Replacing HD Water Treatment Components Raises Hemoglobin Levels

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • Pre-emptive replacement of hemodialysis (HD) water-treatment components could significantly increase hemoglobin levels at lower doses of erythropoiesis-stimulating agents (ESAs) in HD patients.
  • Serum hemoglobin levels rose significantly from 12.1 g/dL before replacement to 12.3 g/dL after; ESA requirements decreased significantly from 47.7 to 45.8 mcg.
  • The cost associated with replacing water-treatment components would likely be offset by a reduction in ESA use.

Pre-emptive replacement of hemodialysis (HD) water-treatment components could significantly increase hemoglobin levels at lower doses of erythropoiesis-stimulating agents (ESAs) in HD patients, British researchers reported in a study presented at Renal Week 2009.

Seema Singh, MD, and colleagues at West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, London, noted that HD patients are exposed to large volumes of water with direct access for bloodstream contaminants.

Unexplained trends toward the need for higher doses of ESAs in the absence of microbial failure prompted the investigators to consider water quality. They studied 685 patients from six HD units, retrospectively collecting data on these patients for the three months prior to replacement of HD water-treatment components.

Serum hemoglobin levels rose significantly from 12.1 g/dL before replacement to 12.3 g/dL after, according to the researchers. Meanwhile, ESA requirements decreased significantly from 47.7 to 45.8 mcg. The researchers observed no significant difference in mean serum ferritin and C-reactive protein.

They also performed hemolytic screens in one of the six HD units and found no evidence of overt hemolysis. However, they observed a significant reduction in reticulocyte count after replacement of water-treatment components.

The researchers recommended a cyclical program of replacement of water-treatment components and said a formal cost-effectiveness analysis should be performed. Dr. Singh, who presented the study's findings, said the cost associated with replacing components would likely be offset by a reduction in ESA use.

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