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Contaminants in water used for hemodialysis

Nicholas Hoenich, PhD
Richard A Ward, PhD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Water is required for hemodialysis. Hemodialysis patients are vulnerable to contaminants in the water used to prepare concentrate and dialysis fluid or in water used for reprocessing dialyzers (see "Reuse of dialyzers", section on 'Reprocessing techniques'). This vulnerability is due to the following:

Hemodialysis patients are exposed to extremely large volumes of water. The estimated water intake of a healthy individual is 2 L per day or 14 L per week. By comparison, during a single dialysis treatment lasting four hours, performed at a dialysis fluid flow rate of 800 mL/min, a hemodialysis patient is exposed to 192 L of water or to 576 L per week, if treated three times weekly. This exposure may increase further if the patient is treated by daily or nocturnal hemodialysis schedules, particularly if conventional rather than reduced dialysis fluid flow rates are used.

Hemodialysis patients have inadequate barriers to waterborne contaminants. In healthy individuals who are not on dialysis, the gastrointestinal tract separates blood from contaminants in the water. By comparison, the barrier between blood and water in hemodialysis patients is the membrane within the hemodialyzer through which transfer of contaminants is limited only by the size of the contaminant.

Hemodialysis patients are unable to renally excrete any contaminants taken up from the dialysate.

For many patients, the water used in the preparation of dialysis fluid is derived from a large municipal water supply. However, for some patients, particularly those in rural areas or treated in dialysis units located in small towns with a community water system, the water may be drawn from a local borehole or well. The microbiological and chemical quality of the water from such supplies is less certain. For example, a public health study of the occurrence of pathogens in untreated water from 244 US public water supply wells found that approximately 50 percent of wells initially considered more vulnerable to contamination and 40 percent of wells considered less vulnerable were positive for one or more fecal indicators (total coliform bacteria, Escherichia coli, enterococci, viruses infecting coliform bacteria, and human viruses) [1].

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Literature review current through: Nov 2017. | This topic last updated: Jun 09, 2016.
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