Heavy Metals in Dialysis Fluid and Blood Samples from Hemodialysis Patients in Dialysis Centers in Baghdad, Iraq

BACKGROUND. The kidney is the first target organ of heavy metal toxicity due to its capacity to reabsorb and accumulate divalent metals. Hemodialysis therapy is used to purify the blood of individuals with impaired kidney function. OBJECTIVE. The aim of the present study was to evaluate the relationship between dialysis fluid quality and the health of hemodialysis patients. METHODS. A field sampling program was conducted to collect blood samples from 320 hemodialysis patients (56% males and 44% females) in order to examine the concentrations of heavy metals that typically occur in municipal water in Baghdad (aluminum (Al), copper (Cu), lead (Pb), and zinc (Zn)), and explore associations with the same metals in dialysis fluid collected from four major dialysis centers in Baghdad hospitals for a period of one year (2018). RESULTS. The results showed that the dialysis fluid quality was not in compliance with international standards. The dialysis fluid in 63% of the samples contained high Al concentrations, while Cu and Zn concentrations were within international standards. Lead concentrations were elevated in dialysis fluid in some hospitals as well. DISCUSSION. The average blood levels of biologically important heavy elements were significantly varied in hemodialysis patients when compared with local reference values. CONCLUSIONS. Since both deficiency and excess elements are potentially harmful, the hypothesis that heavy element status affects the risk of adverse clinical outcomes is a worthy investigation. PARTICIPANT CONSENT. Obtained ETHICS APPROVAL. The study was approved by the Baghdad Ethics Committee of the Iraqi Ministry of Health and Environment. COMPETING INTERESTS. The authors declare no competing financial interests.