Trace elements and micropollutant anions in the dialysis and reinfusion fluid prepared on-line for haemodiafiltration

Exposure to the trace elements and micropollutions of tap water may be very considerable in dialysis patients. As few data on trace elements in reinfusion and dialysis fluid for haemodiafiltration (HDF) have been reported, we studied nine trace elements (mu g/l; Al, As, Cd, Cr, Cu, He, Pb, Se, Zn) and five anions (mg/l; F-, NO2-, NO3-, PO43-, SO42-) in tap water, in water after two passages of reverse osmosis (2RO), in dialysate and in on-line prepared reinfusate. NO3- and SO42- were somewhat elevated in our tap water (22.2 +/- 7.6 and 21.8 +/- 11.3 mg/l) but decreased (P < 0.001) after 2RO (1.4 +/- 1.5 and 0.9 +/- 1.1 mg/l); the other anions, which were at a very low level, remained unchanged. All trace elements decreased, with statistical significance only for Al, Cr and Zn from 14.9 +/- 19.9, 2.6 +/- 0.6 and 35.1 +/- 41.1 mu g/l to 3.2 +/- 2.1, 0.2 +/- 0.2 and 3.5 +/- 4.8 mu g/l, respectively. Due to impurities in concentrate salts for Al (5.4 +/- 3.1), Cr (0.5 +/- 0.4) and SO42- (2.4 +/- 1.8), greater concentrations were found in dialysate and reinfusate than in tap water after 2RO (P < 0.03). For all measurements, trace elements and anions were at acceptable levels according to international standards. Simultaneous determinations of trace elements at inflow (Din) and outflow (Dout) of the dialysate as well as in plasma or in whole blood at the beginning of on-line HDF documented Dout/Din > 1 for Al, Cu and Zn and a positive gradient between the concentration in blood and dialysate inlet. In conclusion, our dialysate and reinfusate can be considered safe regarding trace elements and micropollution: two passages through reverse osmosis reduces the concentrations of trace elements and anions. The impurities of concentrates are acceptable. Accumulation or depletion of trace elements should be evaluated after longitudinal studies of plasma concentrations.