ABSTRACT

Background: Standard water purity is one of the essential ingredients in achieving the goals of haemodialysis. However, water purity, though cardinal to the outcomes of haemodialysis, is probably the most neglected aspect of renal replacement therapy with haemodialysis.

Methods: A total of eight haemodialysis (HD) centres were studied. Water samples were analysed from three points: (a) water storage tank, (b) an outlet in the piping connection between the water storage tank and reverse osmosis (RO) machine and (c) an outlet piping between the RO machine and HD machine. Samples from A and B were referred to as pre-treated water, while samples from C were referred to as post-treated water. These samples were tested for aluminium, calcium and magnesium using the colorimeter; potassium and sodium using flame photometer; chloramines, nitrate, and free chlorine using colometric method. Water samples were also cultured in tryptone glucose extra agar at 37°C for 48 hours. Endotoxin analysis was done using limulus Amaeboctye assay.

Results: Borehole was the commonest source of water for haemodialysis, 63%. Treated water was tested for chemical and bacteriological contaminations every 3 months in 50% of the centres, every 6 months in 25% and rarely in 12.5%. One centre never tested their water. Combination methods were used in all the centres for water treatment. Mean concentration of aluminium (0.35 ± 0.06), chloramines (0.84 ± 0.88) and nitrate (2.54 ± 2.07) exceeded the Association for Advancement of Medical Instrumentation (AAMI) recommendation. The microbial counts were within the AAMI recommendation level.

Conclusion: Water purification in our environment is not optimal. This is cause for calls for serious concern.