Organic contamination in dialysis water: trichloroethylene as a model compound

Water quality in conventional and home haemodialysis

Dialysis water can be contaminated by chemical and microbiological factors, all of which are potentially hazardous to patients on haemodialysis. The quality of dialysis water has seen incremental improvements over the years, with advances in water preparation, monitoring and disinfection methods, and high standards are now readily achievable in clinical practice. Advances in dialysis membrane technology have refocused attention on water quality and its potential role in the bioincompatibility of haemodialysis circuits and adverse patient outcomes. The role of ultrapure dialysate is increasingly being advocated, given its proposed clinical benefits and relative ease of production as a result of the widespread use of reverse osmosis and ultrafiltration. Many of the issues pertaining to water quality in hospital-based dialysis units are also pertinent to haemodialysis in the home. Furthermore, an increased awareness of the environmental and financial consequences of home haemodialysis has resulted in the development of automated and more efficient dialysis machines. These new machines have an increased emphasis on water conservation and recycling along with a decreased need for a complex infrastructure for water purification and maintenance.

Avoiding toxicity from water-borne contaminants in hemodialysis: new challenges in an era of increased demand for water

Water is necessary for all hemodialysis treatments. However, drinking water contains a range of substances that are toxic to patients on hemodialysis. Thus, all dialysis facilities are equipped with a water treatment system that removes those substances from the water before it is used to prepare dialysate. Increased demand for water and ever-evolving drinking water regulations are leading to changes in drinking water quality that may compromise the ability of typical dialysis water treatment systems to adequately remove substances that are known to be toxic or to deal with unexpected increases in other substances of unknown toxicity. In addition to these external challenges to dialysis water quality, the growing recognition that microbial contaminants in dialysate contribute to long-term morbidity has led to more stringent microbiological quality standards for dialysate and a consequent need to control biofilm formation in the fluid pathways involved in dialysate preparation. Avoiding toxicity from water contaminants in this dynamic environment requires a comprehensive approach to water treatment, including flexibility regarding the choice of water treatment processes, close communication with the suppliers of drinking water, and an emphasis on training technicians responsible for monitoring and maintaining all aspects of the fluid handling systems.