Nature and Consequences of Water and Dialysis Fluids Contamination

The fluid used in dialysis therapy (dialysis fluid) consists of dialysis concentrates and mainly of water (common ratios are 1:34 and 1:44). Whereas the concentrate is commonly produced commercially at a consistent composition, the water used may vary widely in its composition and quality. The source of dialysis water is drinking (tap) water which is submitted to purification cascade that involves, among others, pressure driven membranes processes such as reverse osmosis (RO). Dialysis water quality depends on its source (ground water, surface water), its geographical and geological origin, seasonal variations and the water treatment processes used and their performance.


How are Dialysis Patients Exposed to Water?

Typically a healthy adult is exposed (via ingestion) to 10–12 liters of water per week. Water goes across a selective barrier of the gastrointestinal tract and some toxic contaminants are removed by the kidney.

In contrast, hemodialysis patients undergoing 4-hour dialysis sessions, thrice weekly and are exposed to more than 360 liters of dialysis fluid per week. Dialysis fluids and consequently water contaminants (if present) may pass through the non-selective dialyzer membrane and as a result of limited or no renal function, a patient may find it difficult to maintain their normal balance of contaminants. Moreover, the highly permeable membranes used in dialysers today result in greater convective volumes and this has the potential to increase the level of contaminants passing through the membrane and consequently into the blood.
Therefore, the chemical and microbiological quality of the water used for dialysis is essential if an additional health risk to haemodialysis patients is to be avoided.

"Quality is not an act, it is a habit"


Links & More Information

ISO 11663

ISO 13958

ISO 13959

ISO 23500

ISO 26722

WHO Drinking Water Guidelines

UN Water

The Renal Association

Water Regulations Advisory Scheme


Water & Dialysis Fluids Quality Standards



ISO - International Organization for Standardization ISO13959:2014 - Water for haemodialysis and related therapies & ISO 11663:2014 - Quality of dialysis fluid for haemodialysis and related therapies.

EBPG - European Best Practice Guidelines (2002).

EP - European Pharmacopoeia (2014).

AAMI - International Association for the Advancement of Medical Instrumentation (ANSI/AAMI RD5:2003).











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