water purification for hemodialysis procedure

1. Water Purification for
Hemodialysis dialysis
and Dialysis solution
Yousaf khan
Renal dialysis lecturer
IPMS-KMU

2. Did You Know??
• An Average Hemodialysis patient is exposed to approximately 560
liters of water through their weekly Dialysis Treatments. This is more
water than most people in a lifetime

3. Water Treatment for Dialysis

4. Water Treatment
• It is important to treat water so impurities and excess minerals
are removed. Minerals in the water can be toxic to patients
and harmful to equipment.
• Elements in untreated water may be small enough to pass
from the dialysate side of the membrane into the patient’s
blood.

5. Water contaminants harmful for
dialysis patient
Sign or Symptom Possible Water Contamination-Related Cause
• Anemia - Aluminum, chloramines, copper, zinc
• Bone Disease - Aluminum, floride
• Hemolysis - Aluminum, copper, nitrates, chloramines
• Hypertension - Calcium, sodium
• Hypotension - Bacteria, endotoxins, nitrates
• Metabolic Acidosis - Low pH, sulfates
• Muscle Weakness - Calcium, Magnesium
• Nausea and Vomiting - Bacteria, calcium, copper, endotoxin, low pH,
magnesium, nitrates, sulfates, zinc
• Neurological deterioration - Aluminum
• Fever, chills - Bacteria, endotoxin, copper, zinc

6. Methods of purifying water for
hemodialysis
• Pre Treatment
• Primary Purification
• Distribution

7. Pre Treatment
• Preliminary filtration
• Softening
• Adsorption with activated carbon
• This cascade is designed to prepare the water for optimal operation of the
primary purification process.
• Correction of PH (HCL) – Correct excessive alkalinity which can impede
functioning of carbon adsorption beds as well as RO membrane.

8. Water softener
• Used to remove calcium and
magnesium from water by
ionic exchange with sodium
that has been affixed to a
resin bed.
• Resin exchanges two Na+ ions
for Ca++ and Mg++ as well as
other cations such iron and
manganese.
• Protect RO membrane.

9. Carbon adsorption
• Activated carbon is utilized to
remove chlorine and
chloramines which are not
removed by reverse osmosis.
• Cause hemolytic anemia
• Chloramines take longer time
to adsorbed by carbon than
chlorine.
• Also removed organic
compound

10. Primary purification process
Reverse osmosis:
• Achieved by high pressure filtration of water (using powerful pump)
through semipermeable membrane that will hold back the dissolved
solutes.
• Reverse osmosis will removed more than 95% of ionic contaminants
and non ionic contaminants as small as glucose
• Provide effective barrier against bacteria and endotoxins
• RO provide water of sufficient quality for the preparation of dialysis
solution with out further purification.

11. Primary purification process
Deionization:
• Used as alternative to reverse osmosis.
• But is more frequently used to further purify water
• Deionizers do not remove nonionic contaminants bacteria or
endotoxins
• Contain two beds ( one for the cationic resin and the other for
anionic resin)
• Cationic resins contain sulfuric radicals and these exchange H ion for
other cation such as Na, Ca and aluminum
• Anionic resins contain ammonium radicals which exchange hydroxyl
ion for other anions such as chloride, phosphate and fluoride.

12. Primary purification process

13. Water treatment for Hemodialysis

14. Distribution of purified water
• Distribution of purified water must be free of contaminants
• Chemical contaminants must be avoided by using inert materials
such as plastic for all components that contact the purified water
and dialysis solution.
• Microbiologic contamination is avoided by using appropriately
designed and constructed piping systems in combination with
regular disinfection

15. Safety standards
• Careful procedure and documentation of the functioning of each
part of the water supply system must be done.
• Both AAMI (Association for advancement of medical
instrumentation ) and the European Best Practices Group have
developed standards for equipment used to purify water for dialysis
that are designed to maximized patient safety.
• These include chemical purity monitoring of water and dialysis
solution
• Chloramines are checked for at least daily.

16. Thank you