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Maximum allowable levels of inorganic chemical contaminants in dialysis water and the corresponding values in drinking water (mg/L)[1]

Maximum allowable levels of inorganic chemical contaminants in dialysis water and the corresponding values in drinking water (mg/L)[1]
  Dialysis water Drinking water
ISO 23500-3:2019 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 – 0.002
ISO: International Standards Organization; WHO: World Health Organization; SDWA: Safe Drinking Water Act.
* 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.
Reference:
  1. Kasparek T, Rodriguez OE. What Medical Directors Need to Know about Dialysis Facility Water Management. Clin J Am Soc Nephrol 2015; 10:1061.
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: [email protected]; Web site: www.annanurse.org.
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