Abstract
Hemodialysis water and dialysates are fundamental in the treatment of kidney disease. During just one hemodialysis session, 120 liters of dialysate are consumed. Thus, it is essential that the parameters of chemical and microbiological quality of the fluids used in dialysis systems are carefully observed. In this study, water samples were collected at 12 hospitals in the state of Rio de Janeiro. The samples were obtained at three points of fluid reservoirs: pre-, post-osmosis and dialysis solution. After collection, colony forming units (CFU), total coliforms and Escherichia coli 100 mL -1 were quantified. Later, isolated colonies and endotoxin content were identified by biochemical assays. Data about total aluminum levels per sample (mg L -1 ) were also obtained. Samples of all mobile dialysis services and points of collection were contaminated above the levels set out by national laws, in particular by Pseudomonas aeruginosa . Endotoxin levels were also above the recommended by current legislation (> 0.25 EU mL -1 ). Only three samples contained detectable levels of aluminum, which were found to be above the recommended values for the corresponding resolution (0.01 mg L -1 ). Finally, there were no observable amounts of total coliforms and E. coli 100 mL -1 sample. The data from this study are an important step forward in the standardization and control of chemical/microbiological quality of mobile dialysis services.
Highlights
Despite the presence of multiple barriers in the treatment of dialysis waters, the risk of contamination by microorganisms, pyrogens and metals should be carefully considered (Ferreira et al, 2015)
Approximately 120 liters of dialysate are used for blood depuration, water purity is essential to avoid additional risks to the patient’s health (Bommer & Jaber, 2006).The European Pharmacopoeia recommends an upper limit of 100 colony forming units (CFU) mL-1 for purified water used in dialysates (Council of Europe, 2013), once several studies have demonstrated the importance of maintaining low bacterial load within the dialysate, preventing clinical complications due to bacterial contaminants (Brunet & Berland, 2000; Lonnemann, 2000)
The presence of microorganisms was detected in all hospital units (1-12) and collection points, id est preosmosis, post-osmosis and dialysate solution
Summary
Despite the presence of multiple barriers in the treatment of dialysis waters, the risk of contamination by microorganisms, pyrogens and metals should be carefully considered (Ferreira et al, 2015). Ultrapure dialysates should contain no more than 0.1 CFU mL-1 (colony-forming units mL-1) and 0.03 EU mL-1 (endotoxin units mL-1) These purified dialysate solutions are efficient in preventing chronic inflammation and reducing the frequency of infection in patients under dialytic treatment (Association for the Advancement of Medical Instrumentation [AAMI], 2001; Arizono, Nomura, Motoyama, Takeshita, & Fukui, 2004; Ward, 2004; Bommer & Jaber, 2006), indicating the importance of maintaining high microbiological standards for dialysates. Approximately 120 liters of dialysate are used for blood depuration, water purity is essential to avoid additional risks to the patient’s health (Bommer & Jaber, 2006).The European Pharmacopoeia recommends an upper limit of 100 CFU mL-1 for purified water used in dialysates (Council of Europe, 2013), once several studies have demonstrated the importance of maintaining low bacterial load within the dialysate, preventing clinical complications due to bacterial contaminants (Brunet & Berland, 2000; Lonnemann, 2000). Our data are an important advance in the standardization of chemical/microbiological quality control in mobile dialysis services
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