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1、QualityofDialysateWaterBy:Dr.MagdyEl-SharkawyMDAss.Prof.OfInt.Med&NephrologyAin-ShamsUniversity•WhyareHDpatientareatriskfromdialysatewater?•Whatadverseeffectsrelatedtowatercontamination?•Whatarethemaincontaminents?•Howcanweassuresafelevelsofthesecontaminents?Vulnerabilityofdialysispatient
2、stowatercontaminants•Anormalingestssomethinglike14litersofwateraweek.•Toxicorpotentiallytoxicsubstancegetsintothebloodstreamhasareadymeansofexcretion.•Sonormalpeopleareprotectedbyhavingarelativelysmallwaterintake,havingabarrieragainstabsorption,andameansofexcretion.•Hemodialysispatients,o
3、ntheotherhand,areentirelydifferent.Vulnerabilityofdialysispatientstowatercontaminants•Theblood/waterbarrierisanon-selectivemembrane.•Sotheyhaveverylargeexposure,noprotectivebarrier,andnomeansofexcretion.•Thushemodialysispatientswillbeextreamlysensitivetoanytoxicmaterialsthathappentobeinth
4、iswatersupply.SourceofContaminants•someofthecontaminantsthatarecommonlyfoundinwatersupplies.•Someofthemareinthesourcewater.–Forexample,ifyouareinanagriculturalarea,thereislikelytobenitratesinthewaterfromfertilizers.•Someofthemcomefrommunicipalwatertreatmentpractices.•Someofthesetoxinsarea
5、ctuallydeliberatelyaddedtothewatersupplyforgeneralpublichealthconsiderations.SourceofContaminants•Somesubstancescanbeaddedatthedialysisunit,suchasbacterialproliferationinourwatersuppliesorthatwegoandusepiping,likecopperorgalvanizedpiping.•Somesubstancesthataregenerallynottoxictothegeneral
6、populationastheyareinsmallconcentrationsbuttheyarequitetoxictodialysispatients.•Othersubstanceslikecalcium,magnesium,potassiumandsodium,thatwecantolerateinthewatersupply,buttheyarenotdesirableastheywillactuallyaffectthecompositionofthefinaldialysate.EatonJW,KolpinCF,SwoffordHS,Kjellstrand
7、CM,JacobHS.Chlorinatedurbanwater:acauseofdialysis-inducedhemolyticanemia.Science.1973Aug3;181(98):463-4.Standardsofwater•Neartheendofthe1970sitwasrecognizedthatdialysatewatercanhavetoxicsubstancesaffectingthehealthoddialysispatients.•Beginningofthe1980s,astandardfor
