Microbial quality of hemodialysis water, a survey of six centers in Lagos, Nigeria Rotimi Williams BRAIMOH, 1,2 Monica Omolara MABAYOJE, 1 Christiana Oluwatoyin AMIRA, 1 Babawale Taslim BELLO 1 1 Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria; 2 Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria Abstract Patients with end-stage kidney disease (ESRD) on maintenance hemodialysis (HD) are usually exposed to large volumes of dialysate, which is separated from patients’ blood only by thin membrane of dialyzer. It is therefore essential to frequently monitor the quality of HD water to ensure that it meets the recommended standards. The objective of this study was to evaluate the microbial quality of HD water in Lagos, Nigeria. Four sets of pre- and post-treatment water samples, 20 mL each, were collected from six HD centers in Lagos and tested for microbial contamination using the molten Tryptic soy agar in accordance with Association for Advancement of Medical Instrumentation (AAMI) and European Best Practice Guidelines (EBPG). Pyrogen tests were also conducted on pre- and post-treatment samples using standard technique. Information on water treatment modalities, maintenance practices and quality control measures in each center were obtained using a questionnaire. All centers use treated water for HD purpose. None of the HD centers met EBPG/AAMI guidelines for microbial contaminants as the mean levels of Escherichia coli in both feed and treated water were 441.7 ± 87.90 and 168.5 ± 64.03, respectively. E. coli was the commonest organism isolated in both feed and treated water in all the centers. HD water quality is still a neglected problem in our environment and more efforts are required to ensure good water quality for HD purpose. Key words: Microbial quality, hemodialysis, water INTRODUCTION Chronic kidney disease (CKD) is associated with increased risk of adverse outcomes, including end-stage renal disease (ESRD) with a substantial reduction in life expec- tancy. 1,2 One modality of treatment for ESRD is hemodi- alysis (HD), which requires the use of well treated, uncontaminated water. Patients on maintenance HD are exposed to as much as 350–500 L of water per week. 3–5 The water is separated from patient’s blood by a thin membrane of dialyzer through which transfer of contami- nants is only limited by the size of contaminant. During HD, the usual net movement of water is from blood to dialysate, but movement of water from dialysate to blood can occur within the dialyzer through back-filtration. 6 This can lead to microbial contamination of patient’s blood, causing pyrogenic reactions and sepsis and conse- quently severe hypotension and shock, which will further worsens patients’ condition. Long-term problems associ- ated with microbial contamination of HD water include beta-2 microglobulin-related amyloidosis, resistance to Correspondence to: R. W. Braimoh, MBBS, Department of Medicine, College of Medicine of the University of Lagos, Idi-Araba, P.M.B. 12003, Lagos, Nigeria. E-mail: rotelbraimoh@yahoo.com Conflict of interest: None. Grants of other funding: Nil. Hemodialysis International 2014; 18:148–152 © 2013 International Society for Hemodialysis DOI:10.1111/hdi.12070 148