Novel and Current Techniques to Produce Endotoxin-free Dialysate in Dialysis Centers – An Update on Legal Requirements for Dialysis Water and Fluids

Extracorporeal blood detoxification treatments for kidney failure (such as heamodialysis, haemofiltration and haemodiafiltration) require special water-treatment processes to prevent acute and chronic complications caused by use of water of poor quality from both a chemical and a microbiological point of view. So far, national recommendations on the maximum allowable levels of contaminants and on equipment and processes that should be used to produce, store and distribute dialysis water and fluid varied broadly. In this paper, updated information is reported in a summary format on more recent international standards than those reported in a previous chapter with which hemodialysis centers worldwide will have to comply to minimize health hazards and complications caused by the use of impure water and contaminated dialysis fluid.