Dialysis Facilities

PREPARE FOR THE CHLORAMINE CONVERSION

In February 2004, the San Francisco Public Utilities Commission (SFPUC) will switch from chlorine to chloramine disinfection for drinking water. Chloramine is a combination of chlorine and ammonia that is considered a better disinfectant. Many Bay Area Communities are successfully using chloramine disinfection.

Chloramine lasts longer in water to more effectively remove pathogens such as bacteria and viruses. Compared to chlorine, chloramine produces lower levels of trihalomethanes, suspected carcinogens that form when chlorine mixes with natural organic substances in water.

Water customers in San Francisco and communities in San Mateo, Santa Clara and Alameda counties will begin receiving chloraminated water in February 2004.

DIALYSIS FACILITIES AND PATIENTS

What do dialysis patients and providers need to know?
Like chlorine, chloramine can harm kidney dialysis patients during the dialysis process if it is not removed from water before entering the bloodstream. It is safe for dialysis patients to drink, cook with and bathe in chloraminated water because the digestive process neutralizes chloramine before it enters the bloodstream.

How do we prepare for the chloramine conversion?
The California Department of Health Services will inspect dialysis equipment and facilities to ensure providers successfully upgrade their dialysis equipment to remove chloramine before the conversion in February 2004. Dialysis units must be prepared for the anticipated chloramine concentration of 2 to 4 milligrams per liter. The maximum concentration allowed by law is 4 milligrams per liter.

Two methods are typically used to remove chloramine from water before dialysis:

Ascorbic acid, or
A granular-activated carbon filtration system specifically designed to remove chloramine.

Home dialysis patients should work with their home dialysis facility and physician to make necessary adjustments to their equipment.

Will boiling remove chloramine?
Chloramine cannot be removed by boiling water, adding salt, or letting water stand in an open container to dissipate the chloramine.

Need more information?
For further information, contact your dialysis provider of the Trans Pacific Renal Network: 415-472-8590 or visit: http://www.network17.org

NOTE:
The California Department of Health Services will inspect commercial dialysis facilities and ensure dialysis providers successfully upgrade their dialysis equipment to remove chloramine from the water before the conversion to chloramine takes place.