HDCN Article Review/Hyperlink

Rosenthal AF

Why do aluminum analyses?

Dial Transplant (Oct) 26:670-673 1997

This review paper by Rosenthal expresses the opinion (without any hard data), that dialysis center water should be tested for aluminum frequently. AAMI recommends annual testing; Dr. Rosenthal suggests it should be done quarterly.

He cites several case reports where elevated aluminum levels were found. In one center, a cluster of patients was found to have high serum aluminum levels (20-30 µg/L). The cause was addition of alum to the source water by the local water authority, to assist in precipitating particulate matter (this became necessary after recent drought conditions). Dr. Rosenthal points out that in his experience (again without denominators it is difficult to understand the importance of the effect), on at least 9 separate occasions, center wide aluminum contamination of dialysis center water systems occurred. Causes included:

Causes of center-wide contamination of water with aluminum
Alum added to water supply (most frequent)
Torn RO membrane; failure to monitor RO rejection ratio
Micropuncture of RO membrane by CaCO3 crystals; softener depleted of salt
Failure to turn RO system back on after servicing
Presence of aluminum component or contaminant in dialysis system tubing

He also discusses other chemical contaminants, notably fluoride, although the discussion is not developed in great detail.

Comment: I believe that AAMI is proposing revised standards now, which are open for comment. You can reach the AAMI site at www.aami.org . Unfortunately, most AAMI documents are not available via the Web. They can be purchased for an exorbitant price as a CD-ROM ($1100.00!!). (John T. Daugirdas, M.D., University of Illinois at Chicago)