Quality of hemodialysis water in a resource-poor country: The Nigerian example

Hemodialysis (HD) patients are exposed to large volumes of water, separated from patients' blood by semipermeable membrane of dialyzers. Chemical contaminants in poorly treated water impact negatively on quality of life of these patients. This survey was carried out to assess the HD water quality in Lagos, Nigeria. Ten milliliters of feed and treated water from all six HD centers in Lagos were tested for aluminum, copper, zinc, magnesium, calcium using atomic absorption spectrometry; sodium and potassium were tested using flame photometry, fluoride with molecular photoluminescence method; sulfate using turbidimetry, nitrates measured by cadmium column reduction method, chloramines and free chlorine were measured using N, N-diethyl-1-P-phenylenediamine colorimetric method. Information on sources of feed water, frequency of testing of HD water, methods of water treatment, type of water purification system and maintenance was also obtained. All centers used borehole as main source of water supply. None of the centers met Association for the Advancement of Medical Instrumentation (AAMI) guidelines for most chemical contaminants. Only chlorine (0.48 +/- 0.07?mg/L) and potassium (3.9 +/- 0.95?mg/L) levels met AAMI standards after treatment. Mean levels of chemical contaminants in treated water were as follows: aluminum 0.04 +/- 0.01?mg/L, zinc 0.27 +/- 0.08?mg/L, chloramines 0.16 +/- 0.03?mg/L, fluoride 1.83 +/- 0.40?mg/L, sulfate 117 +/- 86.1?mg/L which were mildly elevated; calcium 126.00 +/- 22.7?mg/L, sodium 179 +/- 25.6?mg/L, and nitrate 70.5 +/- 50.8?mg/L, which were markedly elevated; and magnesium 8.3 +/- 3.38?mg/L, which was moderately elevated above AAMI recommended levels. HD water quality is poor in our environment. Concerted efforts are required to ensure good quality water for HD.