Abstract
AbstractContaminants commonly found in tap water are toxic to hemodialysis patients. To prevent patient injury from these contaminants, standards for the quality of water used to prepare dialysate have been developed. These standards are in general agreement concerning maximum allowable levels of inorganic chemical contaminants known to have adverse consequences for dialysis patients. There is less agreement about inorganic chemical contaminants that may be toxic, and most standards omit any requirements for organic chemical contaminants. There are considerable differences between standards regarding the maximum allowable levels of microbiological contaminants, as well as the methods to be used for measuring them. Harmonization of existing standards may improve patient protection by promoting demonstrated best practices. Harmonization will require innovation and compromise to produce a standard that is widely applicable, provides patients with the necessary safeguards, and whose requirements can be routinely achieved within the constraints imposed by local reimbursement practices.
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