EVALUATION OF BACTERIOLOGICAL QUALITIES OF DIALYSIS WATER IN HAEMODIALYSIS UNITS CARING FOR FIRST NATIONS PATIENTS WITH HIGH INFLAMMATORY MARKERS IN NORTHERN TERRITORY OF AUSTRALIA: AN INFERR CLINICAL TRIAL SUB STUDY
Dr Gathika Kodithuwakku1, Jane Nelson2, Associate Professor Asanga Abeyaratne1, Stephanie Long2, Cheryl Ross2, Archana Khadka Shapkota2, Leiana Hewett2, Jaclyn Tate-Baker3, Rose Mukula2, Cynthia Tetteh2, Daniel Winder2, Sajiv Cherian4, Basant Pawar4, Lorna Murakami Gold6, Mark Mayo2, Geetha Rathnayake3, Vijay Karepalli1, Louise Maple-Brown2, Peter Morris2, Tina Noutsos2, David Kiran Fernandes4, Sajan Thomas4, Paul D. Lawton7, Federica Barzi8, Sean Taylor3, Robert Batey3, Jane Davies2, Professor Alan Cass2, Professor Sandawana William Majoni1, INFERR clinical trial study group
1Royal Darwin Hospital, Darwin, Australia, 2Menzies School of Health Research, Charles Darwin University,, Darwin, Australia, 3Northern Territory Department of Health, NT health, Darwin, Australia, 4Alice Springs Hospital, Alice Springs, Australia, 5Flinders University, Darwin, Australia, 6Flinders University, Alice Springs, Australia, 7Monash University & Alfred Health,, Melbourne , Australia, 8UQ Poche Centre for Indigenous Health, The University of Queensland, , St Lucia, Australia
Aim: To evaluate whether impurities of dialysis water is related to elevated inflammatory markers in first nations hemodialysis patients.
Background: Previous observational studies reported a higher prevalence of inflammatory markers such as CRP and ferritin levels in first nations hemodialysis patients in Northern Territory of Australia. Even minor bacteriological impurities of dialysis water can cause an inflammatory response in dialysis patients who are exposed to more than 300 liters of dialysis water each week. Currently INFERR clinical trial is evaluating the efficacy and safety of IV Iron therapy in first nations patients on dialysis.
Methods: We performed a retrospective observational study to investigate the bacteriological properties of water used in eight main dialysis centers across Northern territory of Australia, collecting data from a total of 484 dialysis water samples which were analyzed periodically between January 2021 to December 2023. Water quality was defined in to three categories for the analysis as desirable, borderline, and contaminated for both bacterial colony count (<50,50-100,>100 cfu) and endotoxin levels (<0.12, 0.12-0.25,>0.25 EU/mL).
Results: 247 samples for bacterial colony count and 241 samples for bacterial endotoxin levels were observed. All samples for endotoxin were desirable, except for 1 contaminated sample (0.4%). All samples were negative for contamination with heterotrophic bacteria.
Over three years, samples from 391 INFERR study participants had a median ferritin value of 811 µg/L and had estimated dialysis water exposure of 587 patient years.
Conclusion: Dialysis water quality met the strict bacteriological quality parameters used in this study to analyze even minor impurities of water and water quality is unlikely to be related to the elevated inflammatory markers observed in hemodialysis patients in Northern territory of Australia.
Biography:
Dr Gathika Kodithuwakku is an advanced traineee in Nephrology in Royal Darwin Hospital. He completed his medical education and local renal specialist training in Sri Lanka and currently completing his overseas training in Australia. He is interested in research with regards to first nations health and has published several interesting case studies in the past. In addition he is keen on renal interventions and currently he is enhancing his skills as a renal interventionalist in Darwin.