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In 1996 in Curacao, acute aluminum (al) intoxication sickened patients in a dialysis center that used tap water to prepare dialysate. The mortality rate was 32 percent A new factory-lined cement-mortar water distribution pipe had recently been installed. It is known that substantial amounts of barium, cadmium, and chromium can leach from cement-mortar linings. This article shows that high concentrations of Al can leach from cement mortars for at least two years in soft, aggressive water. The newly installed pipe, cement containing four times as much Al as usual, corrosive water, the high pH and temperature of the water, long residence time, and perhaps the corrosion inhibitor polyphosphate may have promoted this leaching. Certification of cements used to line water pipes is warranted. Central water treatment plants must distribute noncorrosive water, especially plants that use membrane desalination or other reverse osmosis or nanofiltration processes. Dialysis units should be promptly informed of any impending change in water treatment that might increase the Al content of tap water and also of any accidental pollution of the water distributed. Dialysis centers should always practice extended purification of tap water used for dialysate. Although Al as a risk factor for Alzheimer's disease in the general population is still debated, there is no doubt that Al causes dialysis encephalopathy. Includes 38 references, tables, figures.

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Edition: Vol. 91 - No. 7 Published: 07/01/1999 Number of Pages: 10File Size: 1 file , 660 KB