What are the requirements for dialysis water system in hemodialysis, and how is quality ensured?

As is well known, water is the source of life. Hemodialysis treatment also relies on water, but the water used for hemodialysis is different from ordinary tap water. High-quality dialysis water system are required to ensure patient safety.

For a long time, dialysis water system were only considered ancillary products of dialysis machines, with little technical complexity, as long as the water output was sufficient. However, a series of serious accidents involving casualties caused by excessive levels of unqualified chemical agents in water – such as aluminum pollution in Portugal in 1993, chloramine pollution in Spain in 1996, and formaldehyde pollution in Ohio, USA – clearly demonstrate how crucial the safety of water treatment is.

During dialysis treatment, 99.3% of the dialysate is water. Throughout the dialysis period, each patient will be exposed to the filtration of 15,000 to 30,000 liters of water per year. Dialysis patients are directly connected to the water used, and even small errors can harm them. It is important to note that the opportunity for contact between dialysis water and a patient's blood during hemodialysis is more than 20 times greater than the total amount of water consumed. This means that if a person consumes 1000 mL of water per day, the total amount of impurity components entering the patient's body during hemodialysis, based on the upper safety limit of impurities in the consumed water, could be 10 to 25 times higher. On the other hand, consumed water always reaches the bloodstream through gastrointestinal absorption. When water is absorbed from the gastrointestinal tract, cell membranes can selectively absorb substances, thereby altering the proportion of chemical components in the water.

During hemodialysis, water diffuses into the blood through a non-biological membrane (artificial membrane). The dialysis membrane cannot selectively absorb or reject specific ions. Thus, substances present in the dialysate, provided their molecular size allows passage through the dialysis membrane, can enter the bloodstream. Consequently, water that may be harmless for drinking can be toxic when used as dialysate without reliable dialysis water system.

If municipal tap water were used directly for hemodialysis, particulate matter and microorganisms could damage dialysis equipment, while inorganic or organic substances and bacterial byproducts could poison patients, causing symptoms such as Hard Water Syndrome, dialysis fever, chloramine poisoning, hemolysis, etc. The quality of the dialysate water directly affects the patient's nutritional status and is also a risk factor for complications. Therefore, the quality of dialysis water is a crucial link in ensuring effective and safe patient treatment, which depends on advanced dialysis water system.

With the rapid development of blood purification technology, the quality of life and survival rate of dialysis patients continue to improve. The series of clinical problems caused by contamination of dialysis water and dialysate have garnered attention from patients, families, medical workers, and scholars, leading to great emphasis being placed on it. Below, we elaborate on the hazards arising from substandard dialysis water quality:

Hazards of Non-Compliant Dialysis Water Quality

Aluminum Poisoning: Can cause low-turnover bone disease, as well as microcytic hypochromic anemia, dementia, tremors, and speech difficulties.

Hard Water Syndrome: Patients exhibit acute poisoning symptoms such as nausea, vomiting, fatigue, itching, severe hypertension, and even convulsions and coma.

Acute Hemolysis: Mild hemolysis may be asymptomatic. Significant hemolysis can manifest as cherry-red transparent blood coming from the dialyzer outlet, with patients experiencing chest tightness, chest pain, nausea, vomiting, dyspnea, and arrhythmia.

Pyrogenic Reaction: Bacterial and endotoxin contamination in dialysis water is a critical issue in the field of blood purification. Bacteria adhere to surfaces via "biofilms" they produce, particularly on reverse osmosis membranes, water delivery pipes, dialysis machine water pathways, etc. If the dialysis membrane is compromised, bacterial byproducts and cell membrane components can pass through the membrane pores into the blood, causing pyrogenic reactions in patients. This leads to symptoms like fever, chills, hypotension, and in severe cases, death. Endotoxins produced by bacteria can cause fever in patients. Long-term exposure can lead to various chronic complications, including decreased immune function, amyloidosis, atherosclerosis, and hypercatabolism. This can cause resistance to erythropoietin, leading to refractory anemia.

Other Adverse Reactions:

Certain substances naturally present in water, additives to the water source, supply pipelines, dialysis water treatment systems, and hemodialysis machines can all lead to serious adverse reactions. When collective adverse events occur, the possibility of issues with dialysis water should be considered. Tests such as complete blood count, bacterial culture, botulinum toxin, disinfectant residue levels, and chemical contaminant analysis of reverse osmosis water should be performed based on the patient's condition. Furthermore, substandard dialysis water quality can cause malfunctions in water delivery pipelines and dialysis machines, even shortening their service life and increasing costs for the blood purification center.

Measures to Ensure Quality of Dialysis Water System. 

Regularly test the quality of dialysis water and strictly adhere to aseptic techniques.

Maintain maintenance records for the dialysis water treatment systems, regularly assess the function of reverse osmosis membranes and filters, and replace them periodically.

Ensure the water treatment system is designed and installed scientifically and rationally. The dialysis water pipeline structure should be reasonable, without dead ends, allowing for thorough disinfection and cleaning.

Enhance training and education. Disinfect dialysis machines every shift, disinfect dialysis water pipelines monthly, and disinfect the reverse osmosis unit every three months. The concentration of disinfectant residues must be measured after disinfection.

Dialysis water safety management relates to the quality of the blood purification center, the service life and operating costs of equipment, and, most importantly, the dialysis quality and survival rate of patients. We must give it sufficient attention and implement effective dialysis water safety management both in mindset and action.

LEADER-T is committed to providing overall solutions for hospital smart water systems. The water supply pipelines are designed without dead ends, effectively preventing microbial contamination of dialysis water.

The Leader-T dialysis water treatment systems are currently among the most advanced in China. The quality of its reverse osmosis water can meet ultrapure water standards, with various indicators exceeding Chinese national standards, fundamentally ensuring the quality of patients' hemodialysis.

Leader-T conducts regular monthly ongoing equipment maintenance, not only ensuring the safety of dialysis water quality for patients but also preventing cross-infection between patients. To ensure patient safety and improve their quality of life, the Blood Purification Center team of the Nephrology Department will wholeheartedly serve patients.

Contact us to learn more about Leader-T dialysis water system and how they can ensure safe hemodialysis water quality.