ABSTRACT
In July 2004, an anemia outbreak was identified in our hemodialysis (HD) unit. The dialysate chloramine levels had risen from <0.1 mg/mL in May to 0.27 mg/mL in August 2004. Other parameters of water quality were within accepted standards. Hematocrit (Ht) and hemoglobin (Hb) returned to basal values after one month without changing recombinant human erythropoetin (rHuEpo) doses and with exchange of activated charcoal column. Chloramines (chlorine and ammonia) are used routinely to disinfect and sterilize potable water. High blood levels of chloramines are associated with hemolysis and rarely methemoglobinemia. Uremic patients have a decreased ability to withstand oxidative stress. It is postulated that their antioxidant capacity is reduced, yet the mechanism remains unclear. Patients on maintenance hemodialysis are vulnerable to chloramine toxicity if chloramines are inadequately removed from water.
Subject(s)
Anemia/chemically induced , Chloramines/adverse effects , Dialysis Solutions/chemistry , Renal Dialysis , Renal Insufficiency/therapy , Adult , Aged , Aged, 80 and over , Anemia/epidemiology , Anemia/therapy , Chloramines/analysis , Cohort Studies , Disease Outbreaks , Erythropoietin/therapeutic use , Female , Hemodialysis Units, Hospital , Humans , Male , Middle Aged , Recombinant Proteins , Renal Insufficiency/complications , Renal Insufficiency/metabolism , Retrospective Studies , Risk Factors , Water PurificationABSTRACT
BACKGROUND: This study was aimed at examining the effects of radiocontrast agents on selected membrane transport functions. METHODS: The effect of diatrizoate sodium (DS), diatrizoate meglumine (DM), and diatrizoate compound (DC) on Na+/K+ pump activity and number, L-arginine, and choline transports were evaluated in erythrocytes of normal individuals and patients undergoing cardiac catheterization. RESULTS: Norrmal individuals' erythrocytes potassium influxes were 1.50+/-0.35, 1.32+/-0.37, 1.28+/-0.30, and 1.01+/-0.25 mmol/L cell/h in control, DS, DM, and DC groups, respectively (P=0.004; DC vs. control). Patients exposure to Hypaque M-76 significantly diminished Na+/K+ pump activity (1.40+/-0.36 before, vs. 1.27+/-0.40 mmol/L cell/h after; P=0.039). The number of Na+/K+ pumps was reduced (156+/-36 vs. 143+/-34 pumps/erythrocyte; P=0.015) in presence of DS. L-arginine and choline transports changed only at high radiocontrast concentrations. CONCLUSION: Selective changes in erythrocytes membrane transport function take place on exposure to radiocontrasts.
