Salts as a source of metals in dialysis fluids: an assessment study by means of neutron activation analysis

Thirty-nine trace metals were determined by neutron activation analysis (NAA) in nine salts (glucose, NaCl, KCl, CaCl2, MgCl2, Na-lactate, Na-acetate, NaHCO3 and NaOH), from different European producers, used in the preparation of dialysis fluids. Metal concentrations vary widely from less than 1 ng g-1 to several micrograms per gram. The data are used to assess the potential metal contribution of the salts to a hypothetical dialysis fluid. A comparison of these calculations with NAA of commercial haemodialysis solutions, and water used for their preparation, suggests that salts are the main source of metal contamination of the dialysate. Despite this, the chemical purity of the salts analyzed is considered to be good and it would be unrealistic to expect a clearly better chemical quality on a commercial scale. In order to protect the health of dialysis patients against abnormal metal exposure, toxicological research directed towards the estimation of the effective daily metal exposure and the determination of possible metal overloads in dialysis patients is necessary. A standardization of the dialysis systems actually used is also an important aspect if uncontrolled metal contamination of the dialysis fluid is to be avoided.