What is Hemodialysis?
Hemodialysis is a treatment method that artificially performs the cleansing function that the kidneys cannot do. This treatment filters the patient's blood through a machine, removing excess fluids, electrolytes, and waste products. The cleansed blood is then returned to the patient. Hemodialysis is usually a procedure that lasts about 4 hours and is done three times a week.
Why Is It Important for Kidney Patients?
The kidneys are vital organs that filter waste products and excess fluids from the body. Patients with chronic kidney failure have kidneys that cannot perform this function adequately. Hemodialysis improves the quality of life for these patients by cleansing waste materials and excess fluids, offering them a longer lifespan.
Where Is Kidney Failure Most Common?
Kidney failure is a global health problem affecting millions of people worldwide. However, some countries and regions face this issue more intensely:
- United States: High rates of diabetes and high blood pressure make kidney failure quite common in the U.S.
- China: Rapid industrial growth and environmental pollution are increasing kidney diseases in China.
- India: Inadequate medical infrastructure and lack of early diagnosis exacerbate kidney failure in India.
- African Continent: Water pollution and insufficient healthcare services are increasing the risk of kidney failure in Africa.
The Biggest Challenge for Dialysis Patients: Water Restriction and Ways to Cope
There are many factors that affect the quality of life for individuals undergoing dialysis treatment, but perhaps one of the most significant challenges is water restriction. Although this treatment is incredibly helpful for patients with kidney failure, the water consumption limitations it imposes can create both physical and psychological difficulties. So, why is water restriction such a big issue for dialysis patients, and how can they cope with this situation?
Why Water Restriction?
Patients undergoing dialysis treatment cannot excrete excess fluid from their bodies. This puts an extra burden on the heart and circulatory system, potentially triggering health issues such as hypertension and edema. Therefore, fluid intake, including water, is generally limited to 1-1.5 liters per day.
What Is the Role of Pure Water in Dialysis?
Dialysis is a crucial treatment for patients with kidney failure. In the hemodialysis process, the quality of pure water is a critical factor for both the efficacy of the treatment and the patient's health. So, what is the role of pure water in the dialysis process, and why is it so important?
Role of Pure Water in the Dialysis Machine
The dialysis machine filters the patient's blood, removing harmful waste materials, excess salt, and fluids. The quality of water circulating within the machine directly affects the outcomes. Pure water comes into contact with the patient's blood in the part of the machine known as the hemodialyzer or 'artificial kidney.' Any risk of contamination could lead to serious health issues.
Equipment Providing Pure Water
Dialysis centers usually employ water purification methods like reverse osmosis or deionization. These systems are designed to bring water to a high level of purity. Regular maintenance and calibration of these systems ensure the process is safe and effective.
Importance of Pure Water for Dialysis Patients
For dialysis patients, pure water is not just a requirement but also a critical factor for the success of the treatment. Therefore, it is essential for dialysis centers to make significant investments in water purification systems and equipment and to continuously monitor these systems.
Also known as artificial kidney treatment, hemodialysis is a critical and effective treatment for chronic kidney failure. The quality of the fluid used in this treatment process is highly critical for patient health.
Why Are Water Purification Systems Important?
In hemodialysis treatment, the patient's blood goes through a series of filtration and cleansing processes. In this process, the purity of the water used plays a key role in effectively removing toxins and waste materials. Medical water purification systems ensure that the fluid meets appropriate quality standards.
Types of Basic Equipment
Pre-Filters: Pre-filters are the initial stage in hemodialysis water purification systems, used to remove large particles, sediments, and other mechanical impurities from water. These filters are typically devices that first process raw water from the source and prepare it for subsequent purification stages. Pre-filters often work in conjunction with other purification equipment such as reverse osmosis units, carbon filters, UV sterilizers, and other treatment components to form a water purification system. Regular inspection and maintenance of pre-filters are essential to ensure the compatibility and effective operation of these systems.
Removal of Large Particles and Sediments: Pre-filters clean water by removing large particles such as sand, mud, rust, and other contaminants.
Protection: Pre-filters protect more delicate and expensive purification equipment (e.g., reverse osmosis membranes) by eliminating large particles that could potentially damage such equipment.
Parameters Required for Dialysis
- Filtration Size: Pre-filters typically need to filter with a minimum sensitivity of 5 microns, although this can vary depending on the application and the quality of the water source.
- Material: Filter material generally needs to be resistant to corrosion and chemical effects. Materials such as stainless steel or polypropylene are often used.
- Flow Rate: The speed at which the filter can process water is an important factor for the overall efficiency of the system.
- Ease of Maintenance: Filters should be easy to replace or clean, which is important for operational convenience and low operating costs.
- Chemical and Biological Compatibility: Pre-filters need to be chemically and biologically compatible with other treatment stages and the dialysis process.
- pH Regulation Valve: In hemodialysis water purification systems, the pH regulation valve, often known as a "mixing valve" or "pH regulation valve," is responsible for adjusting the pH level. This valve monitors the incoming water's pH level and makes adjustments as necessary to achieve an ideal pH level. The ideal pH level for hemodialysis is generally between 7.0 and 7.8. The valve aims to maintain the water's pH within this ideal range by adding acidic or alkaline substances. These valves are usually made from high-quality materials and equipped with sophisticated sensors and control systems, as medical applications demand a high degree of precision and reliability. Regular calibration and maintenance of these valves are essential for the proper functioning of the system.
- RO Units (Reverse Osmosis Units): Reverse osmosis (RO) units clean out tiny harmful components.
- UV Sterilizers: UV sterilizers play a critical role in hemodialysis water purification systems. These devices use ultraviolet rays to purify water from microorganisms (bacteria, viruses, fungal spores, etc.).
UV rays disrupt the DNA or RNA structure of microorganisms, preventing their replication and activity. This ensures that the water used in the dialysis process is clean and safe. UV sterilizers are generally highly effective and can achieve a 99.9% elimination of microorganisms. Additionally, unlike chemical disinfectants, these systems do not leave chemical residues, preserving the physical and chemical properties of the water. This is crucial for the safe and effective execution of the hemodialysis process.
UV sterilizers require regular maintenance and the replacement of lamps after a certain period. Additionally, for UV rays to effectively penetrate the water, the water needs to have a specific level of clarity. Therefore, UV sterilizers are often used in conjunction with other treatment methods such as mechanical filters or reverse osmosis systems.
- Endotoxin Filters: Special filters that remove endotoxins.
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TDS (Total Dissolved Solids)
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This parameter measures the quantity of minerals, salts, and metals in water. For hemodialysis, the TDS level should be extremely low.
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| pH Value |
The ideal pH level should range between 7.0 and 7.8. Maintaining this range contributes to a safer and more effective treatment process. |
| Microbiological Standards |
Bacterial and endotoxin levels can be managed through regular sterilization of the equipment.
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Conductivity
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Conductivity (Conductance) is a parameter that measures how effectively a liquid carries ionic substances. Low conductivity indicates high purity in water.
Conductivity, also known as conductance, is a parameter that measures how effectively a liquid carries ionic substances. In the context of hemodialysis, the conductivity of the water used is an important indicator of water purity and ion concentration.
A high conductivity value indicates that the water has a high ionic concentration and is therefore less pure. For hemodialysis water purification systems and dialysis patients, low conductivity values are generally preferred.
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Ideal Conductivity Values:
Hemodialysis Water Purification Systems: Ideal conductivity values generally vary depending on the specifications of the dialysis machine and membrane. However, it is often recommended that conductivity should be 25 µS/cm (microsiemens per centimeter).
Dialysis Patients: Low conductivity values translate to safer and more effective dialysis treatment for patients. High ion concentrations can disrupt the patient's electrolyte balance and lead to various health issues.
Usage Values: What Each Equipment Does
- Pre-Filters: Perform filtration with a minimum sensitivity of 5 microns.
- Mixing Valve: Aims to maintain the pH level around 7.2.
- Reverse Osmosis (RO) Units: Strive to reduce TDS (Total Dissolved Solids) as much as possible.
- UV Sterilizers: Provide 99.9% elimination of microorganisms.
- Bacterial and Endotoxin Contamination: Maintain endotoxin levels below 0.03 IU/mL. The water should be free from bacterial contamination. Organizations like AAMI recommend keeping bacterial colony counts in water samples below 100 CFU/mL (Colony Forming Units per milliliter). Endotoxin levels should also be quite low, generally below 0.25 EU/mL (Endotoxin Units per milliliter).
Chemical Parameters
• Aluminum: Typically should be below 10 µg/L (micrograms per liter).
• Chlorine: Recommended to be below 0.1 mg/L.
• Fluoride: Should be below 0.2 mg/L.
• Calcium and Magnesium: Water hardness is generally recommended to be 2 mg/L as CaCO3 or lower.
• Total Dissolved Solids (TDS): The quality of water used in the hemodialysis process must be very high since this water comes into direct contact with the patient's blood. In water treatment systems, the Total Dissolved Solids (TDS) value for hemodialysis water should generally be very low. The recommended TDS value for hemodialysis should be quite low.
• pH Value: The pH level of water should generally be between 5-10, but this can vary depending on the requirements of the dialysis machine.
Other Important Factors
• Chloramine: Chloramine should not be present in dialysis water as it can lead to hemolytic anemia. Chloramine levels are generally recommended to be below 0.1 mg/L.
• Sulfate, Nitrate, Copper, Zinc, etc.: These substances also have strict limits and are generally required to be in parts per billion (ppb) levels.
Monitoring and Testing
Dialysis water should be periodically analyzed, often performed by both hospital laboratories and external laboratories. Tests are usually conducted monthly, but some situations may require more frequent testing.
All these parameters are typically determined by both national and international regulations. Dialysis units must strictly adhere to these guidelines.
As RIVAMED, we choose the most suitable and high-quality system based on analysis values and parameter results demonstrating water quality for institutions, organizations, and centers in need. After the system design and planning, the installation of RIVAMED hemodialysis water purification systems is carried out turnkey. We provide 24/7 technical support and after-sales services to offer the best service to patients for institutions or centers.