“I Don’t Know About This!” ( A Patients Initial Dialysis Treatment) Pt. 9

Hello, AW, very nice to meet you. Thank you for coming here to get your treatments. I have huge empathy for what you go through day in and day out and admire your dedication and commitment to your life. With that said, it is my duty to dedicate and make a commitment to your life, with full integrity.

So, Dwelyn told me you wanted to learn a bit about dialysis water treatment. Well, I’d love to educate you, A Dubs! 

First things first, all these incredible nurses and hardworking technicians are the heartbeat of your care. The heartbeat to this facility itself is the water room. Biomedical Technicians, like myself, are the backbone to your care. Though you don’t have the pleasure to see us often, we are busy keeping the physical facility safe, functional and comfortable for you to come to. We spend hours maintaining and repairing this machine here that is sustaining your life. We also assure the water that is feeding this machine is 100% safe for you. 

I’m sure Dwelyn has told you a ton already but did you know that during the course of your treatment you are exposed to roughly 50 gallons of water!? People without ESRD consume about one half gallon per day. You require 100 times that in just 4 hours, this is a big reason why water treatment is so critical, but it goes way beyond that. I’ll get into that shortly. 

Without getting too technical, I will keep this simple so that you fully understand. 

There are two sources of water, surface water and groundwater. Surface water is generally more contaminated with organisms and microbes, industrial wastes, fertilizers, and sewage. Groundwater is generally lower in organic materials but contains higher inorganic ions such as iron, calcium, magnesium, and sulfate.

You should not be exposed to any of this kind of water. You need water that is highly pure and all these contaminants removed. This is the purpose of the water room. 

Are you understanding all this so far, A Dubs? Yes, very much so, Eric, AW replies. Do you have any questions so far, A Dubs? Not at all. 


The municipal water treatment plants adds chemicals to make water safe for drinking, most commonly chlorine. Chlorine is highly toxic even in really small amounts when on a dialysis machine. When chlorine is combined with ammonia it produces what is called chloramine. Also very harmful for you. 

In the water room here there are a series of filters. At this facility the water first goes through a filter called the sediment filter. This one does just what the name of it implies, it removes the larger particles from the water, or sediment. 

Then, the water flows through two carbon tanks in series. As I was mentioning a moment ago about chlorine and chloramine being highly toxic for you, the purpose of these filters are to remove that from the water. The first tank removes nearly all of it down to <0.1 parts per million or milligrams per liter. That is next to nothing! The second tank is basically a safety net in case the first tank experiences failure. 

Am I boring you yet? “No, no, not at all. This is really interesting actually. Eric, how do you know it’s less than 0.1?”

That is a terrific question, A Dubs! I see you’re starting to understand the critical nature of the water room. 

There are sampling ports right after the first tank and the second tank; this is where total chlorine is tested daily, at least every 4 hours at the first tank’s sampling port. There is little to no chance of these vicious chemicals harming you. If we find that the first tank has chlorine breaking through we will immediately check the port after the second tank. 

There is also a water softener in the water room. This is my favorite filter in the water room because the theory behind it is awesome,but I’ll keep it simple. It’s called a softener because it softens hard water. Hard water or hardness is basically calcium and magnesium. 

“Oh, those are the ions you were talking about in the groundwater!”

Exactly! I’m so glad you’re listening. It’s so important to the safety of your treatment. I can’t stress it more. 

“Yes, Eric, I understand why you call it the heartbeat.” 

Great, but there’s more. Are you ready for more? 

“Yes, I am, E Dubs. Hahaha” 

Oh boy, now look what I started… 

So, Dwelyn told me he explained the reverse osmosis machine. It’s highly effective in removing all those other organics and inorganics from the ground and surface water. 

From there, the high purified water gets sent to a large holding tank and a pump pulls it from the tank and sends it to each and every one of these wall boxes, the unused water goes back to the tank so it is not wasted. We call this the loop.

“Wait, so if water is always in the loop wouldn’t algae and bacteria eventually start growing? You mentioned that is harmful to me too.”

That is such a good question, so glad you asked! 

As I mentioned earlier, my biomeds take care of all the equipment in this facility. In order to assure bacteria does not have an opportunity to grow, we draw water samples, test for bacteria and endotoxins and disinfect the loop monthly. I’m sure you’re going to ask what are endotoxins? 

To put it simply, it’s a toxic matter released when bacteria cells die. Again, not at all good for you. They can make you very ill if exposed to you. The maintenance of the water room is important to maintain and maintain correctly. 

Your care technicians also come in super early daily to do a bunch of tests on the water system to assure its safe for patient use. 

That brings us to these wall boxes. We know there is water here waiting to be used. The dialysis machine connects directly to it. So, the water in the loop is feeding your machine right now! 

That acid and bicarbonate Dwelyn mentioned, the machine is also connected to those ports. When high purified water, bicarb and acid are mixed, that’s what we call dialysate. To put it simply for you, this machine is a proportioning and fluid removal system. 

Biomeds make sure all the pumps in the machine are calibrated impeccably to deliver the correct proportions so you can receive the highest quality treatment. There are dozens of other calibrations too that are critical but we won’t get into those. 

The last bit I would like to talk about, is this dialyzer. If you look closely you see tiny tubes running from top to bottom. On the inner portion of those tubes is the blood compartment. The outside is the dialysate. Just like the RO, the tubes are a semi-permeable membrane. For the sake of this discussion, if we didn’t remove the bacteria and endotoxins and the chlorine during the water treatment process, those 3 contaminants in particular, can pass through the membrane into your blood and result in serious illness or even death. 

I hope this paints a picture for you about the critical nature of dialysis water.

“Wow, Eric. Definitely does! I really appreciate the time you took to educate me on the critical nature of the Biomeds role too. I am thankful you are here and proud to say my equipment is maintained by expert Biomeds from Biomedix Dialysis.”

Eric Cirignano

Founder & CEO Biomedix Dialysis


Published by DiabeTech77

Hello to all of you our wonderful Kidney Trail Hikers . My name is Dwelyn Williams, CCHT, Immediate Past President NANT . I would like to say Thank You for joining us on The Kidney Trails. A brief story of who I am . I started my Hemodialysis Technician career in January of 2000 in Charlotte,NC. During that time and now the present I have been a Traveling Hemodialysis Technician, a Chronic Preceptor, an Acute Preceptor, Kidney Smart Educator, proud NANT Board Member , and a Hemodialysis Technician Instructor. My current status is a proud employee of Fresenius Kidney Care- Arcadia as a Hemodialysis Technician CCHT/VAM and also an Acute Hemodialysis Technician here in the Phoenix, Arizona area. My involvement with dialysis goes back as far as the early 90’s. My mother was a ESRD patient during that time. We as a family contributed to her well being by assisting her with CAPD at home. After a year of doing a home modality, she ventured out into outpatient dialysis in a chronic setting of hemodialysis. With that being said , I developed not only a interest I dialysis but an extreme curiosity of what this disease was and its effect on my mother and our family. This placed a heavy matter on me due to the fact that it was beyond personal and it could happen to any of our loved ones. Serving as a NANT member and on the NANT Board has aloud me to express my concern and issues amongst others. The ability to possibly influence others. To share my passion within my profession alongside developing my craft. My goal is to encourage every Nephrology Clinical Technician that they are important in more ways than one, and to know that they matter in our patients lives. I hope to inspire more Nephrology Clinical Technicians to take on more leadership roles in their communities, clinics, and NANT. As a newly Author and Kidney Trails Family member it’s is my duty to deliver the most epic and profound stories of my vision of Renal World. What a great time none other than during this tough time we are having in the world today being impacted by the COVID 19/ Coronavirus. We hope as you hike with us along The Kidney Trails , that each step we take is with Essential Potential.

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