Nephrology Dialysis Transplantation, Vol 14, Issue 3 666-675, Copyright © 1999 by Oxford University Press
I Vorbeck-Meister, R Sommer, F Vorbeck and W Horl
Background. The bacterial and chemical contamination
of dialysate fluids are important problems in haemodialysis therapy and may
be caused by the water used for dialysate preparation. Methods.
We performed a survey of the microbiological and chemical
quality of the water used in seven dialysis wards. Special attention was
paid to the effects of each water treatment step, for example ion exchange,
reverse osmosis and UV disinfection, on the number of bacteria (measured as
colony forming units, CFU), the amount of endotoxin (endotoxin units, EU)
and various chemical parameters, the main focus being on calcium,
magnesium, sulphate, aluminium and heavy metals. Results.
CFU values exceeding the European Pharmacopeia value, determined
at an incubation temperature of 22°C, were found in the samples of
raw water (20.0%, n=25), after ion exchange (66.7%,
n=12), after reverse osmosis (33.3%,
n=18) and also in samples of the dialysis water taken
at the inlets (12.5%, n=40) and outlets (50.0%,
n=18) of the machines. Whereas all raw water samples
from the wards showed high mean values for endotoxin (0.56-9.10 EU/ml) and
the endotoxin levels were often enhanced after ion exchange
(0.13->9.49 EU/ml), treatment by reverse osmosis led to a
satisfactory decrease in endotoxin all samples (<0.03 EU/ml).
Sufficient reductions in calcium, magnesium and sulphate could only be
achieved by the combined application of ion exchange and reverse osmosis.
Mercury contamination was observed in the samples after ion exchange at
three treatment plants, this was possibly caused by polluted regenerants.
Increased amounts of aluminium, copper and zinc were found in water samples
from different sites in the treatment systems and were caused by materials
in contact with the water. Conclusions. A sufficient
chemical water purification treatment system should consist of ion exchange
and reverse osmosis. Attention has to be paid to the suitability of
materials in contact with the water and of the chemicals used, for example
regenerants or corrosion inhibitors. From the microbiological point of
view, a safety UV disinfection step in the water treatment system is
favourable. To avoid bacterial recontamination periodic cleaning and
disinfecting of the water-treatment and distribution systems, as well as
the dialysis machine are essential. There is the need for complete
guidelines regarding dialysis water that include all relevant chemical and
microbiological parameters. Based on this standard, periodic examination of
the water after each treatment step has to be performed.
Keywords: bacteria; chemical parameters; endotoxin;
heavy metals; haemodialysis; water
ORIGINAL ARTICLES
Quality of water used for haemodialysis: bacteriological and chemical parameters
Hygiene Institute, University of Vienna, Kinderspitalgasse 15, A-1095 Vienna, Austria; Department of Radiology 6F and Department of Nephrology and Dialysis, General Hospital, University of Vienna, Vienna, Austria; Corresponding author
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