1
|
Ghafari S, Alavi SM, Khaghani S. Potentially pathogenic culturable bacteria in hemodialysis waters. BMC Microbiol 2024; 24:276. [PMID: 39054498 PMCID: PMC11270894 DOI: 10.1186/s12866-024-03430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Hemodialysis patients are at risk of acquiring healthcare-related infections due to using non-sterile water to prepare hemodialysis fluid. Therefore, microbiological control and monitoring of used water are of crucial importance. MATERIALS AND METHODS In this work, we identified bacterial populations occupying a hemodialysis water distribution system for almost a 6-month period in Ahvaz city, southwest of Iran. A total of 18 samples from three points were collected. We found high colony counts of bacteria on R2A agar. 31 bacteria with different morphological and biochemical characteristics were identified by molecular-genetic methods based on 16 S rRNA gene sequencing. Endotoxin concentrations were measured, using Endosafe® Rapid LAL Single-Test Vials. RESULTS A diverse bacterial community was identified, containing predominantly Gram-negative bacilli. The most frequently isolated genus was Sphingomonas. Five species including M. fortuitum, M. lentiflavum, M.szulgai, M. barrassiae, and M. gordonae was identified .Despite the presence of Gram-negative bacteria the endotoxin analysis of all samples revealed that their endotoxin values were below the detection limit. CONCLUSION The members of Sphingomonas genus along with Bosea and mycobacteria could be regarded as pioneers in surface colonization and biofilm creation. These bacteria with others like Pelomonas, Bradyrhizobium, staphylococcus, and Microbacterium may represent a potential health risk to patients under hemodialysis treatment.
Collapse
Affiliation(s)
- Shokouh Ghafari
- Cellular and Molecular Research Center, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Seyed Mohammad Alavi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soheila Khaghani
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
2
|
Segev G, Foster JD, Francey T, Langston C, Schweighauser A, Cowgill LD. International renal interest society best practice consensus guidelines for intermittent hemodialysis in dogs and cats. Vet J 2024; 305:106092. [PMID: 38442779 DOI: 10.1016/j.tvjl.2024.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
Intermittent hemodialysis (IHD) is an advanced adjunctive standard of care for severe acute kidney injury (AKI) and other indications. Most animals with AKI are managed medically, however, when the disease is severe, medical management may not control the consequences of the disease, and animals with a potential for renal recovery may die from the consequences of uremia before recovery has occurred. Extracorporeal therapies aid the management of AKI by expanding the window of opportunity for recovery of sufficient kidney function to become dialysis independent. Intermittent hemodialysis (IHD) was introduced into veterinary medicine over 50 years ago, however, updated guidelines for the delivery of IHD have not been published for several decades. To that end, the International Renal Interest Society (IRIS) constituted a Working Group to establish best practice guidelines for the safe and effective delivery of IHD to animals with indications for dialytic intervention. The IRIS Working Group generated 60 consensus statements and supporting rational for a spectrum of prescription and management categories required for delivery of IHD on designated intermittent dialysis platforms (i.e., AKI, chronic hemodialysis and intoxications). A formal consensus method was used to validate the recommendations by a blinded jury of 12 veterinarians considered experts in extracorporeal therapies and actively performing IHD. Each vote provided a level of agreement for each recommendation proposed by the Working Group. To achieve a consensus, a minimum of 75% of the voting participants had to "strongly agree" or "agree" with the recommendation.
Collapse
Affiliation(s)
- Gilad Segev
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel.
| | - Jonathan D Foster
- Department of Nephrology and Urology, Friendship Hospital for Animals, Washington DC, USA
| | - Thierry Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Catherine Langston
- Veterinary Clinical Science, The Ohio State University, Columbus, OH, USA
| | - Ariane Schweighauser
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Larry D Cowgill
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
| |
Collapse
|
3
|
Yüzbaşıoğlu Y, Hazar M, Aydın Dilsiz S, Yücel C, Bulut M, Cetinkaya S, Erdem O, Basaran N. Biomonitoring of Oxidative-Stress-Related Genotoxic Damage in Patients with End-Stage Renal Disease. TOXICS 2024; 12:69. [PMID: 38251024 PMCID: PMC10819997 DOI: 10.3390/toxics12010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
Chronic kidney disease (CKD), a common progressive renal failure characterized by the permanent loss of functional nephrons can rapidly progress to end-stage renal disease, which is known to be an irreversible renal failure. In the therapy of ESRD, there are controversial suggestions about the use of regular dialysis, since it is claimed to increase oxidative stress, which may increase mortality in patients. In ESRD, oxidative-stress-related DNA damage is expected to occur, along with increased inflammation. Many factors, including heavy metals, have been suggested to exacerbate the damage in kidneys; therefore, it is important to reveal the relationship between these factors in ESRD patients. There are very few studies showing the role of oxidative-stress-related genotoxic events in the progression of ESRD patients. Within the scope of this study, genotoxic damage was evaluated using the comet assay and 8-OHdG measurement in patients with ESRD who were undergoing hemodialysis. The biochemical changes, the levels of heavy metals (aluminum, arsenic, cadmium, lead, and mercury) in the blood, and the oxidative biomarkers, including superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels were evaluated, and their relationship with genotoxic damages was revealed. Genotoxicity, oxidative stress, and heavy-metal levels, except mercury, increased significantly in all renal patients. DNA damage, 8OHdG, and MDA significantly increased, and GSH significantly decreased in patients undergoing dialysis, compared with those not having dialysis. The duration and the severity of disease was positively correlated with increased aluminum levels and moderate positively correlated with increased DNA damage and cadmium levels. In conclusion, this study revealed that the oxidative-stress-related DNA damage, and also the levels of Al and Cd, increased in ESRD patients. It is assumed that these changes may play an important role in the progression of renal damage. Approaches for reducing oxidative-stress-related DNA damage and heavy-metal load in ESRD patients are recommended.
Collapse
Affiliation(s)
- Yücel Yüzbaşıoğlu
- Department of Emergency Medicine, Ankara Gülhane Training and Research Hospital, Health Sciences University, Ankara 06018, Türkiye
| | - Merve Hazar
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Ağrı İbrahim Cecen University, Ağrı 04100, Türkiye;
| | - Sevtap Aydın Dilsiz
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara 06100, Türkiye;
| | - Ciğdem Yücel
- Department of Clinical Biochemistry, Ankara Gülhane Training and Research Hospital, Health Sciences University, Ankara 06018, Türkiye;
| | - Mesudiye Bulut
- Department of Nephrology, Ankara Gülhane Training and Research Hospital, Health Sciences University, Ankara 06018, Türkiye;
| | - Serdar Cetinkaya
- Department of Pharmaceutical Toxicology, Gülhane Faculty of Pharmacy, Health Sciences University, Ankara 06018, Türkiye; (S.C.); (O.E.)
| | - Onur Erdem
- Department of Pharmaceutical Toxicology, Gülhane Faculty of Pharmacy, Health Sciences University, Ankara 06018, Türkiye; (S.C.); (O.E.)
| | - Nursen Basaran
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Başkent University, Ankara 06790, Türkiye;
| |
Collapse
|
4
|
Phua E, Shen Y. The climate impact of dialysis. Curr Opin Nephrol Hypertens 2024; 33:97-101. [PMID: 37889560 DOI: 10.1097/mnh.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW A reciprocal relationship currently exists between climate change and healthcare, mutually influencing each other. There have been significant planetary shifts in recent decades, marked by escalating temperatures, frequent natural calamities, a disturbing surge in climate-linked fatalities, and a heightened incidence of kidney disease diagnoses. RECENT FINDINGS Dialysis, a life-preserving treatment for kidney failure, extends to 2-3 million patients globally, mainly through in-centre haemodialysis. This treatment exerts an environmental toll, contributing to the healthcare sector's carbon footprint through water usage, energy consumption, waste generation, and current procurement practices. Diligent scrutiny and data collection of these facets have spurred sustainability initiatives, beginning at the local level with water, energy, and waste management. Still, this represents just the tip of the iceberg, with a pressing need for more comprehensive and habitual sustainable dialysis practices. SUMMARY This review examines the carbon footprint from dialysis, probes its ecological ramifications, and underscores potential solutions to lessen its climate impact.
Collapse
Affiliation(s)
- Elaine Phua
- Renal Department, Royal North Shore Hospital
| | - Yvonne Shen
- Renal Department, Royal North Shore Hospital
- Sydney Dialysis Centre, Herbert Street, St Leonards
- University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
5
|
Raimundo R, Preciado L, Belchior R, Almeida CMM. Water quality and adverse health effects on the hemodialysis patients: An overview. Ther Apher Dial 2023; 27:1053-1063. [PMID: 37381091 DOI: 10.1111/1744-9987.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
Hemodialysis is considered a treatment of choice for patients with renal failure worldwide, allowing the replacement of some kidney functions by diffusion and ultrafiltration processes. Over 4 million people require some form of renal replacement therapy, with hemodialysis being the most common. During the procedure, contaminants in the water and the resulting dialysate may pass into the patient's blood and lead to toxicity. Thus, the quality of the associated dialysis solutions is a critical issue. Accordingly, the discussion of the importance of a dialysis water delivery system controlled by current standards and recommendations, with efficient monitoring methods, disinfection systems, and chemical and microbiological analysis, is crucial for improving the health outcomes of these patients. The importance of treatment, monitoring, and regulation is emphasized by presenting several case studies concerning the contamination of hemodialysis water and the adverse effects on the respective patients.
Collapse
Affiliation(s)
- Raquel Raimundo
- Laboratory of Bromatology and Water Quality, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Laura Preciado
- Laboratory of Bromatology and Water Quality, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Rita Belchior
- Laboratory of Bromatology and Water Quality, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Cristina M M Almeida
- Laboratory of Bromatology and Water Quality, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
- iMed.UL (Institute for Medicines and Pharmaceutical Sciences, Portugal), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| |
Collapse
|
6
|
Engelen MM, Verhamme P, Vanassche T. Clotting of the Extracorporeal Circuit in Hemodialysis: Beyond Contact-Activated Coagulation. Semin Nephrol 2023; 43:151473. [PMID: 38233291 DOI: 10.1016/j.semnephrol.2023.151473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Thrombotic complications in patients with end-stage kidney disease are frequent. While being a lifesaving treatment for these patients, hemodialysis introduces a thromboinflammatory environment. Additionally, the extracorporeal hemodialysis circuit itself is prone to clotting because of an interaction between different activation mechanisms of the coagulation system, platelets, and the immune system. Anticoagulation of the patient and the machine is frequently complicated by bleeding. We discuss the factors important in this balancing act and touch on potential strategies that are on the horizon to target thromboinflammation.
Collapse
Affiliation(s)
- Matthias M Engelen
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| |
Collapse
|
7
|
AKTAŞ A, ÖZER H, BALOĞLU İ, TONBUL HZ, GÜNEY İ, SELÇUK NY. Individualized hemodialysis: Is similar hemodialysis adequacy possible using less water? Turk J Med Sci 2023; 53:1863-1869. [PMID: 38813487 PMCID: PMC10760548 DOI: 10.55730/1300-0144.5756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/12/2023] [Accepted: 10/10/2023] [Indexed: 05/31/2024] Open
Abstract
Background and aim There are over 60,000 hemodialysis (HD) patients in Türkiye, and the number of patients is increasing yearly. Dialysate flow rate (Qd) is a factor in HD adequacy. Approximately 150 L of water are consumed per session to prepare the dialysate. We aimed to investigate whether HD effectiveness can be achieved at a low Qd in different patient groups for the purpose of saving water. Materials and methods This prospective study included 81 HD patients from 2 centers. The patients underwent an aggregate total of 486 HD sessions, including 3 sessions at a Qd of 500 mL/min and 3 sessions at a Qd of 300 mL/min for each patient. We used online Kt/V readings recorded at the end of each dialysis session to compare the effectiveness of these 2 types of HD session performed at a different Qd. Results The online Kt/V readings were similar between the standard (500) and low (300) Qd HD (1.51 ± 0.41 and 1.49 ± 0.44, respectively, p = 0.069). In the subgroup analyses, men had higher online Kt/V values at the standard Qd compared to the low Qd (1.35 ± 0.30 and 1.30 ± 0.32, respectively, p = 0.019), but the Kt/V values were not different for women. While the low Qd did not reduce online Kt/V in patients using small surface area dialysis membranes (1.75 ± 0.35 for 300 Qd and 1.75 ± 0.32 for 500 Qd, p = 0.931), it was associated with reduced online Kt/V in patients using large surface area dialysis membranes (1.12 ± 0.25 for 300 Qd and 1.17 ± 0.24 for 500 Qd, p = 0.006). The low Qd did not result in differences in online Kt/V among low-weight patients. However, online Kt/V values were better with the standard Qd in patients weighing 65 kg and above. Conclusion In our study, dialysis adequacy at a reduced dialysate flow was not inferior for women, patients with low body weight, or patients using small surface area membranes. Individualized HD at a reduced Qd of 300 mL/min in eligible patients can save 48 L of water per HD session and an average of 7500 L of water per year.
Collapse
Affiliation(s)
- Ali AKTAŞ
- Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya,
Turkiye
| | - Hakan ÖZER
- Division of Nephrology, Department of Internal Medicine, Konya City Hospital, Konya,
Turkiye
| | - İsmail BALOĞLU
- Division of Nephrology, Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya,
Turkiye
| | - Halil Zeki TONBUL
- Division of Nephrology, Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya,
Turkiye
| | - İbrahim GÜNEY
- Division of Nephrology, Department of Internal Medicine, Konya City Hospital, Konya,
Turkiye
| | - Nedim Yılmaz SELÇUK
- Division of Nephrology, Department of Internal Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, Konya,
Turkiye
| |
Collapse
|
8
|
Tange Y, Murata A, Yoshitake S. Efficacy of combined disinfection with a nitric oxide donor in controlling biofilm formation on the reverse osmosis water pathway for hemodialysis. JOURNAL OF WATER AND HEALTH 2023; 21:1591-1599. [PMID: 37902212 PMCID: wh_2023_220 DOI: 10.2166/wh.2023.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The water treatment system for hemodialysis (HD) is used to treat multiple patients requiring HD simultaneously. This system requires a large amount of purified reverse osmosis (RO) water. However, a major drawback of this method is the formation of biofilms in dialysate pathways. The purpose of this study was to investigate the efficacy of NOC 18, a nitric oxide (NO) donor that can be used at neutral pH, in disinfecting the RO water pathway. Silicone tubes were obtained from the terminal sites of two different HD units. The biofilm coverage and mean biofilm thickness on the tube lumen were evaluated by scanning electron microscopy. The results demonstrated that treatment with NOC 18 alone and in conjunction with sodium hypochlorite reduced biofilm coverage and mean biofilm thickness. Thus, NO donor is a potential disinfectant that enhances bacterial dispersion from biofilms formed on the silicone tube lumen and reduces biofilm coverage and thickness on the RO water pathway at neutral pH. Furthermore, combined disinfection with the NO donor and sodium hypochlorite might enhance biofilmremoval efficacy in clinical practice.
Collapse
Affiliation(s)
- Yoshihiro Tange
- Department of Advanced Medical Sciences, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan E-mail:
| | - Ayane Murata
- Department of Medical Engineering, Kyushu University of Health and Welfare, 1714-1 Yoshinomachi, Nobeoka City, Miyazaki 882-8508, Japan
| | - Shigenori Yoshitake
- Department of Clinical Psychology, Kyushu University of Health and Welfare, 1714-1 Yoshinomachi, Nobeoka City, Miyazaki 882-8508, Japan
| |
Collapse
|
9
|
Mishra P, Rai PK, Kumar R, Maniyar V, Rai AK. Monitoring of minerals level in dialysate during hemodialysis treatment of kidney patients using LIBS technique. Lasers Med Sci 2023; 38:165. [PMID: 37481478 DOI: 10.1007/s10103-023-03826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
Chronic kidney patients may have difficulties in blood filtration to eliminate the waste from the blood and to maintain the level of the minerals in the blood. Hemodialysis (HD) is an artificial way to remove the waste from the blood of a kidney patient and to maintain the proper mineral level in the blood. Reverse osmosis (RO) water having less total dissolved solids (TDS) < 50 ppm is used to prepare dialysis fluid/dialysate in dialysis with two chemicals (electrolytes and salts such as sodium bicarbonate). To check the purity of RO water from various RO machines used to prepare dialysate, which is vital for the safety of the patient, the laser-induced breakdown spectroscopy (LIBS) technique has been used. Also, the amount of replacement of electrolytes/minerals between the blood of the patient and dialysate after dialysis has been checked/determined for two different machines: hemodialysis machine (HDM) and on-line hemo-dia filtration machine (on-line HDF machine). It is observed that the proper amount of electrolytes (Na, Ca, and Mg) are maintained/normalized (depending upon patient's need), excess K is removed, and excess urea and creatinine is removed continuously from the blood of a patient during dialysis treatment which is essential for the better health of a kidney patient. Our results show that the RO water used in on-line HDF machine is purer (i.e., ultrapure); therefore, the quality of life of a kidney patient may be better if dialysis is performed with the on-line HDF machine. The experimental results also show that the filtration capacity of the dialyzer decreases after reusing it many times for dialysis treatment.
Collapse
Affiliation(s)
- Pratima Mishra
- Department of Physics University of Allahabad, 211002, Prayagraj, India
| | - Pradeep Kumar Rai
- Opal Hospital, Department of Nephrology, Uttar Pradesh, 221006, Varanasi, India
| | - Rohit Kumar
- Department of Physics, C.M.P. Degree College, University of Allahabad, Prayagraj, 211002, India
| | | | - Awadhesh Kumar Rai
- Department of Physics University of Allahabad, 211002, Prayagraj, India.
| |
Collapse
|
10
|
Raad Humudat Y, Kadhim Al-Naseri S. Assessment of endotoxin levels of water in hemodialysis centers in Iraq. BIONATURA 2023. [DOI: 10.21931/rb/2023.08.01.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
The significance of endotoxin-free, sterile dialysis fluid for long-term, high-quality hemodialysis treatment is obvious and highly desired[MF1] . The current study aimed to determine endotoxin for the water quality used in twenty hemodialysis treatment centers. Eighty samples (40 x dialysates and 40 x dialysis water) were tested for endotoxin using the LAL gel clot method. The results revealed a variation in the quality of the produced water that makes it unaccepted compared to the international standard (ANSI/AAMI/ISO-23500). Endotoxin levels were higher than (0.25 EU/ml) in 40% of dialysis water and 30% of dialysate water, higher than the recommended international standards. The results conclude that systematic water quality monitoring in hemodialysis services is essential for patient safety and health problems.
Keywords: Endotoxin; Water quality; Dialysis fluid; LAL test; Hemodialysis patient
Collapse
Affiliation(s)
- Yasamen Raad Humudat
- Environment and Water Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | | |
Collapse
|
11
|
Novakova G, Bonev P, Duro M, Azevedo R, Couto C, Pinto E, Almeida A. Serum Iodine and Bromine in Chronic Hemodialysis Patients-An Observational Study in a Cohort of Portuguese Patients. TOXICS 2023; 11:247. [PMID: 36977012 PMCID: PMC10053604 DOI: 10.3390/toxics11030247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Background: Patients on chronic hemodialysis therapy are at high risk of disturbances in trace element status due to both the underlying disease and the hemodialysis process itself. Data on iodine and bromine levels in these patients are scarce. Methods: Using an ICP-MS analytical procedure, serum iodine and bromine levels were determined in a cohort (n = 57) of end-stage renal disease patients on chronic hemodialysis. The results were compared with those of a control group (n = 59). Results: Hemodialysis patients presented serum iodine levels within the normal range, slightly lower than in controls, but without reaching a statistically significant difference (67.6 ± 17.1 µg/L vs. 72.2 ± 14.8 µg/L; p = 0.1252). In contrast, serum bromine levels were much lower in patients (1086 ± 244 µg/L vs. 4137 ± 770 µg/L; p < 0.0001), at values only about 26% of the values observed in controls. Conclusions: Hemodialysis patients had normal serum iodine levels, but highly decreased serum bromine levels. The clinical significance of this finding requires further investigation, but it may be associated with sleep disturbances and fatigue that affect hemodialysis patients.
Collapse
Affiliation(s)
- Gergana Novakova
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Presian Bonev
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Mary Duro
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- FP-ENAS—Fernando Pessoa Energy, Environment and Health Research Unit, Fernando Pessoa University, 4249-004 Porto, Portugal
- Laboratório de Análises Clínicas Dra. Matilde Sampaio, 5200-216 Mogadouro, Portugal
- Laboratório de Análises Clínicas Vale do Sousa, 4560-547 Penafiel, Portugal
| | - Rui Azevedo
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Cristina Couto
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- TOXRUN—Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585-116 Gandra, Portugal
| | - Edgar Pinto
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Environmental Health, ESS, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Agostinho Almeida
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| |
Collapse
|
12
|
Naderi B, Attar HM, Mohammadi F. Evaluation of Some Chemical Parameters of Hemodialysis Water: A Case Study in Iran. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221132751. [PMID: 36337088 PMCID: PMC9629571 DOI: 10.1177/11786302221132751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND One of the most common diseases in the world is kidney failure, which can lead to the death of patients. Hemodialysis is a treatment for patients whose kidneys are failing. The water used to perform dialysis must be healthy, safe, and clean. This study aimed to investigate the concentration of heavy metals in hemodialysis water in one of the Hospitals in Iran and compare it with European Pharmacopeia (EPH) and Association for the Advancement of Medical Instrumentation (AAMI) standards. METHODS The present study is a descriptive-analytical study conducted on the inlet water of hemodialysis machines in hospital. The samples were collected for 3 months from June to September 2021, Which was examined in terms of free residual chlorine, electrical conductivity, pH, and calcium, magnesium, sodium, aluminum, zinc, copper, and lead concentration. Metals concentration in hemodialysis water was measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) technique. RESULTS The average value of parameters such as electrical conductivity, pH, residual free chlorine, sodium, calcium, magnesium, zinc, copper and lead in the hemodialysis water was less than the AAMI and EPH standards limits. There was a significant difference at the 95% confidence level with the standard limits, but the aluminum concentration was higher than the standard limits. Also, by examining the medical files of dialysis patients, the most observed problems were anemia and bone diseases, which are probably caused by exposure to high concentrations of aluminum in hemodialysis water. CONCLUSION In present study the aluminum concentration is higher than the standard limits. Considering that the higher aluminum concentration can cause diseases such as anemia, bone diseases, nervous deterioration, and death in hemodialysis patients, therefore, it is recommended to continuously evaluate and monitor the quality of hemodialysis water and the performance of its treatment system.
Collapse
Affiliation(s)
- Babak Naderi
- School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Movahedian Attar
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Mohammadi
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Environment Research Center, Research Institute for Primordial Prevention of Non-communicable disease, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
13
|
Pakkaner E, Orton JL, Campbell CG, Hestekin JA, Hestekin CN. Development of an Integrated Salt Cartridge-Reverse Electrodialysis (Red) Device to Increase Electrolyte Concentrations to Biomedical Devices. MEMBRANES 2022; 12:990. [PMID: 36295749 PMCID: PMC9609955 DOI: 10.3390/membranes12100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Emerging technologies in nanotechnology and biomedical engineering have led to an increase in the use of implantable biomedical devices. These devices are currently battery powered which often means they must be surgically replaced during a patient's lifetime. Therefore, there is an important need for a power source that could provide continuous, stable power over a prolonged time. Reverse electrodialysis (RED) based biopower cells have been previously used to generate continuous power from physiologically relevant fluids; however, the low salinity gradient that exists within the body limited the performance of the biopower cell. In this study, a miniaturized RED biopower cell design coupled with a salt cartridge was evaluated for boosting the salt concentration gradient supplied to RED in situ. For the salt cartridge, polysulfone (PSf) hollow fibers were prepared in-house and saturated with NaCl solutions to deliver salt and thereby enhance the concentration gradient. The effect of operational parameters including solution flow rate and cartridge salt concentration on salt transport performance was evaluated. The results demonstrated that the use of the salt cartridge was able to increase the salt concentration of the RED inlet stream by 74% which in turn generated a 3-fold increase in the open circuit voltage (OCV) of the biopower cell. This innovative adaptation of the membrane-based approach into portable power generation could help open new pathways in various biomedical applications.
Collapse
Affiliation(s)
- Efecan Pakkaner
- Ralph E. Martin Department of Chemical Engineering, University of Arkansas, 800 W. Dickson St., BELL 3202, Fayetteville, AR 72701, USA
| | - Jessica L. Orton
- Department of Biomedical Engineering, University of Arkansas, John A. White, Jr. Engineering Hall, 790 W. Dickson St. Suite 120, Fayetteville, AR 72701, USA
| | - Caroline G. Campbell
- Ralph E. Martin Department of Chemical Engineering, University of Arkansas, 800 W. Dickson St., BELL 3202, Fayetteville, AR 72701, USA
| | - Jamie A. Hestekin
- Ralph E. Martin Department of Chemical Engineering, University of Arkansas, 800 W. Dickson St., BELL 3202, Fayetteville, AR 72701, USA
| | - Christa N. Hestekin
- Ralph E. Martin Department of Chemical Engineering, University of Arkansas, 800 W. Dickson St., BELL 3202, Fayetteville, AR 72701, USA
| |
Collapse
|
14
|
Igomu EM, Ige EO, Adesina OA. Coupled modeling and process optimization in a genetic-algorithm paradigm for reverse osmosis dialysate production plant. SOUTH AFRICAN JOURNAL OF CHEMICAL ENGINEERING 2022. [DOI: 10.1016/j.sajce.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
15
|
Backman L, Dumigan DG, Oleksiw M, Carusillo E, Patel PR, Nguyen DB, Moulton-Meissner H, Boyce JM. A Cluster of Gram-Negative Bloodstream Infections in Connecticut Hemodialysis Patients Associated with Contaminated Wall Boxes and Prime Buckets. Am J Infect Control 2022; 51:638-643. [PMID: 35970421 DOI: 10.1016/j.ajic.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Maintenance hemodialysis (HD) patients are at increased risk of bloodstream infections (BSI). We investigated a cluster of Delftia acidovorans infections among patients undergoing HD at an outpatient unit (Facility A). METHODS A case was defined as a Facility A HD patient with ≥1 culture positive for Delftia acidovorans between February 1 - April 30, 2018. An investigation included review of patient records, facility policies, practice observations, and environmental cultures. RESULTS The cluster included two patients with confirmed D. acidovorans BSI. Both patients had recently been dialyzed at Station #2, where a wall box culture yielded D. acidovorans. One patient also had a BSI due to Enterobacter asburiae, which was recovered from several other wall boxes and saline prime buckets (SPB). Observations revealed leakage of wastewater from wall boxes onto the floor, and that SPBs were not always disinfected and dried appropriately before reuse. Multiple deficiencies in hand hygiene and station disinfection were observed. No deficiencies in water treatment practices were identified, and water cultures were negative for the observed pathogens. CONCLUSIONS The cluster of D. acidovorans infections was most likely due to indirect exposures to contaminated wall boxes and possibly SPBs due to poor hand hygiene and station disinfection.
Collapse
Affiliation(s)
| | | | | | | | - Priti R Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Duc B Nguyen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
16
|
Elias MA, Van Damme W, Wouters E. Accessibility and quality of haemodialysis services in an urban setting in South India: a qualitative multiperspective study. BMJ Open 2022; 12:e052525. [PMID: 35131824 PMCID: PMC8823140 DOI: 10.1136/bmjopen-2021-052525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the accessibility and quality of existing haemodialysis services in an urban setting. SETTING The study was conducted in Bangalore city, India. PARTICIPANTS A total of 28 stakeholders including 2 nephrologists, 7 duty doctors, 13 dialysis technicians and 6 patients on long-term haemodialysis were selected from 20 dialysis centres in Bangalore city. DESIGN AND METHODS Qualitative study using in-depth interviews. A thematic analysis was done using the Availability, Accessibility, Acceptability and Quality Framework of WHO and the Bruce's Quality of Care Framework. RESULTS The study found several gaps with regard to the access and quality of existing services for patients with end-stage kidney disease (ESKD). The charges for dialysis sessions across settings displayed a wide variance. Patients often started dialysis services in private and later shifted to government and non-governmental organisations-run centres and reduced the number of weekly dialysis sessions due to financial constraints. Most standalone dialysis centres did not have the facilities to manage any emergencies. Most centres did not admit patients with hepatitis or HIV. The quality of care in dialysis centres seemed to be variable and most centres were managed solely by dialysis technicians. There were no psychosocial interventions available to the patients irrespective of the settings. Cost-cutting practices such as employing underqualified technicians, reusing dialysis equipment and using substandard water for dialysis were common. CONCLUSION The study highlights the need for more financial and personnel investments in ESKD care in India to ensure optimal care for the growing patient population. The study points towards the need for comprehensive management practices, including diet counselling and psychosocial support. While there are comprehensive guidelines on the establishment and management of dialysis services, more policy attention needs to be on effective implementation of these, to ensure better accessibility and quality of existing services.
Collapse
Affiliation(s)
- Maya Annie Elias
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
17
|
Anversa L, Romani CD, Caria ES, Saeki EK, Nascentes GAN, Garbelotti M, Stancari RCA, Dantas STA, Rall VLM, Ruiz LS, Camargo CH, Richini-Pereira VB. Quality of dialysis water and dialysate in hemodialysis centers: highlight for occurrence of non-fermenting gram-negative bacilli. J Appl Microbiol 2022; 132:3416-3429. [PMID: 35108426 DOI: 10.1111/jam.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from hemodialysis centers. METHODS AND RESULTS Samples were fortnightly collected from three hemodialysis centers in Bauru City, Brazil, between July/2017 and June/2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulfate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity, and genetic similarity among some isolated NFGNB. Of the analyzed samples, only 4/72 (5.6%) had conductivity values ≥ 10 mS/cm, 4/216 (1.9%) presented total coliforms, and 1/216 (0.5%) had heterotrophic bacteria count > 100 CFU/mL. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified microorganisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating persistence of bacterial clones in the systems over time. CONCLUSIONS NFGNB were observed in several dialysis water and dialysate samples from all investigated centers, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY Regular inclusion of actions for NFGNB control and monitoring in hemodialysis fluids are suggested for greater safety of the dialytic process.
Collapse
Affiliation(s)
- L Anversa
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C D Romani
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E S Caria
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E K Saeki
- Adolfo Lutz Institute, Regional Laboratories Center Presidente Prudente, Presidente Prudente, Brazil
| | - G A N Nascentes
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Uberaba, Brazil
| | - M Garbelotti
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - R C A Stancari
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - S T A Dantas
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - V L M Rall
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - L S Ruiz
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C H Camargo
- Adolfo Lutz Institute, Central Laboratory, São Paulo, Brazil
| | | |
Collapse
|
18
|
Carvalho GC, Dua K, Gupta G, Bugno A, Pinto TDJA. Reflection about the hemodialysis water microbiological quality in Brazil. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Kamal Dua
- The University of Newcastle, Australia; Hunter Medical Research Institute, Australia; University of Technology Sydney, Australia
| | | | | | | |
Collapse
|
19
|
Sturmer FDCR, Moreira PR, Cargnelutti JF, Lopes LQS, Lorenzett E, Burgo TADL, Santos RCV. Detection and characterization of Bacillus cereus isolated from the dialysis fluid. Rev Inst Med Trop Sao Paulo 2022; 64:e67. [DOI: 10.1590/s1678-9946202264067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
|
20
|
Bowry SK, Kircelli F, Nandakumar M, Vachharajani TJ. Clinical relevance of abstruse transport phenomena in haemodialysis. Clin Kidney J 2021; 14:i85-i97. [PMID: 34987788 PMCID: PMC8711756 DOI: 10.1093/ckj/sfab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
Haemodialysis (HD) utilizes the bidirectional properties of semipermeable membranes to remove uraemic toxins from blood while simultaneously replenishing electrolytes and buffers to correct metabolic acidosis. However, the nonspecific size-dependent transport across membranes also means that certain useful plasma constituents may be removed from the patient (together with uraemic toxins), or toxic compounds, e.g. endotoxin fragments, may accompany electrolytes and buffers of the dialysis fluids into blood and elicit severe biological reactions. We describe the mechanisms and implications of these undesirable transport processes that are inherent to all HD therapies and propose approaches to mitigate the effects of such transport. We focus particularly on two undesirable events that are considered to adversely affect HD therapy and possibly impact patient outcomes. Firstly, we describe how loss of albumin (and other essential substances) can occur while striving to eliminate larger uraemic toxins during HD and why hypoalbuminemia is a clinical condition to contend with. Secondly, we describe the origins and mode of transport of biologically active substances (from dialysis fluids with bacterial contamination) into the blood compartment and biological reactions they elicit. Endotoxin fragments activate various proinflammatory pathways to increase the underlying inflammation associated with chronic kidney disease. Both phenomena involve the physical as well as chemical properties of membranes that must be selected judiciously to balance the benefits with potential risks patients may encounter, in both the short and long term.
Collapse
Affiliation(s)
- Sudhir K Bowry
- Dialysis-at-Crossroads (D@X) Advisory, Bad Nauheim, Germany
| | - Fatih Kircelli
- Global Medical Information and Education, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Tushar J Vachharajani
- Department of Hypertension and Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
21
|
Chang SP, Jiang HL, Wang YC, Chao HC, Lee JJ, Chung HC, Wang LS, Ding DC. A program to improve the quality of dental unit water in a medical center. Medicine (Baltimore) 2021; 100:e28019. [PMID: 34964798 PMCID: PMC8615353 DOI: 10.1097/md.0000000000028019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
The water quality of dental unit waterlines (DUWLs) is associated with patient safety. No program for DUWL water quality improvement has been formulated since the time they were established 20 years ago. This study provides an improvement program for the quality of dental unit water. The improvement program was implemented step by step: discharge of DUWLs for 5 minutes in the morning before clinical service to flush out the water left in the pipeline overnight; weekly disinfection of the handpiece connector with 75% alcohol and replacement of the old connector when the water quality of the same dental chair unit (DCU) was continuously found to be unqualified; monthly disinfection of the water supply system and pipeline; and establishment of DCU maintenance work standards and staff education and training. From 2016 to 2018, the water quality of 18 DCUs was tested by microorganism culture. The colonies >200 colony forming unit were categorized as unqualified. This program was divided into a pre-test phase, Phase 1, a maintenance phase, and Phase 2. A Chi-square test was used to calculate the difference of unqualified water quality numbers between each phase of the improvement program. In the pre-test phase, the water quality rate (high quality number/high-quality number + low-quality number) was 58.3%. In Phase 1, the quality rate before and after the intervention was 64.8% (35/54) and 92.2% (83/90) (P < .001), respectively. After Phase 1, the quality rate reached 100%. However, the quality rate dropped to 75% during the maintenance phase. Then, we proceeded into Phase 2 of the improvement program by further monthly disinfection to DUWLs. In Phase 2, the quality rate was 62/73 (84.9%) and improved to 142/144 (98.6%) after the intervention (P < .001). The quality rate reached 100% once again and was maintained at 100% thereafter. In conclusion, the 4 steps of the improvement program improved the water quality of the DUWL, which is important for patient safety.
Collapse
Affiliation(s)
- Su-Ping Chang
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Hui-Li Jiang
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Yun-Cheng Wang
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Hui-Chen Chao
- Department of Laboratory Examination, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Jen-Jyh Lee
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Hui-Chun Chung
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Lih-Shinn Wang
- Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
22
|
Jesus PRD, Ferreira JAB, Carmo JDS, Albertino SRG, Vicentini Neto SA, Santos LMGD, Zamith HPDS. Monitoring the quality of the water used in mobile dialysis services in intensive care units in the city of Rio de Janeiro. ACTA ACUST UNITED AC 2021; 44:32-41. [PMID: 34314476 PMCID: PMC8943875 DOI: 10.1590/2175-8239-jbn-2020-0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
Introduction: Monitoring water quality in mobile dialysis (MD) services, assessing critical points and characterizing the risks inherent in the process, is essential to avoid risks to the patient's health. This study evaluated the microbiological quality of water in the MD of 36 hospitals with intensive treatment in the city of Rio de Janeiro. Methods: 204 water samples were collected from the points of entry to the network (NET), post-osmosis (PO) and dialysis solution (DS). The samples were evaluated for heterotrophic bacteria count, pathogen search, presence of endotoxins and aluminum content. Results: Bacterial contamination at 3 collection points in 36 hospitals was 30% (32/108); 42% from DS, 31% from PO and 17% from NET, with the presence of Pseudomonas aeruginosa, Stenotrophomonas maltophilia , Burkholderia cepacia and Ralstonia pickettii in the 3 points. Endotoxin concentrations above 0.25 EU/mL occurred in 77% of the samples (17/22) analyzed in the PO. In the aluminum content, values above 0.01 mg/L were presented in 47% (7/15) of PO samples and 27% (4/15) of NET samples. There is no specific legislation for water used in the MD; therefore, the limits of the RDC of the National Health Surveillance Agency (Anvisa) 11/2014 were used; which regulates conventional hemodialysis services. Conclusion: The results highlight the importance of evaluating water quality in MD services to ensure patient safety and support the sanitary monitoring of this process as a healthcare promoter.
Collapse
Affiliation(s)
| | | | - Juliana Dos Santos Carmo
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde, Rio de Janeiro, RJ, Brasil
| | | | | | | | | |
Collapse
|
23
|
Yiek WK, Coenen O, Nillesen M, van Ingen J, Bowles E, Tostmann A. Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review. Antimicrob Resist Infect Control 2021; 10:77. [PMID: 33971944 PMCID: PMC8108015 DOI: 10.1186/s13756-021-00935-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 04/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in hospitalized patients. Water in the environment can be a source of infection linked to outbreaks and environmental transmission in hospitals. Water safety in hospitals remains a challenge. This article has summarized available scientific literature to obtain an overview of outbreaks linked to water-containing hospital equipment and strategies to prevent such outbreaks. METHODS We made a list of water-containing hospital equipment and devices in which water is being used in a semi-closed circuit. A literature search was performed in PubMed with a search strategy containing the names of these medical devices and one or more of the following words: outbreak, environmental contamination, transmission, infection. For each medical device, we summarized the following information: the function of the medical device, causes of contamination, the described outbreaks and possible prevention strategies. RESULTS The following water-containing medical equipment or devices were identified: heater-cooler units, hemodialysis equipment, neonatal incubators, dental unit waterlines, fluid warmers, nebulizers, water traps, water baths, blanketrol, scalp cooling, and thermic stimulators. Of the latter three, no literature could be found. Of all other devices, one or more outbreaks associated with these devices were reported in the literature. CONCLUSIONS The water reservoirs in water-containing medical devices can be a source of microbial growth and transmissions to patients, despite the semi-closed water circuit. Proper handling and proper cleaning and disinfection can help to reduce the microbial burden and, consequently, transmission to patients. However, these devices are often difficult to clean and disinfect because they cannot be adequately opened or disassembled, and the manufacturer's cleaning guidelines are often not feasible to execute. The development of equipment without water or fluid containers should be stimulated. Precise cleaning and disinfection guidelines and instructions are essential for instructing healthcare workers and hospital cleaning staff to prevent potential transmission to patients.
Collapse
Affiliation(s)
- Wing-Kee Yiek
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Coenen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mayke Nillesen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edmée Bowles
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
| |
Collapse
|
24
|
Lopes LG, Csonka LA, Castellane JAS, Oliveira AW, de Almeida-Júnior S, Furtado RA, Tararam C, Levy LO, Crivellenti LZ, Moretti ML, Giannini MJSM, Pires RH. Disinfectants in a Hemodialysis Setting: Antifungal Activity Against Aspergillus and Fusarium Planktonic and Biofilm Cells and the Effect of Commercial Peracetic Acid Residual in Mice. Front Cell Infect Microbiol 2021; 11:663741. [PMID: 33996634 PMCID: PMC8116949 DOI: 10.3389/fcimb.2021.663741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aspergillus and Fusarium cause a broad spectrum of infections in humans, mainly in immunocompromised patients. Among these, patients undergoing hemodialysis are highly susceptible to infections, requiring a constant and adequate environmental disinfection program. Nevertheless, monitoring the residual disinfectants can contribute to the morbidity and mortality reduction in these patients. Here, we evaluated the susceptibility of Aspergillus spp. (n=19) and Fusarium spp. (n=13) environmental isolates against disinfectants (acetic acid, citric acid, peracetic acid, sodium hypochlorite, and sodium metabisulphite) at different concentrations and time exposures. Also, we investigated the in vivo toxicity of the peracetic acid residual concentration in mice. Fusarium isolates were identified by F. equiseti, F. oxysporum and F. solani while Aspergillus presented clinically relevant species (A. fumigatus, A. niger and A. terreus) and environmental ones. Against planktonic cells, only two disinfectants (acetic acid and sodium hypochlorite) showed a fungicidal effect on Fusarium spp., while only one (sodium hypochlorite) was effective against Aspergillus spp. Both fungi formed robust in vitro biofilms with large amounts of the extracellular matrix, as evidenced by electron micrographs. Exposure of fungal biofilms to disinfectants showed sensitivity to three (acetic, citric, and peracetic acids), although the concentrations and times of exposure varied according to the fungal genus. Mice exposure to the residual dose of peracetic acid during 60 weeks showed anatomopathological, hematological, and biochemical changes. The implementation of news control measures and those that already exist can help reduce infections, the second cause of death and morbidity in these patients, besides providing safety and well-being to them, a priority of any quality health program.
Collapse
Affiliation(s)
- Leonardo G. Lopes
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | - Larissa A. Csonka
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| | | | | | | | | | - Cibele Tararam
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | - Regina H. Pires
- Postgraduate Program in Health Promotion, University of Franca, Franca, Brazil
| |
Collapse
|
25
|
Kohn OF, Plascencia M, Taylor Y, Koyner JL. Novel Use of Premixed Dialysate Bags during Water Supply Interruption in Acute Hospital Setting. KIDNEY360 2021; 2:339-343. [PMID: 35373022 PMCID: PMC8740998 DOI: 10.34067/kid.0004762020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/08/2020] [Indexed: 06/14/2023]
Abstract
Patients on dialysis are exposed to large amounts of water during conventional intermittent hemodialysis; hence, there are strict regulations regarding the quality of water used to prepare dialysate. Occasionally, water systems fail due to natural disasters or structural supply issues, such as water-main breaks or unplanned changes in municipal or facility water quality. It is critical to regularly monitor and immediately recognize such a failure and take steps to avoid exposing the patients to contaminants. In addition to the recognition of the problem, the ability to pivot and continue to provide safe treatment to inpatients who are dependent on dialysis is essential, both from an ultrafiltration and a clearance standpoint. At our hospital, an unforeseen water disruption occurred and we were able to continue to provide KRT with premade, bagged dialysate to mitigate the effect on our patients on dialysis. This is a novel method using available machines and dialysate, which we normally stock for continuous KRT, for short dialysis sessions. The methodology is similar to that which has been widely used for short daily home hemodialysis with low dialysate flow rate. Because this situation occurred in the midst of the SARS-CoV-2 pandemic, we had to be mindful of dialysate volumes and staffing time. Here, we present our investigation into the cause of the water-system failure and how we quickly implemented the alternative dialysis method. Short dialysis with low-flow dialysate will not deliver the same Kt/V per session as standard dialysis; however, this method was successfully implemented and tailored with adjustments for patients requiring higher clearance for specific indications, such as severe hyperkalemia.
Collapse
Affiliation(s)
- Orly F Kohn
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | | | | |
Collapse
|
26
|
Reichelt S, Boschke E, Reinhardt O, Walther T, Lenk F. Development of a Gold Nanoparticle-Based Colorimetric Sensor for Water for Injection At-Line Impurity Testing. SLAS Technol 2020; 26:218-224. [PMID: 33375891 DOI: 10.1177/2472630320978187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The best-known rapid test using gold nanoparticles (AuNPs) is the human chorionic gonadotropin pregnancy test. AuNPs are a powerful tool in point-of-care testing because of their flexibility, modifiability, and visibility. Here, we report a method to detect impurities for at-line process control in water-for-injection (WFI) manufacturing through the example of endotoxins. If a distinct concentration of these amphipathic molecules, originated from gram-negative bacteria, enters the human body, it will result in septic shock, followed by organ failure and possibly death. Every fluid given parenterally is subject to strict regulatory requirements and therefore endotoxin testing. Through use of traditional methods like the limulus amebocyte lysate (LAL) test, it takes more than 2 h to complete. With the presented method, one-fifth of the sample volume is sufficient compared with the LAL test. Once the assay components have been mixed, the result can be interpreted visually within 2 min without the use of further instruments.
Collapse
Affiliation(s)
- Saskia Reichelt
- Institute of Natural Materials Technology, Bioprocess Engineering Technische Universität Dresden, Dresden, Germany
| | - Elke Boschke
- Institute of Natural Materials Technology, Bioprocess Engineering Technische Universität Dresden, Dresden, Germany
| | - Olena Reinhardt
- Institute of Natural Materials Technology, Bioprocess Engineering Technische Universität Dresden, Dresden, Germany
| | - Thomas Walther
- Institute of Natural Materials Technology, Bioprocess Engineering Technische Universität Dresden, Dresden, Germany
| | - Felix Lenk
- Institute of Natural Materials Technology, Bioprocess Engineering Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
27
|
Kim C, Lee C, Kim SW, Kim CS, Kim IS. Performance Evaluation and Fouling Propensity of Forward Osmosis (FO) Membrane for Reuse of Spent Dialysate. MEMBRANES 2020; 10:membranes10120438. [PMID: 33352895 PMCID: PMC7765897 DOI: 10.3390/membranes10120438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
The number of chronic renal disease patients has shown a significant increase in recent decades over the globe. Hemodialysis is the most commonly used treatment for renal replacement therapy (RRT) and dominates the global dialysis market. As one of the most water-consuming treatments in medical procedures, hemodialysis has room for improvement in reducing wastewater effluent. In this study, we investigated the technological feasibility of introducing the forward osmosis (FO) process for spent dialysate reuse. A 30 LMH of average water flux has been achieved using a commercial TFC membrane with high water permeability and salt removal. The water flux increased up to 23% with increasing flowrate from 100 mL/min to 500 mL/min. During 1 h spent dialysate treatment, the active layer facing feed solution (AL-FS) mode showed relatively higher flux stability with a 4–6 LMH of water flux reduction while the water flux decreased significantly at the active layer facing draw solution (AL-DS) mode with a 10–12 LMH reduction. In the pressure-assisted forward osmosis (PAFO) condition, high reverse salt flux was observed due to membrane deformation. During the membrane filtration process, scaling occurred due to the influence of polyvalent ions remaining on the membrane surface. Membrane fouling exacerbated the flux and was mainly caused by organic substances such as urea and creatinine. The results of this experiment provide an important basis for future research as a preliminary experiment for the introduction of the FO technique to hemodialysis.
Collapse
Affiliation(s)
- Chaeyeon Kim
- Global Desalination Research Center, School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Korea; (C.K.); (C.L.)
| | - Chulmin Lee
- Global Desalination Research Center, School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Korea; (C.K.); (C.L.)
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.W.K.); (C.S.K.)
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea; (S.W.K.); (C.S.K.)
| | - In S. Kim
- Global Desalination Research Center, School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology (GIST), 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Korea; (C.K.); (C.L.)
- Correspondence: ; Tel.: +82-62-715-2436; Fax: +82-62-715-2584
| |
Collapse
|
28
|
Diniz Rocha VF, Cavalcanti TP, Azevedo J, Leal HF, Oliveira Silva GE, Xavier Malheiros AR, Ataide LA, Lima Filho JA, Pinto Almeida AR, de Andrade Khouri N, Reis MG, Neves Reis J. Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center. Am J Trop Med Hyg 2020; 104:848-853. [PMID: 33319730 DOI: 10.4269/ajtmh.20-1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/07/2020] [Indexed: 12/19/2022] Open
Abstract
Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through PCR-RAPD and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.
Collapse
Affiliation(s)
- Verônica França Diniz Rocha
- Secretaria Estadual de Saúde do Estado da Bahia, Centro Administrativo da Bahia, Salvador, Brazil.,Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Jailton Azevedo
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Helena Ferreira Leal
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | - Ledilce Almeida Ataide
- Secretaria Estadual de Saúde do Estado da Bahia, Centro Administrativo da Bahia, Salvador, Brazil
| | - José Admirço Lima Filho
- Secretaria Estadual de Saúde do Estado da Bahia, Centro Administrativo da Bahia, Salvador, Brazil
| | | | - Nadia de Andrade Khouri
- Secretaria Estadual de Saúde do Estado da Bahia, Centro Administrativo da Bahia, Salvador, Brazil
| | - Mitermayer Galvão Reis
- Yale School of Public Health, Yale University, New Haven, Connecticut.,Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brazil
| | - Joice Neves Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Salvador, Brazil.,Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| |
Collapse
|
29
|
Eneanya ND, Crews DC. “Place, Not Race”: A Focus on Neighborhood as a Risk Factor for Hospitalizations in Patients Receiving Maintenance Hemodialysis. Am J Kidney Dis 2020; 76:749-751. [DOI: 10.1053/j.ajkd.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
|
30
|
Almeida A, Gajewska K, Duro M, Costa F, Pinto E. Trace element imbalances in patients undergoing chronic hemodialysis therapy - Report of an observational study in a cohort of Portuguese patients. J Trace Elem Med Biol 2020; 62:126580. [PMID: 32619919 DOI: 10.1016/j.jtemb.2020.126580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patients with end-stage renal disease undergoing hemodialysis therapy are at risk of developing deficiencies of essential trace elements and/or overload of toxic trace elements, both of which may significantly affect their clinical status of. Those imbalances may result from the disease itself but also from the quality of the therapeutic process, namely the hemodialysis process, which has greatly evolved in the last decades. Thus, old observations that have been assumed as very well-proven have been recently questioned. In this case-control study we evaluate the current trace elements status in a group of Portuguese patients under hemodialysis therapy. MATERIAL AND METHODS Serum samples from patients (n = 93), collected for the routine periodic control of Al levels, were analyzed for a wide panel of trace elements (Li, Al, Mn, Co, Ni, Cu, Zn, Se, Rb, Sr, Mo, Cd, Ba, Pb) using inductively coupled plasma mass spectrometry technique (hemodialysis patients' group). For comparison purposes, samples of individuals with no evidence of renal disease according to standard laboratory analytical criteria (n = 50) were also analyzed (control group). RESULTS The results showed significant differences between the two groups, with higher values in hemodialysis patients group for Al (14.6 vs. 9.5 μg/L), Co, Ni, Sr, Mo (4.5 vs. 1.4 μg/L), Cd (0.058 vs. 0.025 μg/L) and Pb (0.55 vs. 0.30 μg/L); and lower values in hemodialysis patients group for Li (4.0 vs. 75.8 μg/L), Mn, Cu (943.5 vs. 1038.5 μg/L), Zn (943.5 vs. 1038.5 μg/L), Se (71.5 vs. 103.8 μg/L), Rb (202.4 vs. 300.3 μg/L) and Ba (0.65 vs. 8.7 μg/L). CONCLUSION This study confirms that hemodialysis patients tend to present significant trace elements imbalances, which may be related to the higher morbidity and mortality observed in this specific patients' group.
Collapse
Affiliation(s)
- Agostinho Almeida
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Katarzyna Gajewska
- Chair of Chemistry, Department of Analytical Chemistry, Medical University of Lublin, Lublin, Poland
| | - Mary Duro
- Faculty of Health Sciences, University Fernando Pessoa, Praça 9 de Abril 349, 4249-004 Porto, Portugal; Laboratory Dra. Matilde Sampaio, Lda., Mogadouro, Portugal
| | - Félix Costa
- LAQV/REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Edgar Pinto
- Department of Environmental Health, School of Health, P.Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072, Porto, Portugal
| |
Collapse
|
31
|
Raad Humudat Y, Al-Naseri SK. Evaluation of Dialysis Water Quality at Hospitals in Baghdad, Iraq. J Health Pollut 2020; 10:201211. [PMID: 33324508 PMCID: PMC7731494 DOI: 10.5696/2156-9614-10.28.201211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dialysis water quality is one of the most important factors for ensuring the safe and effective delivery of hemodialysis. It has been known for over a decade that there might be hazardous contaminants in the water and concentrates used to prepare dialysis fluid. Rigorous international standards for the purification of dialysis fluids have been established, which were used in the present study to compare the quality of dialysis water as there is no national standard for dialysis water quality in Iraq. OBJECTIVES There are more than 20 dialysis centers in Iraq, most of which contain similar units for the processing of dialysis water. The present study evaluated the quality of water used for dialysis in four dialysis centers located within Baghdad hospitals. METHODS Physical and chemical tests were carried out in the laboratory after sampling water from each dialysis center. Water samples were collected from three locations in each dialysis center. Hospital municipal water samples were collected from the tanks feeding dialysis units; samples of dialysis water were collected from the dialysis water treatment unit outlets; and samples of dialysis water were collected from the distribution network in dialysis rooms. RESULTS The results showed a fluctuation in the quality of the dialysis water (dialysis water and water from the dialysis distribution network), indicating that it is unacceptable compared to international standards. Chemical analysis showed that 75% of the dialysis water had elevated aluminum concentrations. Chemical analysis also found that dialysis water had elevated concentrations of free residual chlorine at some dialysis centers. CONCLUSIONS All hemodialysis centers need careful monitoring and preventive maintenance to ensure good water quality. In addition, it is important to revise the design of the water treatment units according to water quality. COMPETING INTERESTS The authors declare no competing financial interests.
Collapse
Affiliation(s)
- Yasamen Raad Humudat
- Environment and Water Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | | |
Collapse
|
32
|
Characterization of the Bacterial Biofilm Communities Present in Reverse-Osmosis Water Systems for Haemodialysis. Microorganisms 2020; 8:microorganisms8091418. [PMID: 32942620 PMCID: PMC7564833 DOI: 10.3390/microorganisms8091418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
Biofilm in reverse osmosis (RO) membranes is a common problem in water treatment at haemodialysis facilities. Bacteria adhere and proliferate on RO membranes, forming biofilms, obstructing and damaging the membranes and allowing the transfer of bacteria and/or cellular components potentially harmful to the health of haemodialysis patients. Our aim was to characterize the bacterial community associated to biofilm of RO membranes and to identify potentially pathogenic bacteria present in the haemodialysis systems of two dialysis centres in Chile. The diversity of the bacterial communities present on RO membranes and potable and osmosed water samples was evaluated using Illumina sequencing. Additionally, bacteria from potable water, osmosed water and RO membrane samples were isolated, characterized and identified by Sanger’s sequencing. The molecular analyses of metagenomics showed that the phyla having a greater relative abundance in both dialysis centres were Proteobacteria and Planctomycetes. Pseudomonas, Stenotrophomonas, Agrobacterium, Pigmentiphaga, Ralstonia, Arthrobacter, Bacteroides and Staphylococcus were bacterial genera isolated from the different samples obtained at both haemodialysis centres. Pseudomonas spp. was a bacterial genus with greater frequency in all samples. Pseudomonas and Staphylococcus showed higher levels of resistance to the antibiotics tested. Results demonstrated the presence of potentially pathogenic bacteria, showing resistance to antimicrobials on RO membranes and in osmosed water in both dialysis centres studied.
Collapse
|
33
|
Humudat YR. Heavy Metals in Dialysis Fluid and Blood Samples from Hemodialysis Patients in Dialysis Centers in Baghdad, Iraq. J Health Pollut 2020; 10:200901. [PMID: 32874757 PMCID: PMC7453809 DOI: 10.5696/2156-9614-10.27.200901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/30/2020] [Indexed: 04/21/2023]
Abstract
BACKGROUND The kidney is the first target organ of heavy metal toxicity due to its capacity to reabsorb and accumulate divalent metals. Hemodialysis therapy is used to purify the blood of individuals with impaired kidney function. OBJECTIVE The aim of the present study was to evaluate the relationship between dialysis fluid quality and the health of hemodialysis patients. METHODS A field sampling program was conducted to collect blood samples from 320 hemodialysis patients (56% males and 44% females) in order to examine the concentrations of heavy metals that typically occur in municipal water in Baghdad (aluminum (Al), copper (Cu), lead (Pb), and zinc (Zn)), and explore associations with the same metals in dialysis fluid collected from four major dialysis centers in Baghdad hospitals for a period of one year (2018). RESULTS The results showed that the dialysis fluid quality was not in compliance with international standards. The dialysis fluid in 63% of the samples contained high Al concentrations, while Cu and Zn concentrations were within international standards. Lead concentrations were elevated in dialysis fluid in some hospitals as well. DISCUSSION The average blood levels of biologically important heavy elements were significantly varied in hemodialysis patients when compared with local reference values. CONCLUSIONS Since both deficiency and excess elements are potentially harmful, the hypothesis that heavy element status affects the risk of adverse clinical outcomes is a worthy investigation. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL The study was approved by the Baghdad Ethics Committee of the Iraqi Ministry of Health and Environment. COMPETING INTERESTS The authors declare no competing financial interests.
Collapse
|
34
|
Humudat YR, Al-Naseri SK, Al-Fatlawy YF. Assessment of microbial contamination levels of water in hemodialysis centers in Baghdad, Iraq. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2020; 92:1325-1333. [PMID: 32187760 DOI: 10.1002/wer.1329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 06/10/2023]
Abstract
Monitoring water quality in hemodialysis systems is extremely important to maintain adequate quality services for patients suffering from kidney failure. This work aims to examine and evaluate bacteriological characteristics and endotoxin contamination levels in hemodialysis water produced in dialysis centers. Forty-eight water samples were collected and analyzed from four major hospitals in Baghdad for one year to evaluate seasonal effects. The analysis included the determination of total heterotrophic bacteria using the pour plate method, identification of bacterial isolate using the Vitek2 compact instrument, and the determination of endotoxins levels using Limulus amebocyte lysate (LAL) method. In addition, tap water samples (a source for the hemodialysis water) were also examined bacteriologically. Results showed that 44% of the tested samples for bacterial levels are higher than the maximum value of (100 CFU/ml) set out by the international standards. Endotoxin values for these centers fluctuated during the study period, and 44% of them exceeded the international standards (>0.25 EU/ml). These results call for applying improved technology to modify the existing water treatment units for better control and for national standardization of the microbiological quality of hemodialysis water. PRACTITIONER POINTS: Four hemodialysis centers were assessed by measuring the bacteriological and endotoxins levels of their feed and product water. Product water showed elevated levels of bacteria that exceeded the international guideline value of 100 CFU/ml. Most of the identified bacterial species were Gram-negative that arise the possibility of contributing to endotoxin generation. Product water showed fluctuated values of endotoxins. About 44% of the measured samples were higher than the international guideline values of 0.25 EU/ml.
Collapse
Affiliation(s)
- Yasamen R Humudat
- Environment and Water Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | - Saadi K Al-Naseri
- Environment and Water Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | - Yaaroub F Al-Fatlawy
- University of Baghdad, Ministry of Higher Education and Scientific Research, Baghdad, Iraq
| |
Collapse
|
35
|
Morghad T, Hassaine H, Boutarfi Z, Gaouar S, Bellifa S, Meziani Z. Bacteriological water quality and biofilm formation in the treatment system of the hemodialysis unit in Tlemcen, Algeria. Semin Dial 2020; 33:394-401. [DOI: 10.1111/sdi.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Touhami Morghad
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| | - Hafida Hassaine
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| | - Zakaria Boutarfi
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| | - Sarah Gaouar
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| | - Samia Bellifa
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| | - Zahera Meziani
- Laboratoire de Microbiologie Appliquée à l’Agroalimentaire, au Biomédical et à l’Environnement (LAMAABE) Faculty of Nature and Life, Earth and Universe Sciences University of Tlemcen Tlemcen Algeria
| |
Collapse
|
36
|
Piccinelli G, De Francesco MA, Corbellini S, Lorenzin G, Caruso A. Detection of microbial contamination in dialysis water and gastrointestinal endoscopes by the Uro4 HB&L™ system. J Infect Public Health 2020; 13:1054-1056. [DOI: 10.1016/j.jiph.2020.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
|
37
|
Carvalho GC, Bugno A, Almodovar AAB, Silva FPDLE, Pinto TDJA. Validation and applicability of an alternative method for dialysis water and dialysate quality analysis. J Bras Nefrol 2020; 42:163-174. [PMID: 32364558 PMCID: PMC7427643 DOI: 10.1590/2175-8239-jbn-2019-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION In hemodialysis, patients are exposed to a large volume of water, which may lead to fatal risks if not meeting quality standards. This study aimed to validate an alternative method for monitoring microbiological quality of treated water and assess its applicability in dialysis and dialysate analysis, to allow corrective actions in real-time. METHODS Validation and applicability were analyzed by conventional and alternative methods. For validation, E. coli standard endotoxin was diluted with apyrogenic water in five concentrations. For the applicability analysis, treated water for dialysis was collected from different points in the treatment system (reverse osmosis, drainage canalization at the storage tank bottom, reuse, and loop), and dialysate was collected from four machines located in different rooms in the hemodialysis sector. RESULTS The validation results were in accordance with the Brazilian Pharmacopoeia acceptance criteria, except for the last two concentrations analyzed. In addition, the ruggedness criterion performed under the US Pharmacopoeia was in agreement with the results. DISCUSSION A limiting factor in the applicability analysis was the absence of the endotoxin maximum permitted level in dialysate by the Brazilian legislation. When comparing the analysis time, the alternative method was more time-consuming than the conventional one. This suggests that the alternative method is effective in the case of few analyses, that is, real-time analyses, favoring corrective actions promptly. On the other hand, it does not support the implementation of the alternative method in a laboratory routine due to the high demand for analyses.
Collapse
Affiliation(s)
- Gabriela Corrêa Carvalho
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas, Departamento de Farmácia, São Paulo, SP, Brasil
| | | | | | | | | |
Collapse
|
38
|
Blackburn L, Acree K, Bartley J, DiGiannantoni E, Renner E, Sinnott LT. Microbial Growth on the Nails of Direct Patient Care Nurses Wearing Nail Polish. Oncol Nurs Forum 2020; 47:155-164. [PMID: 32078608 DOI: 10.1188/20.onf.155-164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether nurses wearing nail polish pose a greater infection risk to patients than nurses who are not wearing nail polish. SAMPLE & SETTING 89 direct patient care oncology nurses at a large midwestern National Cancer Institute-designated comprehensive cancer center. METHODS & VARIABLES The investigators assigned participants' three middle fingers of their dominant hand to three groups. RESULTS Comparison of colony-forming units revealed that one-day-old polish exhibited fewer gram-positive microorganisms than the unpolished nail (p = 0.04). The four-day-old polish showed significantly more microorganisms than the one-day-old polish (p = 0.03). The same trend was demonstrated for gram-negative microorganisms, but the difference was not statistically significant (p = 0.3 and p = 0.17, respectively). IMPLICATIONS FOR NURSING The results should be interpreted and applied to expert nursing practice in the care of vulnerable patient populations. Each institution and practitioner should make their own decisions and interpretation of evidence into practice.
Collapse
Affiliation(s)
- Lisa Blackburn
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Kelly Acree
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Judith Bartley
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Elizabeth DiGiannantoni
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | - Elizabeth Renner
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at the Ohio State University Comprehensive Cancer Center
| | | |
Collapse
|
39
|
Yassin MH, Abramovitz B, Hariri R, McKibben L, Pinevich A. Delftia acidovorans pseudo outbreak in portable reverse osmosis machines: Interventions to ensure safe and cost-effective hemodialysis. Am J Infect Control 2020; 48:304-308. [PMID: 31952870 DOI: 10.1016/j.ajic.2019.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Reverse osmosis (RO), a major advance in hemodialysis (HD) safety, effectively clears most water organisms. Delftia acidovorans is an environmental water-borne pathogen that is rarely reported to cause human infections. We report a pseudo outbreak caused by colonization of RO machines with D acidovorans with no reported human infections and interventions to improve HD safety. METHODS Repeated positive RO product water cultures triggered our hospital to initiate an investigation, RO machines were examined for mechanical integrity by biomedical engineers. Cultures of product water as well as RO parts were done. Testing for bacterial relatedness after identification was performed. An investigation was conducted in a systematic fashion to determine the cause and the extent of the problem. RESULTS Upon formal review of policies and procedures, there were minor deficiencies. Rectifying these deviations from policies did not stop the repeated positive water cultures. A 7-step investigation and correction was successfully conducted. City water testing with filtration and concentration methods was positive for D acidovorans. Major renovation of the HD unit with replacement of all RO machines and a 2-step water filtration resulted in elimination of the pseudo outbreak. CONCLUSION City water was the source of biofilm formation of D acidovorans in RO machines that was not possible to eradicate. Application of incoming water filters was an effective preventive strategy. Replacement of RO machines after 4 failed disinfection attempts is the most cost-effective strategy as well for persistent positive water cultures. The HD remains RO water culture negative 2 years after changes.
Collapse
|
40
|
Single-species (bacterial, fungal, or mycobacterial) biofilms or dual-species (mycobacterial-fungal) biofilms formed in dialysis fluids. Diagn Microbiol Infect Dis 2020; 96:114870. [PMID: 31955953 DOI: 10.1016/j.diagmicrobio.2019.114870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/21/2022]
Abstract
Continuous hemodialysis system monitoring is necessary to prevent microorganism growth and health problems. This study evaluates single- and dual-species biofilm formation in microtiter plates by using dialysis solutions under aerobiosis or 5% CO2 atmosphere. Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, Candida parapsilosis sensu lato, and Mycobacterium smegmatis produce single-species biofilms in all dialysis solutions in both oxygenation conditions. Dual-species biofilm cultures grown at 5% CO2 atmosphere and in dialysate containing glucose reveal that M. smegmatis benefits from its association with C. parapsilosis. The dialysate and its constituent solutions support the growth of all the mono-species and the inter-kingdom mycobacterial/yeast biofilms in both aerobiosis and microaerophilic conditions.
Collapse
|
41
|
Brys AD, Di Stasio E, Lenaert B, Sanguinetti M, Picca A, Calvani R, Marzetti E, Gambaro G, Bossola M. Serum interleukin-6 and endotoxin levels and their relationship with fatigue and depressive symptoms in patients on chronic haemodialysis. Cytokine 2020; 125:154823. [DOI: 10.1016/j.cyto.2019.154823] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/04/2023]
|
42
|
Hilinski EG, Almodovar AAB, Silva FPDLE, Pinto TDJA, Bugno A. Is dialysis water a safe component for hemodialysis treatment in São Paulo State, Brazil? BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000417835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
43
|
Uchida T, Kaku Y, Hayasaka H, Kofuji M, Momose N, Miyazawa H, Ueda Y, Ito K, Ookawara S, Morishita Y. Utility Of An Automatic Limulus Amebocyte Lysate Kinetic Turbidimetric Test For Endotoxin Screening Of Dialysate Samples. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:429-433. [PMID: 31632161 PMCID: PMC6789175 DOI: 10.2147/mder.s225246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Endotoxin contamination of dialysate has serious adverse effects on patients undergoing hemodialysis. Therefore, endotoxin activity in dialysate is closely monitored. Limulus amebocyte lysate (LAL) has been used as a reagent to measure endotoxin activity. Here, we investigated the efficacy of an automatic LAL kinetic turbidimetric test (Toxinometer ET-mini) for screening endotoxin activity in dialysate. Methods In total, endotoxin activity was measured in 110 dialysate samples obtained from several sites within hemodialysis circuits between June 2012 and March 2018. The results were compared with those from a conventional chromogenic substrate LAL test conducted by a clinical examination laboratory. Results Both the automatic LAL test and the chromogenic substrate LAL test had a minimum detection level of 0.001 endotoxin units (EU)/mL. Endotoxin activity levels measured via the automatic LAL test showed a strongly positive correlation (concordance correlation coefficient: 0.9933; 95% CI: 0.9902–0.9954) and good agreement (mean difference: 0.00±0.01 EU/mL) with those obtained using the chromogenic substrate LAL test. Conclusion The results suggest that the automatic LAL test may be useful for endotoxin activity screening in hemodialysis facilities.
Collapse
Affiliation(s)
- Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Yoshio Kaku
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Naoki Momose
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
| |
Collapse
|
44
|
Abstract
The prevalence of antimicrobial resistance among many common bacterial pathogens is increasing. The emergence and global dissemination of these antibiotic-resistant bacteria (ARB) is fuelled by antibiotic selection pressure, inter-organism transmission of resistance determinants, suboptimal infection prevention practices and increasing ease and frequency of international travel, among other factors. Patients with chronic kidney disease, particularly those with end-stage renal disease who require dialysis and/or kidney transplantation, have some of the highest rates of colonization and infection with ARB worldwide. These ARB include methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp. and several multidrug-resistant Gram-negative organisms. Antimicrobial resistance limits treatment options and increases the risk of infection-related morbidity and mortality. Several new antibiotic agents with activity against some of the most common ARB have been developed, but resistance to these agents is already emerging and highlights the dire need for new treatment options as well as consistent implementation and improvement of basic infection prevention practices. Clinicians involved in the care of patients with renal disease must be familiar with the local epidemiology of ARB, remain vigilant for the emergence of novel resistance patterns and adhere strictly to practices proven to prevent transmission of ARB and other pathogens.
Collapse
Affiliation(s)
- Tina Z Wang
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | | | - David P Calfee
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
45
|
Suzuki MN, Fregonesi BM, Machado CS, Zagui GS, Kusumota L, Suzuki AK, da Costa JAC, Llopart JS, Nadal M, Domingo JL, Segura-Muñoz S. Hemodialysis Water Parameters as Predisposing Factors for Anemia in Patients in Dialytic Treatment: Application of Mixed Regression Models. Biol Trace Elem Res 2019; 190:30-37. [PMID: 30218313 DOI: 10.1007/s12011-018-1515-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022]
Abstract
Contamination by metals and microbiological agents in hemodialysis water can cause clinical intercurrences in hemodialysis patients. Evaluating and assuring minimum levels of contamination from metals and microorganisms in hemodialysis water can improve patient safety. The objective of this study was to assess hemodialysis water quality in a major tertiary hospital in Brazil and investigate the relationship between hemodialysis water quality and clinical intercurrences in hemodialysis patients. A prospective-observational cohort study for evaluation of water quality parameters and clinical intercurrences present by patients (n = 52) were performed from May 2014 to April 2015. Mixed linear regression models and binary regression models were fitted for water quality parameters and patients' clinical parameters. The increase in the levels of copper and nitrate in hemodialysis water was significant (p < 0.05) to explain anemia. Bone pain was related to age, sex (female), and hemodialysis treatment duration (years). Hypotensive episodes were related to serum sodium decrease. Aluminum in hemodialysis water was present in an average concentration higher than the permitted threshold (15.35 ± 14.53 μg/L). Cadmium, total coliforms, Escherichia coli, and endotoxins in hemodialysis water were not detected and the heterotrophic bacteria count was below the reference limit. These parameters' concentrations varied during the study, evidencing the need for continuous monitoring.
Collapse
Affiliation(s)
- Meire Nikaido Suzuki
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Brisa Maria Fregonesi
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Carolina Sampaio Machado
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Guilherme Sgobbi Zagui
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Luciana Kusumota
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Adriano Kamimura Suzuki
- Department of Applied Mathematics and Statistics, Institute of Mathematical and Computing Sciences, University of São Paulo, Av. Trabalhador São Carlense 400, São Carlos, São Paulo, 13560-970, Brazil
| | - José Abrão Cardeal da Costa
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Jordi Sierra Llopart
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
- Laboratory of Soil Science, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII s/n., 08020, Barcelona, Catalonia, Spain
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Jose Luis Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Susana Segura-Muñoz
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil.
| |
Collapse
|
46
|
Lui SL, Yap D, Cheng V, Chan TM, Yuen KY. Clinical practice guidelines for the provision of renal service in Hong Kong: Infection Control in Renal Service. Nephrology (Carlton) 2019; 24 Suppl 1:98-129. [PMID: 30900339 PMCID: PMC7167703 DOI: 10.1111/nep.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | - Desmond Yap
- Department of MedicineThe University of Hong KongHong Kong
| | - Vincent Cheng
- Department of MicrobiologyQueen Mary HospitalHong Kong
| | - Tak Mao Chan
- Department of MedicineThe University of Hong KongHong Kong
| | - Kwok Yung Yuen
- Department of MicrobiologyThe University of Hong KongHong Kong
| |
Collapse
|
47
|
Gabbay E, Meyer KB. Amazing and Fantastic Infection Control: The Case of Dialyzer Reuse. Am J Kidney Dis 2018; 69:717-719. [PMID: 28532633 DOI: 10.1053/j.ajkd.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ezra Gabbay
- Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
48
|
Oliveira LT, Lopes LG, Ramos SB, Martins CHG, Jamur MC, Pires RH. Fungal biofilms in the hemodialysis environment. Microb Pathog 2018; 123:206-212. [DOI: 10.1016/j.micpath.2018.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
|
49
|
Vieira RGL, Moraes TDS, Silva LDO, Bianchi TC, Veneziani RCS, Ambrósio SR, Bastos JK, Pires RH, Martins CHG. In vitro studies of the antibacterial activity of Copaifera spp. oleoresins, sodium hypochlorite, and peracetic acid against clinical and environmental isolates recovered from a hemodialysis unit. Antimicrob Resist Infect Control 2018; 7:14. [PMID: 29410782 PMCID: PMC5782372 DOI: 10.1186/s13756-018-0307-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Patients submitted to hemodialysis therapy are more susceptible to infection, especially to infection by Gram-positive bacteria. Various research works have attempted to discover new antimicrobial agents from plant extracts and other natural products. Methods The present study aimed to assess the antibacterial activities of Copaifera duckei, C. reticulata, and C. oblongifolia oleoresins; sodium hypochlorite; and peracetic acid against clinical and environmental isolates recovered from a Hemodialysis Unit. The Minimum Inhibitory Concentration and the Fractionated Inhibitory Concentration Index were determined; the ability of the tested compounds/extracts to inhibit biofilm formation was evaluated by calculating the MICB50 and IC50. Results C. duckei was the most efficient among the assayed Copaifera species, and its oleoresin was more effective than peracetic acid and sodium hypochlorite. Copaifera oleoresins and disinfectants did not act synergistically at any of the tested combinations. Certain of C. duckei oleoresin, peracetic acid, and sodium hypochlorite concentrations inhibited biofilm formation and eradicated 50% of the biofilm population. Conclusion C. duckei oleoresin is a potential candidate for disinfectant formulations. Based on these results and given the high incidence of multi-resistant bacteria in hemodialysis patients, it is imperative that new potential antibacterial agents like C. duckei oleoresin, which is active against Staphylococcus, be included in disinfectant formulations.
Collapse
Affiliation(s)
- Rosimara Gonçalves Leite Vieira
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thaís da Silva Moraes
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Larissa de Oliveira Silva
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thamires Chiquini Bianchi
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Rodrigo Cassio Sola Veneziani
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Sérgio Ricardo Ambrósio
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Jairo Kenupp Bastos
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n, Ribeirão Preto - São Paulo, 14040-903 Brazil
| | - Regina Helena Pires
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Carlos Henrique Gomes Martins
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| |
Collapse
|
50
|
Abstract
The End-Stage Renal Disease (ESRD) program now serves approximately 675,000 individuals in the United States at a cost of $26.1 billion to the Medicare system. Given the size of this population, healthcare providers from all disciplines will deliver care to patients on dialysis. Mortality remains high among patients on chronic dialysis, with 42.3% surviving 5 years. As this is a vulnerable population, it is important in the care of ESRD patients that non-nephrologists have a working knowledge of issues germane to dialysis. This review examines the physiology, mechanics, complications, and care delivery concerns of kidney dialysis modalities relevant to the non-nephrologist. The majority of patients receive in-center hemodialysis thrice weekly, with a small proportion on home-based therapies such as peritoneal dialysis or home hemodialysis. Inpatients may undergo hemodialysis or peritoneal dialysis, and in critically ill patients, continuous renal replacement therapies are utilized. Practical aspects of each of these modalities are discussed.
Collapse
Affiliation(s)
- Matt Foy
- Division of Nephrology, Department of Medicine, Louisiana State University Health Science Center, Baton Rouge, LA, USA
| | - C John Sperati
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|