Reflection about the hemodialysis water microbiological quality in Brazil

Dialysis has been widely used in the treatment of patients with chronic kidney diseases and is considered a global public health issue. This treatment, which has changed the prognosis and quality of life in patients with chronic renal failure, can lead to complications that are often fatal. For this reason, there is a need for validation of alternative tests that favor the monitoring of treated water for dialysis in real-time to promote and prevent injuries to patients submitted to this procedure.

Keywords:
Quality control; Dialysis; Water microbiological characteristics; Biological contamination

Authorship

Gabriela Corrêa Carvalho ^**Correspondence: Gabriela Corrêa Carvalho. Departamento de Farmácia. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Av. Professor Lineu Prestes, 580 - Bloco 13A, térreo, São Paulo SP, Brasil. Phone: (11) 999271486. E-mail: gabrielacarvalho57@yahoo.com

Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, São Paulo, BrazilUniversity of São PauloBrazilSão Paulo, São Paulo, BrazilDepartment of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil

https://orcid.org/0000-0002-4071-5364

Kamal Dua

School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, AustraliaThe University of NewcastleAustraliaNewcastle, New South Wales, AustraliaSchool of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, New South Wales, Australia

Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, New South Wales, AustraliaHunter Medical Research InstituteAustraliaNewcastle, New South Wales, AustraliaPriority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, New South Wales, Australia

Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, AustraliaUniversity of Technology SydneyAustraliaUltimo, New South Wales, AustraliaDiscipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia

Gaurav Gupta

School of Pharmaceutical Sciences, Jaipur National University, Jagatpura, Jaipur, IndiJaipur National UniversityIndiJagatpura, Jaipur, IndiSchool of Pharmaceutical Sciences, Jaipur National University, Jagatpura, Jaipur, Indi

Adriana Bugno

Adolfo Lutz Institute, São Paulo, São Paulo, BrazilAdolfo Lutz InstituteBrazilSão Paulo, São Paulo, BrazilAdolfo Lutz Institute, São Paulo, São Paulo, Brazil

Terezinha de Jesus Andreoli Pinto

*Correspondence: Gabriela Corrêa Carvalho. Departamento de Farmácia. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Av. Professor Lineu Prestes, 580 - Bloco 13A, térreo, São Paulo SP, Brasil. Phone: (11) 999271486. E-mail: gabrielacarvalho57@yahoo.com

SCIMAGO INSTITUTIONS RANKINGS

Adolfo Lutz Institute, São Paulo, São Paulo, BrazilAdolfo Lutz InstituteBrazilSão Paulo, São Paulo, BrazilAdolfo Lutz Institute, São Paulo, São Paulo, Brazil

Figures | Tables

Figures (4)
Tables (2)

Thumbnail

FIGURE 1
Estimated prevalence of dialysis patients in Brazil, by region in the period of 2014-2017 (SOURCE: Adapted from Thomé et al., 2019Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. Braz J Nephrol . 2019; [Ahead of Print]. [citad 2018 June 6]. Available from: Available from: http://www.scielo.br/pdf/jbn/2019nahead/2175-8239-jbn-2018-0178.pdf
http://www.scielo.br/pdf/jbn/2019nahead/... ).

Thumbnail

FIGURE 2
Estimated incidence of dialysis patients in Brazil, by region in the period of 2014-2017 (SOURCE: Adapted from Thomé et al., 2019Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. Braz J Nephrol . 2019; [Ahead of Print]. [citad 2018 June 6]. Available from: Available from: http://www.scielo.br/pdf/jbn/2019nahead/2175-8239-jbn-2018-0178.pdf
http://www.scielo.br/pdf/jbn/2019nahead/... ).

Thumbnail

FIGURE 3
Dialysis water treatment scheme.

Thumbnail

FIGURE 4
Frequency of unsatisfactory results determined at the initial sample collection as a function of the analyzed parameter (Source: Buzzo et al., 2018Buzzo ML, Silva FPL, Hilinski EG, Bugno A. Effectiveness of the monitoring program for ensuring the quality of water treated for dialysis in the state of São Paulo. Braz J Nephrol. 2018;40(4):344-350.).

Thumbnail

TABLE I
Biological and microbiological quality standard for dialysis water

Thumbnail

TABLE II
Main types of alternative microbiological methods and their respective technologies

FIGURE 1 Estimated prevalence of dialysis patients in Brazil, by region in the period of 2014-2017 (SOURCE: Adapted from **Thomé et al., 2019**Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. Braz J Nephrol . 2019; [Ahead of Print]. [citad 2018 June 6]. Available from: Available from: http://www.scielo.br/pdf/jbn/2019nahead/2175-8239-jbn-2018-0178.pdf
http://www.scielo.br/pdf/jbn/2019nahead/... ).

FIGURE 2 Estimated incidence of dialysis patients in Brazil, by region in the period of 2014-2017 (SOURCE: Adapted from **Thomé et al., 2019**Thomé FS, Sesso RC, Lopes AA, Lugon JR, Martins CT. Brazilian chronic dialysis survey 2017. Braz J Nephrol . 2019; [Ahead of Print]. [citad 2018 June 6]. Available from: Available from: http://www.scielo.br/pdf/jbn/2019nahead/2175-8239-jbn-2018-0178.pdf
http://www.scielo.br/pdf/jbn/2019nahead/... ).

FIGURE 3 Dialysis water treatment scheme.

The water first passes through a membrane filter and follow to a sand sediment filter. Then it passes through two activated carbon filters, subsequently, the water passes through the ion exchange resin (softener or deionizer depending on the objective). Then the water passes through another membrane filter, finally, it passes by reverse osmosis (which can be single or double). The treated water is stored in clean tanks and then distributed to the point of use.

FIGURE 4 Frequency of unsatisfactory results determined at the initial sample collection as a function of the analyzed parameter (Source: **Buzzo et al., 2018**Buzzo ML, Silva FPL, Hilinski EG, Bugno A. Effectiveness of the monitoring program for ensuring the quality of water treated for dialysis in the state of São Paulo. Braz J Nephrol. 2018;40(4):344-350.).

TABLE I Biological and microbiological quality standard for dialysis water

Component	Maximum Allowable Value
Heterotrophic bacteria count	100 UFC*/mL
Total Coliforms	Absence in 100mL
Endotoxins	0,25 EU**/mL

* Colony-forming unit; **Endotoxin unit
Source: adapted from Anvisa, 2014Agência Nacional de Vigilância Sanitária, Brasil (Anvisa). Resolução nº 11, de 13 março 2014. Requisitos de Boas Práticas de Funcionamento para os Serviços de Diálise e dá outras providências. Diário Oficial União, 14 mar. 2014..

TABLE II Main types of alternative microbiological methods and their respective technologies

Methods				Technologies
Growth-based		Electrochemical Methods	Bioluminescence	Gas production or consumption detection	Use of chromogenic substrates
Viability-based		Solid phase cytometry	Flow cytometry	Direct epifluorescence
Cellular component-based	Phenotypic	Immunological	Fatty Acid Profile	Fourier Transform-Infrared	Mass spectrometry	Biochemical Assays Based on Physiological Reactions
Cellular component-based	Genotypic	Nucleic Acid Amplification	Fingerprint

Source: Adapted from Anvisa, 2019Agência Nacional de Vigilância Sanitária, Brasil (Anvisa). Farmacopéia brasileira. 6. ed. Brasília, 2019. v. 1..

How to cite

copy

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês

Versões e tradução automática

Versão original do texto

English

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Reflection about the hemodialysis water microbiological quality in Brazil

PlumX

Mensagem

[1] *Correspondence: Gabriela Corrêa Carvalho. Departamento de Farmácia. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Av. Professor Lineu Prestes, 580 - Bloco 13A, térreo, São Paulo SP, Brasil. Phone: (11) 999271486. E-mail: gabrielacarvalho57@yahoo.com