A study of outcome and complications associated with temporary hemodialysis catheters in a Nigerian dialysis unit.

Hemodialysis (HD) catheters are commonly used as temporary vascular access in patients with kidney failure who require immediate HD. The use of these catheters is limited by complications such as infections, thrombosis resulting in poor blood flow. We studied the complications and outcomes of nontunneled catheters used for vascular access in our dialysis unit. The records of all patients, with renal failure who were dialyzed over a two-year period and had a double lumen nontunneled catheter inserted, were retrieved. Catheter insertion was carried out under ultrasound guidance using the modified Seldinger technique. The demographic data of patients, etiology of chronic kidney disease, and complications and outcomes of these catheters were noted. Fifty-four patients with mean age 43.7 ± 15.8 years had 69 catheters inserted for a cumulative total of 4047 catheter-days. The mean catheter patency was 36.4 ± 37.2 days (range: 1-173 days). Thrombosis occluding the catheters was the most common complication and occurred in 58% of catheters leading to catheter malfunction, followed by infections in18.8% of catheters. During follow-up, 30 (43.5%) catheters were removed, 14 (20.3%) due to catheter malfunction, eight (11.6%) due to infection, five (7.2%) elective removal, and three (4.3%) due to damage. Thrombotic occlusion of catheters was a major limiting factor to the survival of HD catheters. Improvement in catheter patency can be achieved with more potent lock solutions.

Microbial quality of hemodialysis water, a survey of six centers in Lagos, Nigeria.

Patients with end-stage kidney disease (ESRD) on maintenance hemodialysis (HD) are usually exposed to large volumes of dialysate, which is separated from patients' blood only by thin membrane of dialyzer. It is therefore essential to frequently monitor the quality of HD water to ensure that it meets the recommended standards. The objective of this study was to evaluate the microbial quality of HD water in Lagos, Nigeria. Four sets of pre- and post-treatment water samples, 20 mL each, were collected from six HD centers in Lagos and tested for microbial contamination using the molten Tryptic soy agar in accordance with Association for Advancement of Medical Instrumentation (AAMI) and European Best Practice Guidelines (EBPG). Pyrogen tests were also conducted on pre- and post-treatment samples using standard technique. Information on water treatment modalities, maintenance practices and quality control measures in each center were obtained using a questionnaire. All centers use treated water for HD purpose. None of the HD centers met EBPG/AAMI guidelines for microbial contaminants as the mean levels of Escherichia coli in both feed and treated water were 441.7 ± 87.90 and 168.5 ± 64.03, respectively. E. coli was the commonest organism isolated in both feed and treated water in all the centers. HD water quality is still a neglected problem in our environment and more efforts are required to ensure good water quality for HD purpose.

Quality of hemodialysis water in a resource-poor country: the Nigerian example.

Hemodialysis (HD) patients are exposed to large volumes of water, separated from patients' blood by semipermeable membrane of dialyzers. Chemical contaminants in poorly treated water impact negatively on quality of life of these patients. This survey was carried out to assess the HD water quality in Lagos, Nigeria. Ten milliliters of feed and treated water from all six HD centers in Lagos were tested for aluminum, copper, zinc, magnesium, calcium using atomic absorption spectrometry; sodium and potassium were tested using flame photometry, fluoride with molecular photoluminescence method; sulfate using turbidimetry, nitrates measured by cadmium column reduction method, chloramines and free chlorine were measured using N, N-diethyl-1-P-phenylenediamine colorimetric method. Information on sources of feed water, frequency of testing of HD water, methods of water treatment, type of water purification system and maintenance was also obtained. All centers used borehole as main source of water supply. None of the centers met Association for the Advancement of Medical Instrumentation (AAMI) guidelines for most chemical contaminants. Only chlorine (0.48 ± 0.07 mg/L) and potassium (3.9 ± 0.95 mg/L) levels met AAMI standards after treatment. Mean levels of chemical contaminants in treated water were as follows: aluminum 0.04 ± 0.01 mg/L, zinc 0.27 ± 0.08 mg/L, chloramines 0.16 ± 0.03 mg/L, fluoride 1.83 ± 0.40 mg/L, sulfate 117 ± 86.1 mg/L which were mildly elevated; calcium 126.00 ± 22.7 mg/L, sodium 179 ± 25.6 mg/L, and nitrate 70.5 ± 50.8 mg/L, which were markedly elevated; and magnesium 8.3 ± 3.38 mg/L, which was moderately elevated above AAMI recommended levels. HD water quality is poor in our environment. Concerted efforts are required to ensure good quality water for HD.