Water Treatment for Hemodialysis

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Introduction

Water purity for dialysis is of critical importance for patient health and outcome, and in this regard, there are three major points to consider:

  • Hemodialysis (HD) patients are exposed to more than 400 Liters of water per week. Contrast this with a person with a normal kidney drinking only less than 15 Liters
    of water per week.

  • The stomach acid and intestinal barrier protection from the ills of contaminated water more effectively than the barrier imposed by the dialyzer membrane.

  • The functioning kidney can further protect the normal individual from the contaminants of water by eliminating these, this protection being absent for the HD patient.

Water consumption for each bed is calculated at approximately 50 liters per hour.

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Water Concerns

The contaminants can be divided into three major categories:

  1. Particulate Matter
    These cause turbidity and include clay, iron, sand, chalk, silica, etc.

  2. Chemicals
    These include dissolved inorganic ions and salts, such as Na, Cl, Al, Ca, Mg, and Fl. Organic matter includes industrial and agricultural toxins such as fertilizers, pesticides, and oils.

  3. Microorganisms and Endotoxins
    These include predominantly bacteria and occasionally fungi, viruses, protozoa, spores, and endotoxins produced by the organisms.

Rotek’s mission is to reduce all contaminants from the raw water to the level that meets standards of
The Association for the Advancement of Medical Instrumentation (AAMI).

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What is Endotoxin?

Viable bacteria and endotoxins in water sometimes cause problems for human health. Endotoxins are major components of the outer cell wall of gram-negative bacteria. in medical procedures, especially hemodialysis (HD) and related therapies HDF and HF, endotoxins in the water for hemodialysis can permeate through the hemodialysis membrane and cause microinflammation or various related illnesses. To decrease such a biological risk, RO and UF membranes are generally used. Also, hot water disinfection.

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Design Criteria

Based on the raw water quality analysis, we will provide our design suggestions follow by the 4 major treatment setup:

Filtration Systems
This section is basically responsible to filter out most of the fine particles, heavy metals, chlorine, organic matters, bacteria, color & odors. The filtration system usually consists of Clino-X Multimedia Sand Filter, Activated Carbon Filter, Water Softener, Ultra-Filtration System, Anti-Scale, and Chlorination Chemical Dosing Systems.

1st Pass Purification Systems
Reverse osmosis (RO) is a water purification technology that ROTEK uses most of the time for many industries. RO can remove many types of molecules and ions from solutions and is used in both industrial processes and to produce potable water. Depending on the raw water quality, if raw water TDS is below 50ppm, then this section of the purification system may not be required as part of the design for bottled water production.

 

Remineralization Systems

Although RO removes everything from the water (including good and bad minerals),
however low mineralized water have few adverse effects:
- High corrosion potential
- Dietary deficiency causing risks of ischaemic heart and cerebrovascular disease (WHO, 2005a; WHO, 2006; Cotruvo, 2006)
The WHO recommends 10 mg/L of Magnesium and 30 mg/L of Calcium for drinking water. Therefore adding beneficial minerals to the product water is a process called demineralization. ROTEK uses natural minerals called "Camag" for adding pure Magnesium and Calcium to the product water with great improvement on the taste and pH level.

Disinfection Systems
The most common bacteria found in bottled water is Pseudomonas fluorescens, which is common in fresh-water springs. It is not considered to be a health threat until you leave the bottle open for extended periods of time and the bacteria begin to react with the carcinogens in the plastic. Reducing bacteria and microbial to the minimum is the most important issue in the bottled water production business. ROTEK disinfection system consists of UV sterilizer, Nanosilver Activated Carbon, 0.2-micron filter, and ozone disinfection. With four levels of protections, the ROTEK disinfection system will make sure the bacteria level is reduced to nil before filled to the bottle.