Abstract
Failure on the water treatment poses hemodialysis patients at risk of injury and death. Identifying if the patients are exposed to water quality related microbiological risks is an important objective to reduce the mortality for chronic renal patients and is the main issue of this study. We evaluated the microbiological water quality used by 205 dialysis services in Sao Paulo State, Brazil between 2010 to 2016. The study included heterotrophic bacteria count, total coliforms research, and bacterial endotoxin determination in 1366 dialysis water samples. The number of unsatisfactory clinics for at least one microbiological parameter decreased 16.0% between 2010 to 2015 but increased 57.2% in 2016. In 2010, the most frequent unsatisfactory parameter was related to heterotrophic bacteria count (54.8%) followed by endotoxin determination (45.2%). However, in 2013 an opposite situation was observed: endotoxin determination as the parameter of the higher incidence of nonconformities. Total coliform was verified at a lower frequency. We highlighted the importance of regular monitoring of dialysis water quality to prevent infections caused by dialytic procedures and to ensure that the water is a safe component of the treatment.
Highlights
Dialysis water quality is the product of an integrated sequence of purification systems and disinfection steps
1,209 dialysis water samples were collected in 205 different clinics located in all 15 macroregions of São Paulo State, Brazil (Figure 1)
We verified an average increase of approximately 2.2% per year in the number of dialytic services operating in the State during the period studied, a similar result (2.8%) observed for Brazilian Society of Nephrology in a country-wide study between 2011 to 2014 (Brasil, 2014; Sesso et al, 2014)
Summary
Dialysis water quality is the product of an integrated sequence of purification systems and disinfection steps. Failure on the water treatment poses hemodialysis patients at risk of injury and death. When present in the dialysis water, endotoxins may enter the blood compartment and potentially activate monocytes to produce pro-inflammatory cytokines, related to several distinct acute and chronic problems of hemodialysis patients (Linde et al, 1999; Garcia, Benitez, 2000). The frequency of pyrogenic reactions associated with contamination of the hemodialysis treatment system is about 0.7 per 1000 sessions (Linde et al, 1999).
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