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Biol Trace Elem Res. 2019 Jul;190(1):30-37. doi: 10.1007/s12011-018-1515-7. Epub 2018 Sep 14.

Hemodialysis Water Parameters as Predisposing Factors for Anemia in Patients in Dialytic Treatment: Application of Mixed Regression Models.

Author information

1
Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil.
2
Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil.
3
Department of Applied Mathematics and Statistics, Institute of Mathematical and Computing Sciences, University of São Paulo, Av. Trabalhador São Carlense 400, São Carlos, São Paulo, 13560-970, Brazil.
4
Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil.
5
Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain.
6
Laboratory of Soil Science, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII s/n., 08020, Barcelona, Catalonia, Spain.
7
Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil. susis@eerp.usp.br.

Abstract

Contamination by metals and microbiological agents in hemodialysis water can cause clinical intercurrences in hemodialysis patients. Evaluating and assuring minimum levels of contamination from metals and microorganisms in hemodialysis water can improve patient safety. The objective of this study was to assess hemodialysis water quality in a major tertiary hospital in Brazil and investigate the relationship between hemodialysis water quality and clinical intercurrences in hemodialysis patients. A prospective-observational cohort study for evaluation of water quality parameters and clinical intercurrences present by patients (n = 52) were performed from May 2014 to April 2015. Mixed linear regression models and binary regression models were fitted for water quality parameters and patients' clinical parameters. The increase in the levels of copper and nitrate in hemodialysis water was significant (p < 0.05) to explain anemia. Bone pain was related to age, sex (female), and hemodialysis treatment duration (years). Hypotensive episodes were related to serum sodium decrease. Aluminum in hemodialysis water was present in an average concentration higher than the permitted threshold (15.35 ± 14.53 μg/L). Cadmium, total coliforms, Escherichia coli, and endotoxins in hemodialysis water were not detected and the heterotrophic bacteria count was below the reference limit. These parameters' concentrations varied during the study, evidencing the need for continuous monitoring.

KEYWORDS:

Clinical intercurrences; Cohort study; Hemodialysis treatment; Hemodialysis water quality

PMID:
30218313
DOI:
10.1007/s12011-018-1515-7
[Indexed for MEDLINE]

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