SIN survey on quality control of dialysis water in Italy

BACKGROUND: The importance of high quality water for dialysis is well established. This study aimed to obtain a picture of the Italian situation to develop national guidelines. METHODS: Questionnaire analysis was used to assess water quality control protocols and types of chemical and microbiological parameters monitored. Regions with responses from at least half the units were considered for the study. RESULTS: Eighteen out of 20 regions fulfilled the inclusion criteria; 297/469 dialysis units answered the questionnaire (5208 dialysis beds, 18213 patients). Eighty-one percent of Italian units follow a regular water quality control program. The reverse osmosis outlet is the sampling point used most for assessing chemical and microbiological parameters. The most common frequency in monitoring is < or =6 months. Fifteen chemical items, suggested by the Italian Farmacopea Ufficiale (FU), are periodically controlled by at least half the units. Aluminum is measured in about 70% of units, chloramines and volatile halogenated hydrocarbons, respectively, in 42 and 30% of units. According to the FU, bacterial counts at 22 degrees C (84%) and endotoxin determinations (60%) are the most common microbiological analyzes. CONCLUSIONS: The survey demonstrated protocol differences among the units, confirming the need for Italian guidelines to ameliorate and standardize dialysis water monitoring. More than half the units are following the FU, but we cannot rule out less strict monitoring only in non-participating units.