Evaluation of Dialysis Water Quality at Hospitals in Baghdad, Iraq

Abstract

Background. Dialysis water quality is one of the most important factors for ensuring the safe and effective delivery of hemodialysis. It has been known for over a decade that there might be hazardous contaminants in the water and concentrates used to prepare dialysis fluid. Rigorous international standards for the purification of dialysis fluids have been established, which were used in the present study to compare the quality of dialysis water as there is no national standard for dialysis water quality in Iraq. Objectives. There are more than 20 dialysis centers in Iraq, most of which contain similar units for the processing of dialysis water. The present study evaluated the quality of water used for dialysis in four dialysis centers located within Baghdad hospitals. Methods. Physical and chemical tests were carried out in the laboratory after sampling water from each dialysis center. Water samples were collected from three locations in each dialysis center. Hospital municipal water samples were collected from the tanks feeding dialysis units; samples of dialysis water were collected from the dialysis water treatment unit outlets; and samples of dialysis water were collected from the distribution network in dialysis rooms. Results. The results showed a fluctuation in the quality of the dialysis water (dialysis water and water from the dialysis distribution network), indicating that it is unacceptable compared to international standards. Chemical analysis showed that 75% of the dialysis water had elevated aluminum concentrations. Chemical analysis also found that dialysis water had elevated concentrations of free residual chlorine at some dialysis centers. Conclusions. All hemodialysis centers need careful monitoring and preventive maintenance to ensure good water quality. In addition, it is important to revise the design of the water treatment units according to water quality. Competing Interests. The authors declare no competing financial interests

Evaluation of Some Chemical Parameters of Hemodialysis Water: A Case Study in Iran

“… 19 Other studies are consistent with the results obtained in the present study about aluminum. Studies by Nwobodo et al 39 in South East Nigeria, Shahryari et al 5 in Isfahan hospitals, Sanadgol et al 40 at Khatam Al-Nabi hospital in Zahedan, Vorbeck-Meister et al 14 in Vienna, Austria, Suzuki et al 13 in Brazilian dialysis centers, Humudat and Al-Naseri et al 10 in the dialysis centers of Baghdad, Iraq reported that the mean concentration of aluminum in hemodialysis water was higher than the AAMI standard limit.…”

“… 11 Using coagulants other than aluminum sulfate in water treatment processes can reduce the concentration of aluminum in hemodialysis water. Humudat et al 10 , 11 suggested the use of 2-stage reverse osmosis system instead of one-stage reverse osmosis to improve the chemical quality of hemodialysis water.…”

“…Research in different countries has shown that the level of contamination in a significant proportion of dialysis samples was higher than AAMI standard. 9 Raad Humudat et al 10 conducted a study about the estimation of heavy metals concentration in dialysis fluid and blood samples in dialysis patients in Baghdad, Iraq. Their results showed that the quality of the dialysis fluid was not in accordance with the international standards and about 63% of the samples had aluminum concentration higher than the standard.…”

Assessment of water quality status of hemodialysis treatment plants in Baghdad, Iraq

“…While the lack of free chlorine in the treatment plants for dialysis water meant that there was initially an inadequate amount of chlorine applied to the water. The reasons for the different levels of municipal water may have been the disinfection methods of municipal water treatment plants and the climatic conditions during the study period [9].…”

“…The results of the study regarding the concentration of aluminum were not similar to the other study by researchers in Iraq. Their study on 18 compositions in the dialysis water showed that the concentrations of metal such as aluminum were higher than the standard limit [9,10].…”