Chloramines, an aggravating factor in the anemia of patients on regular dialysis treatment

In two dialysis centres in the same city, with a total of 56 patients on regular dialysis treatment, it has been shown that the tap water used for the production of the dialysate contains chloramines. Total chlorine concentration and percentage of chloramines varies from 0.5 to 1.1 ppm and from 40 to 95 per cent. There in a high percentage of Heinz bodies in the patients' erythrocytes, and incubation of red cells in vitro with the dialysate raises the methaemoglobin concentration and alters the hexose-monophosphate shunt. The patients' mean haematocrit improved from 23.13 +/- 4.41 SD to 25.93 +/- 5.17 SD (p less than 0.0025) with the administration of ascorbic acid, 500 mg given intravenously once a week, but an unexpected transitory increase of the total chlorine to 3.5 ppm resulted in a serious decline of the mean haematocrit to 20.80 +/- 5.22 SD (p less than 0.0001). Ascorbic acid added to the dialysate at a concentration of 1.7 mg/dl produced a great improvement in the anaemia and the almost total disappearance of Heinz bodies from the patients' red cells.