Water Treatment for Hemodialysis

Ismail, Nuhad; Becker, Bryan N.; Hakim, Raymond M.

doi:10.1159/000168972

Cited by 19 publications

(6 citation statements)

References 38 publications

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“…This water, without the full benefit of water treatment, contained high levels of cyanotoxins that were not removed by the small, inadequately maintained, in-house treatment facility of dialysis center A. This center did not use reverse osmosis in its water treatment process (32,33). Reverse osmosis is used in several dialysis centers in Brazil and in the United States and Europe.…”

Section: Discussionmentioning

confidence: 99%

Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Carmichael¹,

Azevedo²,

An³

et al. 2001

Environmental Health Perspectives

134

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ArticlesAn outbreak of acute liver failure occurred at a dialysis center in Caruaru, Brazil (8°17 ' S, 35°58 ' W), 134 km from Recife, the state capital of Pernambuco. At the clinic, 116 (89%) of 131 patients experienced visual disturbances, nausea, and vomiting after routine hemodialysis treatment on 13-20 February 1996. Subsequently, 100 patients developed acute liver failure, and of these 76 died. As of December 1996, 52 of the deaths could be attributed to a common syndrome now called Caruaru syndrome. Examination of phytoplankton from the dialysis clinic's water source, analyses of the clinic's water treatment system, plus serum and liver tissue of clinic patients led to the identification of two groups of cyanobacterial toxins, the hepatotoxic cyclic peptide microcystins and the hepatotoxic alkaloid cylindrospermopsin. Comparison of victims' symptoms and pathology using animal studies of these two cyanotoxins leads us to conclude that the major contributing factor to death of the dialyses patients was intravenous exposure to microcystins, specifically microcystin-YR, -LR, and -AR. From liver concentrations and exposure volumes, it was estimated that 19.5 µg/L microcystin was in the water used for dialysis treatments. This is 19.5 times the level set as a guideline for safe drinking water supplies by the World Health Organization.

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Section: Discussionmentioning

confidence: 99%

Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Carmichael¹,

Azevedo²,

An³

et al. 2001

Environmental Health Perspectives

134

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“…Several studies have shown the transmembrane crossing of bacterial substances from dialysate to blood compartment either using cellulose low-flux membranes or synthetic high-flux membranes (4,5). Many authors have demonstrated acute pyrogenic reactions and chronic effects when using contaminated dialysate: the bacterial count and the LAL assay performed in water and dialysate are important to avoid risk due to bacterial contamination in the dialysis water (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Microbiological survey of dialysate: Vantage of use of sterile bag concentrate

Pansini¹,

Degaetano²,

Boccassini³

et al. 2001

EDTNA-ERCA Journal

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Haemodialysed patients are exposed to nearly 400 litres of dialysis water weekly. The bacterial contamination of treated dialysate and water induces acute pyrogenic reactions or chronic damage and cytokine activation. The aim of this study was to value the microbiological parameters of dialysis water and dialysate of our monitors by bacterial culture (measured as colony forming units [CFU]) of water samples at 37 degrees C after 48 hours, at 22 degrees C after 72 hours and after seven days, and by measuring endotoxin levels (endotoxin units [EU]). In our centre, there are 16 monitors (6 monitors use sterile dialysate fluid and 10 monitors use non sterile dialysate fluid). The chemicals used for disinfection are chlorine and paracetic acid. Water samples were taken under sterile procedures every three months for a year. No bacteria were found in the samples of water of the dialysis ring; EU were lower than the limit value of 0.25 EU/ml fixed by the European Pharmacopoeia. The concentration of CFU and EU of the dialysate, taken from monitors with a sterile bag, were lower than those of other monitors (p < 0.05 t Student test). However, the levels of CFU/ml and EU/ml of dialysate samples, taken from monitors with a non-sterile bag, were lower than the guideline value of the European Pharmacopoeia (v.n. CFU < 50 CFU/ml and EU < 0.05 EU/ml). Frequent examination of CFU and EU is essential to reduce the damage caused by the use of contaminated water, therefore the goal of future dialytic techniques will be the use of "sterile dialysate".

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“…With Because aluminium sulphate is used to treat municipal supplies, reports of severe bone disease and fatal dialysis encephalopathy have been associated with high levels of aluminium in the water supply (Platts, 1977;Ganzi, 1984;Serrano-Arias, 1995);Ismail, 1996). In 1993, 25 patients in southern Portugal died from severe encephalopathy linked to aluminium intoxication (Stragier 1994).…”

Section: Water Supply -Risks and Hazardsmentioning

confidence: 99%

Forthcoming Papers

Chamney

James

2008

Journal of Renal Care

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This is the accepted version of the paper.This version of the publication may differ from the final published version. However, water quality is an area in which some nurses do not feel confident. PermanentThis article is aimed at providing information about the importance of appropriate water treatment, water testing and monitoring and the implications to the patient if the water is not checked appropriately in accordance with the guidelines.

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Water Treatment for Hemodialysis

Cited by 19 publications

References 38 publications

Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Human Fatalities from Cyanobacteria: Chemical and Biological Evidence for Cyanotoxins

Microbiological survey of dialysate: Vantage of use of sterile bag concentrate

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