Monitoring of water for dialysis

Scottish Trace Element and Micronutrient Reference Laboratory

Scotland's specialised laboratory for trace elements and vitamins in health and disease

Monitoring of Water for Dialysis

Trace Elements

Vitamins

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Information

The water used for preparation of dialysis fluid needs to be pure to prevent transfer of toxic substances to the blood during dialysis. In the 1970s during the development of renal dialysis, patients on dialysis developed osteomalacia and dementia which was shown to be related to accumulation of aluminium. Regulations were introduced to limit the concentration of aluminium in water used for dialysis.

It is now mandatory that water used in haemodialysis is initially purified by reverse osmosis. The Renal Association has published guidelines recommending limits of various trace elements and pathogens in reverse osmosis water (Treatment of adults and children with renal failure. Standards and audit measures. 3rd edition, Aug 2002). It is suggested that full chemical analysis of raw water and purified water should be carried out every 3 months.

Table 1. Recommendations by the Renal Association for limits of impurities in water used for dialysis (mg/l). Full chemical analysis of raw water and purified water should be carried out every 3 months.

Sample Type	Water, dialysis fluids.
Container	Universal container. Sarstedt containers (product number 63.9922.252) are suitable.
Precautions	Zinc and aluminium are found in the lid inserts of some Universal containers (eg. Sterilin) and can contaminate the sample.
Volume	1 mL (minimum)
Renal Association guideline limits	Aluminium 10 µg/L Calcium 2 mg/L Copper 100 µg/L Lead 5 µg/L Magnesium 2 mg/L Potassium 2 mg/L Silver 5 µg/L Sodium 50 mg/L Zinc 100 µg/L
Turnaround time	1 week
Method	Inductively coupled plasma/emission spectrometry

A dialysis station at Glasgow Royal Infirmary