cannon JG, Dinarello CA. A radio-immunoassay for human interleukin1 alpha: measurement of IL-1 alpha produced in vitro by human blood mononuclear cells stimulated with endotoxin. Limphokine Res. 1988;7:75–84.Google Scholar
- 28.Jensen E. Ozone, the alternative for clean dialysis water. Dial Transplant. 1998,27:706–12.Google Scholar
- 37.Food and Drug Administration (FDA). A Manual on Water Treatment for Hemodialysis (FDA 89–4234). Rockville, MD: CDRH, 1989.Google Scholar
- 40.Kulander L, Nisbeth U, Danielsson BG, Eriksson O. Occurrence of endotoxin in dialysis fluids from 39 dialysis units. J Hosp Infect. 1993;24:29–37.Google Scholar
- 48.Canaud B, Bosc JY, Leray H, Stec F. Microbiological purity of dialysate for on-line substitution fluid preparation. Nephrol Dial Transplant. 2000:(Suppl. 2):21–30.Google Scholar