Chemical quality of hemodialysis water in Greece : A multicenter study

Chemical contaminants of purified hemodialysis water are currently drawing little attention in the literature compared to bacterial contamination of treated water and dialysate and their impact on hemodialysis quality. Samples of tap water and treated water from all 85 hemodialysis centers in Greece were tested for Al, Fe, F, Pb, Mn, Ni, Cd, Cu, Cr, Zn, Cl, and NO 3 by the most appropriate method. Water hardness and conductivity levels, as well as information concerning characteristics of the hemodialysis center and the water purification system, were also obtained. All of the hemodialysis centers used treated water. For chemical contaminants, the overall compliance of treated water to the Medical Standards ranged from 92.3% up to 100%, whereas the compliance of feed water samples to our national standards was 80.7%. Water conductivity was below 15 mS/cm in 70% of the centers, while elevated hardness was found in feed water samples derived mainly from island regions. Hemodialysis centers equipped with antibacterial filters presented with water of better conductivity and decreased levels of nitrate and chloride. Our results confirm that hemodialysis centers in Greece are provided with water of satisfactory chemical quality, although chemical monitoring is essential in order to eliminate morbidity due to toxic reactions.