Are there particular risks of fluorosis for people using fluoridated water for dialysis?
People with end-stage kidney disease who undergo dialysis with fluoridated water receive an additional load of fluoride from the dialysate. Compared with the average gastrointestinal uptake, fluoride absorption increases by 20- to 30-fold during a single pass of dialysis [5]. Recommendations for the suitability of water to be used for dialysis are available from the Australian and New Zealand Society of Nephrology [45] and the Caring for Australasians with Renal Impairment (CARI) guidelines [46]. These directives endorse investigation of local water supplies for normal quality and seasonal variation, analysis of water samples for fluoride and removal of fluoride by water treatment systems (including deionizers or reverse osmosis), to ensure that fluoride concentrations in the final feed water to the dialysis machine do not exceed concentrations defined in the Association for the Advancement of Medical Instrumentation (AAMI) guidelines. Failure to comply with standards for dialysis wate
