Quality assurance for dialysis-quality water and dialysis fluid

EDTNA-ERCA Journal

Volumn 30, Issue 2, 2004, Pages 106-112

  Morgan, Ian ^a  

^a KING S COLLEGE HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACTIVATED CARBON; CHLORINE; DIALYSIS FLUID; TOSYLCHLORAMIDE SODIUM;

FILTRATION; HEMODIALYSIS; PRACTICE GUIDELINE; QUALITY CONTROL; REVIEW; WATER QUALITY; WATER STANDARD; WATER TREATMENT;

EID: 3342945302     PISSN: 1019083X     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1755-6686.2004.tb00344.x     Document Type: Review

References (10)

1. Pyo HJ, Kwon YJ, Kwon SY, Lee CH, Kim S, Lee JS, Cho SH, Cha CW. An outbreak of Heinz body positive hemolytic anaemia in chronic hemodialysis patients. Korean Journal of International Medicine 1993; 8 (2): 93-8. An increase in water supply chloramine level to >0.6mg/L had caused an outbreak of Heinz body positive hemolytic anaemia in 34 haemodialysis patients.
2. Richardson D, Bartlett C, Goutcher E, Jones CH, Davidson AM, Will EJ. Erythropoietin resistance due to dialysate chloramine: the two-way traffic of solutes in haemodialysis. Nephrology Dialysis Transplantation 1999; 14: 2625-2627. This article highlighted an occurrence of erythropoietin resistance in a dialysis population where the mains water total chlorine level was 0.7 mg/L. This was reversed by the installation of an activated carbon filter.
3. Fluck S, McKane W, Cairns T, Fairchild V, Lawrence V, Lee J, Murrey D, Polpitiya M, Taube D. Chloramine-induced haemolysis presenting as Erythropoietin resistance. Nephrology Dialysis Transplantation 1999; 14: 1687-1691. An article showing how an increase in dialysate chloramine levels from <0.1 p.p.m to 0.25-0.3 p.p.m. resulting in an increased use of erythropoietin. Following the installation of larger carbon filters and the reduction of chloramine to <0.1 p.p.m. there was an 18.6% rise in haemoglobin levels and a 25% reduction in erythropoietin dose.
4. Becker FF, Janowsky Y, Overath H, Stetter D. Reducing chloramines in drinking water. Biomedical Technology (Berl) 1989; 34 (11); 280-8. The article demonstrates that the final concentration of monochloramine coming from a GAC filter is affected by temperature along with other factors.
5. Stewart MH, Wolfe RL, Means EG. Assessment of the bacteriological activity associated with granular activated carbon treatment of drinking water. Application of Environmental Microbiology 1990; 56 (12): 3822-9. This article showed how EBCT's ranging from 7.5 to 60 minutes had no effect on the heterotrophic plate count of GAC filter effluent.
6. Jourdan JL, Maingourd C, Meguin C, Nivet H, Martin C, Moulier MC. Possible release of aluminium from activated carbon filters used in home hemodialysis. Nephrologie 1986; 7 (4): 153-6. In this article an increase in home haemodialysis patients' sera aluminium from 67.8 to 102.0 micrograms/L was noted following the addition of a carbon filter to their water treatment circuits. Various carbon filters were tested; some gave 20.6 milligrams/L of aluminium in the product water.
7. LeChevallier MW, Hassenauer TS, Camper AK, McFeters GA. Disinfecting of bacteria attached to granular activated carbon. Application of Environmental Microbiology 1984; 48 (5): 918-23. This article demonstrated that no significant decrease in viable count was achieved by disinfecting bacteria laden carbon particles with 2.0 mg/L free chlorine, for 1 hour.
8. Morin P. Identification of the bacteriological contamination of a water treatment line used for hamodialysis and its disinfection. Journal of Hospital Infection 2000; 45 (3): 218-24. This article demonstrates that the disinfection of carbon filters with sodium hypochlorite and peracetic acid is of weak and transient effect.
9. Tipple MA, Shusterman N, Bland LA, McCarthy MA, Favero MS, Arduino MJ, Reid MH, Jarvis WR. Illness in hemodialysis patients after exposure to chloramine contaminated dialysate. ASAIO Trans 1991; 37 (4): 588-91. This article describes an incident in which patients at a dialysis centre in Philadelphia were exposed to chloramine contaminated dialysate when the carbon filter in the water treatment system failed. Forty-one patients required transfusion to treat the resultant haemolytic anaemia.
10. Botella J, Traver JA, Sanz-Guajardo D, Torres MT, Sanjuan I, Zabala P. Chloramines, an aggravating factor in the anemia of patients on regular dialysis treatment. Procedures of the European Dialysis Transplant Association 1977; 14: 192-9. This article describes how an increase in the water supply total chlorine level to 3.5 mg/L caused a decrease in mean haematocrit from 25.93 to 20.80.