Dialysis water | Drinking water | ||
ISO 23500-3:2024 | WHO | SDWA | |
Substances included in the hemodialysis fluid prescription | |||
Calcium | 2 (0.1 mEq/L) | –* | – |
Magnesium | 4 (0.3 mEq/L) | – | – |
Potassium | 8 (0.2 mEq/L) | – | – |
Sodium | 70 (3.0 mEq/L) | – | – |
Substances regulated in drinking water with documented toxicity in hemodialysis patients | |||
Aluminum | 0.01 | 0.1 | 0.05 to 0.2¶ |
Total chlorine | 0.1 | 5 | 4 |
Copper | 0.1 | 2 | 1.3Δ |
Fluoride | 0.2 | 1.5 | 4 |
Lead | 0.005 | 0.01 | 0.015Δ |
Nitrate (as N) | 2.0 | 11 | 10 |
Sulfate | 100 | – | 250¶ |
Zinc | 0.1 | – | 5¶ |
Other substances regulated in drinking water that do not have documented toxicity in hemodialysis patients | |||
Antimony | 0.006 | 0.02 | 0.006 |
Arsenic | 0.005 | 0.01 | 0.01 |
Barium | 0.1 | 0.7 | 2 |
Beryllium | 0.0004 | – | 0.004 |
Cadmium | 0.001 | 0.003 | 0.005 |
Chromium | 0.014 | 0.5 | 0.1 |
Mercury | 0.0002 | 0.006 | 0.002 |
Selenium | 0.09 | 0.04 | 0.05 |
Silver | 0.005 | – | 0.1¶ |
Thallium | – | – | 0.002 |
ISO: International Standards Organization; SDWA: Safe Drinking Water Act; WHO: World Health Organization.
* Indicates no value set.
¶ Non-enforceable guideline.
Δ Action level at which further treatment processes must be initiated to reduce the level of the contaminant.Adapted with permission from: Payne GM, Curtis J. Water Treatment for Hemodialysis: What You Must Know to Keep Patients Safe. Nephrol Nurs J 2018; 45:141. Copyright © 2018 the American Nephrology Nurses Association; East Holly Avenue, Box 56, Pitman, NJ 08071-0056; E-mail: anna@ajj.com; Web site: www.annanurse.org.
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