The Risk of Cyanobacterial Toxins in Dialysate: What Do We Know?

Surface waters are increasingly contaminated by cyanobacteria, which may produce potent cyanotoxins harmful to animals and humans. Hemodialysis patients are at high risk of injury from waterborne contaminants in the water used to prepare dialysate. Episodes of acute illness and death among hemodialysis patients have been reported following exposure to dialysate prepared from drinking water contaminated with elevated concentrations of cyanotoxins. Protecting dialysis patients from these toxins is complicated by a lack of monitoring and regulation of cyanotoxins in drinking water, uncertainty as to their safe levels in dialysate, and incomplete knowledge of how well current dialysate preparation and water treatment practices remove them. Until these issues are adequately addressed, hemodialysis centers should be aware of the potential for cyanotoxins to be present in their potable water supply, particularly when it comes from surface water sources prone to cyanobacterial blooms.