Assessment And Monitoring The Quality Of Treated Water And Dialysate In A Public Hemodialysis Center To Prevent Potential Health Risks

Abstract

This study aimed to assess and monitor the physicochemical, bacteriological and endotoxin quality of dialysis water and dialysate used in a public HD center and to evaluate the performance of the unit to reject organic contaminants. Samples were collected over two years period (October 2014 to April 2017) from different points of the hemodialysis chain. Physicochemical parameters, bacterial count and endotoxin levels in dialysis waters as well as in dialysate were measured according to international standard methods. The water treatment system used at the dialysis center is based on single reverse osmosis The results of this study revealed the presence of chemical contaminants namely trihalomethanes (THMs), total concentration of THMs was found to be 50.69±8.980 and 42.54±19.07 μg/L in treated water and in dialysate respectively and Chloroform was the major contributor to the THMs concentration. A peak of conductivity about 4-fold higher than the norm was recorded. Detection of low microbial perturbation in both feed and treated water as well as in dialysate due probably to inappropriate disinfection.Endotoxins were identified in 84% of treated water samples with values below the limit set by the European Pharmacopoeia (<0.25 EU/mL). During the entire study period the performance of the dialysis unit for THM removal remained moderate and did not reach 50%. More efforts are required regarding water quality management in the HD center for a successful HD therapy. Local guidelines on HD water quality should be developed and enforced.