The use of hard water in the dialysate for home hemodialysis can result in the Hard Water Syndrome. Many patients have secondary hyperparathyroidism due to the renal failure.


The syndrome occurs if

(1) untreated mineral rich ("hard") water is used for the dialysate.

(2) there is failure of the water softening or deionizing system to remove sufficient calcium and/or magnesium


Clinical findings of the Hard Water Syndrome:

(1) headache

(2) diaphoresis (sweating)

(3) tachycardia

(4) hypertension

(5) nausea and vomiting

(6) variable gastrointestinal hemorrhage

(7) variable pancreatitis

(8) variable hypercoagulability


Laboratory findings:

(1) hypercalcemia

(2) hypermagnesemia


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