Water Treatment for Hemodialysis: A 2005 Update

Cappelli, Gianni; Ravera, Federica; Ricardi, Marco; Ballestri, Marco; Perrone, Salvatore; Albertazzi, A

doi:10.1159/000085422

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Although the exact role that biofilms in the water distribution system play is not defined for hemodialysis patients (17), outbreak data demonstrate that it is in the patients' interest to have water and dialysis solutions that are as "microbiologically clean" as possible. Unfortunately, biofilms are highly resistant to disinfectants due to the mixed bacterial community's structure and the formation of exopolysaccharides (EPS).…”

mentioning

confidence: 99%

Hemodialysis and Water Quality

Coulliette

Arduino

2013

Seminars in Dialysis

101

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Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed.

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confidence: 99%

Hemodialysis and Water Quality

Coulliette

Arduino

2013

Seminars in Dialysis

101

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“…The median eGFR was 28.80 mL/min/1.73 m 2 (IQR, 16.20–42.00 mL/min/1.73 m 2 ) and the median BCL was 6.36 nmol/L (IQR, 4.06–9.22 nmol/L). The cadmium levels in the RO water samples from the HD center were all <0.06 nmol/L between 2020 and 2021, far below the American Association for Advancement of Medical Instrumentation standard (<8.90 nmol/L) [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease

Tsai

Hsu

Kung

et al. 2021

IJERPH

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Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroups, including non-dialysis CKD, hypertensive patients, non-smokers, and male patients. In conclusion, female sex, smoking, and CKD stage 5D were the major risk factors for elevated BCL; additionally, statins were negatively associated with BCL in CKD.

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“…Systems should be monitored continuously and the following taken into account [22]: (1) on application of chemical disinfection alone, solutions capable of removing both bacterial biofilms and potential mineral scales that may protect bacteria and/or enhance their survival should be used every 30 days, and (2) daily overnight thermal disinfection should be implemented, and additional monthly or twice monthly disinfection of the osmosis membranes and ring should be undertaken as described above. The authors decided to reduce the interval established by the Italian guidelines for microbiological controls from 4 to 3 months [5] in view of the wide range of seasonal variations.…”

Section: Discussionmentioning

confidence: 99%

The Evolution of Technological Strategies in the Prevention of Dialysis Water Pollution: Sixteen Years’ Experience

et al. 2012

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Aim: This report attempts to illustrate the positive impact on the quality of dialysis water produced over a 16-year period through the progressive optimization of technological procedures. Methods: Fundamental steps included the following: elimination of polyvinyl chloride (PVC), periodical controls, introduction of stainless steel and/or polyethylene polymer and substitution of single-pass reverse osmosis (SRO) with double-pass reverse osmosis (DRO). Daily overnight automatic thermal disinfection of distribution piping rings represented the final step. Results: A dramatic improvement was observed in 645 water samples obtained from distribution piping. The measures applied resulted in a significant improvement of water quality, featuring levels of colony-forming units per milliliter ranging from 247.4 ± 393.7 in the presence of PVC and SRO to 14.1 ± 28.0 with stainless steel and DRO and 2.8 ± 3.2 with cross-linked polyethylene thermoplastic polymer and DRO (p < 0.01). Conclusions: Dialysis water should be viewed by nephrologists as a medicinal product, and every effort should be made to ensure a high-quality liquid.

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Water Treatment for Hemodialysis: A 2005 Update

Cited by 10 publications

References 21 publications

Hemodialysis and Water Quality

Hemodialysis and Water Quality

The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease

The Evolution of Technological Strategies in the Prevention of Dialysis Water Pollution: Sixteen Years’ Experience

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