Water for Hemodialysis
Water for Hemodialysis
Definition
Water for Hemodialysis is specially treated water used to prepare dialysis fluid (dialysate) and for reprocessing hemodialysis machines and equipment. Since patients are directly exposed to large volumes of water during dialysis (through the dialyzer membrane), the water must meet strict chemical and microbiological quality standards.
Importance in Healthcare
-
Patients undergoing dialysis are exposed to 120–200 liters of water per session.
-
Any chemical impurity, pyrogen, or microbial contaminant can directly enter the bloodstream and cause severe toxicity or infection.
-
Safe dialysis water is critical to patient safety, treatment effectiveness, and infection control.
Standards & Guidelines
-
Governed by AAMI (Association for the Advancement of Medical Instrumentation), ISO 23500, USP, and European Pharmacopeia.
-
Two main grades:
-
Treated Water: Used for preparing dialysis fluid.
-
Ultrapure Water: For high-flux dialysis, hemofiltration, and online hemodiafiltration (HDF).
-
Water Treatment Process for Hemodialysis
A multi-barrier purification system is used:
-
Pre-treatment
-
Sand/Multimedia filtration (removes suspended solids).
-
Carbon filtration (removes chlorine/chloramine).
-
Water softener (removes calcium, magnesium).
-
-
Primary Treatment
-
Reverse Osmosis (RO) (removes >95–99% dissolved salts, bacteria, endotoxins).
-
Deionization (if required).
-
-
Polishing & Distribution
-
Ultrafilters (removes endotoxins).
-
UV disinfection.
-
Stainless steel or medical-grade distribution piping with continuous recirculation.
-
Quality Requirements
-
Chemical Quality: Must be free from harmful levels of aluminum, chloramine, fluoride, heavy metals, etc.
-
Microbiological Quality:
-
Bacteria < 100 CFU/mL (treated water), < 0.1 CFU/mL (ultrapure).
-
Endotoxin < 0.25 EU/mL (ultrapure).
-
-
Conductivity & pH: Within safe limits.
Applications
-
Preparation of dialysate for hemodialysis.
-
Reprocessing of dialyzers and hemodialysis machines.
-
Used in high-flux and online therapies (HDF/HF).
✅ In summary:
Water for Hemodialysis is one of the most critical utilities in dialysis treatment. It must be free from microbial, chemical, and endotoxin contamination. Proper design, treatment, monitoring, and maintenance of the dialysis water system are vital for patient safety and compliance with AAMI/ISO standards.