Organic contamination in dialysis water: trichloroethylene as a model compound

Poli, Diana; Pavone, Laura; Tansinda, Pius; Goldoni, Matteo; Tagliavini, Dante; David, S.; Mutti, Antonio; Franchini, I

doi:10.1093/ndt/gfl036

Cited by 8 publications

(2 citation statements)

References 11 publications

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“…Currently, none of the standards and recommendations include limits for organic chemical contaminants, the rationale for this omission being that organic chemicals with specific toxicity to haemodialysis patients have not been identified and that carbon adsorption and reverse osmosis remove most organic compounds. Recently, however, there has been a reported instance of patient exposure following inadequate removal of such compounds [7] .…”

Section: Standards For Chemical and Microbiological Purity Of Water Amentioning

confidence: 99%

Water for Haemodialysis and Related Therapies: Recent Standards and Emerging Issues

2010

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Dialysis is a well-established and widely used procedure. For a number of years, the focus has been on ensuring that water used in the preparation of dialysis fluid meets the required chemical and microbiological quality and complies with national or international standards which have recently been updated. Continued vigilance is required, in particular when new chemicals such as silver-stabilized hydrogen peroxide and chlorine dioxide are used to prevent growth of Legionella bacteria in hospital water systems, since residues are harmful to patients receiving dialysis. To achieve the required quality, large volumes of water are processed, and a substantial portion is sent to waste via the municipal sewer systems with little attempt to reuse such water on site. In view of concern about global warming and climate change, there is a need to adopt a more environmentally conscious attitude requiring dialysis providers to focus on this aspect of water usage.

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Section: Standards For Chemical and Microbiological Purity Of Water Amentioning

confidence: 99%

Water for Haemodialysis and Related Therapies: Recent Standards and Emerging Issues

2010

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“…Of note, none of the existing standards and recommendations includes limits for specific organic chemical contaminants. The rationale for this omission is that organic chemicals with specific toxicity to hemodialysis That hemodialysis patients may be at risk from organic compounds is evidenced, however, by recent reports from Italy describing contamination of water by organo-halogenated compounds that were not removed by standard hemodialysis water treatment practices, 14,15 including the use of activated carbon and reverse osmosis. The Canadian standard 7 does include a maximum allowable level for total organic carbon (0.5 mg/L); however, it is not clear that meeting this requirement would protect against toxic levels of many organic compounds.…”

Section: Current Water Quality Standards and Recommendationsmentioning

confidence: 99%

Worldwide water standards for hemodialysis

Ward

2007

Hemodialysis International

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Contaminants commonly found in tap water are toxic to hemodialysis patients. To prevent patient injury from these contaminants, standards for the quality of water used to prepare dialysate have been developed. These standards are in general agreement concerning maximum allowable levels of inorganic chemical contaminants known to have adverse consequences for dialysis patients. There is less agreement about inorganic chemical contaminants that may be toxic, and most standards omit any requirements for organic chemical contaminants. There are considerable differences between standards regarding the maximum allowable levels of microbiological contaminants, as well as the methods to be used for measuring them. Harmonization of existing standards may improve patient protection by promoting demonstrated best practices. Harmonization will require innovation and compromise to produce a standard that is widely applicable, provides patients with the necessary safeguards, and whose requirements can be routinely achieved within the constraints imposed by local reimbursement practices.

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