WATER TREATMENT

Water is used extensively for making the dialysate of dialysis fluid it is mixed with of special electrolytes.

The quality of water used is therefore critical to the preparation of a dialysis fluid that is free of contamination which have harmful effects on the health of the Haemodialysis patients.

INTRODUCTION

Water has the unique property of being an excellent solvent, high heat capacity and surface tension and hence it is very susceptible to be contaminated to the point where it becomes a health hazard.

The contaminants which may be present in water includes suspended solids, dissolved organics and inorganics, heavy metals & trace minerals and micro organisms.

CONTAMINANTS IN WATER ASSOCIATED WITH DIALYSIS COMPLICATIONS

1. Suspended Solids
Sand Silica

2. Dissolved Inorganics
Calcium Sodium Magnesium Nitrates Sulphates

3. Dissolved Organics
Chloramines Pesticides

4. Heavy Metals & Traced Elements

Iron Copper Lead Cadmium Aluminium

5. Micro organisms
Bacteria Pyrogen Algae

6. Endotoxin

CONTAMINANTS & THE TOXIC EFFECTS

Aluminium
Dialysis encelopathy Bone diseases Microcytic anaemia

Calcium / Magnesium
Hypercalcaemia / Hypermagnesaemia Nausea Vomiting Muscle weakness

Chloramine
Haemolyisis Anaemia

Fluoride
Osteomalacia Osteoporosis

Sodium
Hypertension Pulmonary oedema Tachycardia Vomiting Headache

Zinc
Anaemia Nausea Vomiting

pH
Heparin inactivation Itchiness Nausea Vomiting

pH tap water: 6.0 7.5 pH RO Water: 5.0 7.0

Microbial

Pyrexial reaction

Sulphate
Nausea Vomiting Metabolic acidosis

IMPORTANCE OF WATER TREATMENT

To prevent damage to the hydraulic parts in the machine To facilitate production of dialysate of correct electrolyte content To prevent long term side effects of untreated water

ACCEPATABLE WATER

Calcium & Magnesium should be < 0.5 ppm Free from chlorine Free from ions Bacteria count < 200 cfu / ml (AAMI std) Endotoxin level < 2 EU / ml (AAMI std) Meets AAMI standards
*cfu = colony forming unit * AAMI = Association of the Advancement of Medical Instrumentations

METHODS OF WATER TREATMENT

2 methods of water treatment

Deionizer Reverse Osmosis

Deionizer

Replace all cations & anions with hydrogen & hydroxide ions which in turn, combine to form water molecules. There is the separate column type or the mixed resin column type commonly used in home hemodialysis.

Reverse Osmosis (RO)

Utilises semipermeable membrane & high pressure to separate water from the contaminants present in the adequately treated water. The RO actively repels ions & organic contaminants while allowing pure water to pass through the microporous membrane surfaces.

Components of A Standard RO Water Treatment

Diagram
55% Rejected Water HD Station

45%

Ultraviolet

RO Membrane Storage Tank

Raw Water Tank

Guard Filter

Carbon Filter

Water Softener

Sediment Filter

Raw Water Pump

MAINTENANCE OF THE RO WATER SYSTEM

Daily recording of the various parameters as required by the manufacturer which includes:
-

Pump pressures Temperature Conductivity Flow rates Some others as per log sheet

Daily test for chlorine and hardness

Regular sampling 6 monthly of: - raw water - pre-treated water - treated water

Always adhere to the AAMI Haemodialysis water quality.

Regular preventive maintenance which include cleaning of membrane and changing filters

Replace membranes when output is below 60% of original output or when TDS is too high.

* TDS: Total Dissolved Solids