Heavy Metals in Dialysis Fluid and Blood Samples from Hemodialysis Patients in Dialysis Centers in Baghdad, Iraq

Abstract

Background. The kidney is the first target organ of heavy metal toxicity due to its capacity to reabsorb and accumulate divalent metals. Hemodialysis therapy is used to purify the blood of individuals with impaired kidney function. Objective. The aim of the present study was to evaluate the relationship between dialysis fluid quality and the health of hemodialysis patients. Methods. A field sampling program was conducted to collect blood samples from 320 hemodialysis patients (56% males and 44% females) in order to examine the concentrations of heavy metals that typically occur in municipal water in Baghdad (aluminum (Al), copper (Cu), lead (Pb), and zinc (Zn)), and explore associations with the same metals in dialysis fluid collected from four major dialysis centers in Baghdad hospitals for a period of one year (2018). Results. The results showed that the dialysis fluid quality was not in compliance with international standards. The dialysis fluid in 63% of the samples contained high Al concentrations, while Cu and Zn concentrations were within international standards. Lead concentrations were elevated in dialysis fluid in some hospitals as well. Discussion. The average blood levels of biologically important heavy elements were significantly varied in hemodialysis patients when compared with local reference values. Conclusions. Since both deficiency and excess elements are potentially harmful, the hypothesis that heavy element status affects the risk of adverse clinical outcomes is a worthy investigation. Participant Consent. Obtained Ethics Approval. The study was approved by the Baghdad Ethics Committee of the Iraqi Ministry of Health and Environment. Competing Interests. The authors declare no competing financial interests.

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

“…It was able to reduce the concentration of all elements around the standard limits. However, in studies conducted by Shahryari et al 5 in Isfahan, Pirsaheb et al 21 in Kermanshah, Abualhasan et al 7 in Palestine, Suzuki et al 13 in Brazil and Humudat and Al-Naseri 38 in Iraq, The reverse osmosis system does not have a proper efficiency and has not been able to reduce the concentration of some elements under study, especially heavy metals, to the standard limits. In present study, although the reverse osmosis system was able to reduce the concentration of calcium, magnesium, sodium, zinc, copper and lead under the standard limits, it was unable to reduce aluminum concentration to standard limits.…”

Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis

“…The average blood aluminum level of the dialysis patients was 1.0 ± 0.4 µg/dL, below the cutoff value set by National Kidney Foundation. As shown in Table 3 [ 14 , 17 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], there is a decreasing trend of blood aluminum levels in the dialysis units throughout the world. In the earlier studies, Neiva et al [ 36 ] presented that the mean blood aluminum levels of Brazil hemodialysis patients was 4.5 ± 2.9 µg/dL, and Kazi et al [ 33 ] presented that blood aluminum levels of 22.0 ± 2.5 µg/dL in Pakistan hemodialysis patients.…”

Dialysis Water Quality and Its Impact on Maintenance for the Hemodialysis Community

“…The research in Iraq about water quality in HD units showed that 75% of the Units had high aluminum and some units showed elevated total chlorine levels in dialysis water [7][8][9][10]. Research in Iran also showed the reality of the inability of hemodialysis centers to maintain the dialysis water quality as per the AAMI standard.…”