Hemodialysis Unit Research Articles

Effect of Electronic Moxibustion in Patients with IDH: A Randomized Crossover Pilot Study.

Intradialytic hypotension (IDH), a common complication of hemodialysis (HD), is associated with increased cardiovascular risk, morbidity, and mortality. Fatigue is one of the most frequent symptoms of IDH, and deteriorates the quality of life of patients. This study aimed to evaluate the efficacy and safety of electronic moxibustion for improving IDH and its associated symptoms. We prospectively recruited 32 end-stage renal disease patients with IDH who underwent regular HD at our hospital's dialysis center between April 2019 and April 2020. A randomized, controlled, two-arm crossover trial was performed to evaluate the efficacy of adding one-hour electronic moxibustion during HD. The outcome measurements included patients' subjective assessment of the degree of fatigue, recovery time of fatigue from HD, cold intolerance before and after each intervention, frequency of IDH episodes and nursing interventions needed during HD, and blood pressure changes during HD. Thirty (94%) patients completed the study. Intervention with electronic moxibustion improved the degree of fatigue (95% CI, -2.95 to -0.18, p = 0.027), specifically in patients prescribed with midodrine (95% CI, -4.20 to -0.53, p = 0.013). The short-term use of electronic moxibustion during HD did not significantly alter the frequency of IDH or reduce the degree of decrease in blood pressure. Serious adverse effects were not observed. One patient complained of heat, whereas two patients had local transient erythema and pruritus. Electronic moxibustion appears to be safe and efficacious for improving IDH-related fatigue, thus acting as an adjuvant therapy in HD units to enhance patient comfort and treatment adherence. Further studies with larger sample sizes are required to confirm the benefits of this novel technique.

Obesidade abdominal dinapênica e atividades de lazer em indivíduos em hemodiálise

Introduction: abdominal obesity and dynapenia negatively affect life and increase disability in hemodialysis patients, while leisure activities can bring benefits.Objective: to evaluate the association between leisure activities and abdominal obesity and dynapenia in individuals on hemodialysis. Methods: a cross-sectional epidemiological census of 1,021 hemodialysis patients from all hemodialysis units in the Metropolitan Region of Greater Vitória, Espírito Santo, Brazil. Dynapenia was assessed by handgrip strength and abdominal obesity by the conicity index. Leisure was measured using the Leisure Practices Scale. Differences in proportions between independent variables and the outcome were tested by chi-square tests and variables with p<0.05 were used in Binomial Logistic Regression. Results: high engagement in manual leisure activities protects older people (OR=0.46; 95%CI=0.27 - 0.92) from dynapenic abdominal obesity. In adults, involvement in virtual leisure activities, whether low (OR=2.09; 95%CI= 1.17 - 3.75), medium (OR=2.83; 95%CI= 1.54 - 5.19) or high (OR: 2.64; 95%CI= 1.49 - 4.68) increased the chances of presenting dynapenic abdominal obesity. Conclusion: leisure activities are associated with dynapenic abdominal obesity in both the elderly and adults. Activities that favor sedentary behavior increase the chances of adult individuals on hemodialysis presenting OAD, while high engagement in activities that require some physical effort for older people acts as a protective factor.

Effect of Education Program on Infection Control Practices of Nurses at Haemodialysis Unit in Sohag University Hospital

Effect of Education Program on Infection Control Practices of Nurses at Haemodialysis Unit in Sohag University Hospital

Utilizing Integrated Lung and Inferior Vena Cava Ultrasound for Dry Weight Assessment - Insights from a Single-Center Experience

ABSTRACT Precise dry weight evaluation holds significant importance for individuals with end-stage renal disease (ESRD) undergoing hemodialysis. Fluid overload is associated with an increased likelihood of mortality and morbidity. Ultrasonography aids in assessing dry weight and modifying dialysis prescription. OBJECTIVE: To assess the following in ESRD Patients by ultrasonography: Dry weight and effectiveness of fluid removal Adjust the dialysis prescription METHODOLOGY: A prospective cross-sectional study was carried out in the Pediatric Hemodialysis unit at The Children's Hospital Lahore, over 6 months from July to December 2022. The study included 30 children aged 5-16 years undergoing maintenance hemodialysis and exhibiting signs of overload. Ultrasound was performed for B-lines and IVC diameter before and after dialysis. Dialysis prescriptions were modified and patients were monitored through sequential scans. Data was analyzed using SPSS version 20. RESULTS: A total of 30 patients were enrolled with 53.3% being males. The average pre-dialysis weight was 25.39 kg, systolic blood pressure was 150.67 mmHg and diastolic blood pressure was 92.6 mmHg. Pre-dialysis pleural and pericardial effusions were observed in 86.7% patients, while B-lines were present in 63.3%. Majority of children (83%) were on twice-weekly dialysis and remaining were prescribed thrice weekly dialysis. A significant reduction in weight, blood pressure, pleural and pericardial effusion, B-lines, and IVC diameter was found after dialysis. Dialysis prescription was adjusted following the first session, with 80% subjects receiving thrice-weekly sessions, 16.7% daily, and 3.3% twice-weekly dialysis. CONCLUSION: Monitoring the appropriate fluid removal and adjustments to the dialysis prescription in hemodialysis patients can be accomplished using ultrasonography. Keywords: Dry weight, Ultrasound, B-lines, IVC, Dialysis frequency.

“A Study to Evaluate the Effectiveness of Specific Nursing Intervention in the Management of Chronic Renal Failure Patients who are undergoing Hemodialysis in terms of Knowledge and Practice in selected Hemodialysis Unit of Navsari District, Gujarat”.

The study concludes that there was statistically highly significant knowledge and practice gained (improved) in the experimental group regarding Specific Nursing Intervention In The Management Of Chronic Renal Failure Patients Who Are Undergoing Hemodialysis.

Utilization of complementary and alternative medicine by patients undergoing maintenance hemodialysis for chronic kidney disease in Taiwan: a descriptive investigation

BackgroundDespite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of chronic illness, holistic care, and counteracting the adverse effects of conventional therapies. This study aims to determine the prevalence of CAM use and its associated factors among patients undergoing hemodialysis (HD) in Taiwan.MethodsThis quantitative study was conducted from August 2022 to July 2024 in the HD unit at Kaohsiung Chang Gung Memorial Hospital in Taiwan. Face-to-face questionnaire-based interviews were held with 154 of 163 eligible patients (response rate, 94.5%) at the bedside during HD. The completed questionnaires were entered into a secure computer database. Data was performed by descriptive analysis, Chi-square, and Fisher tests.ResultsMore than half of the patients were CAM users (n = 86; 56%), and women was associated with significantly more usage of CAM. Fifty-six CAM users took Chinese herbal medicine (CHM), 52.3% (n = 45) used dietary supplements, and 19.8% (n = 17) used acupuncture. The benefit in the effectiveness of CAM was the main reason for use, the need of CAM to improve the well-being and HD-related complication was high. 32.7% of patients had used CAM based on recommendation from their family and friends. More than one-third (33.7%) of patients did not disclose their use of CAM to their doctors, most of them think it is unnecessary.ConclusionsThe use of CAM by patients with maintenance HD was relatively frequent. Of these, most used CHM, of which are shown to the trend into routine HD care is inevitable by high coverage and utilization in Taiwanese national health insurance system. These findings indicate that it is important for health care providers working in dialysis to assess CAM use.

Beyond dialysis: Assessing therapeutic regimen compliance and sleep quality in chronic renal failure patients undergoing maintenance hemodialysis in Saudi Arabia.

Given its potential to impact physical and mental health, sleep quality is one of the most significant clinical outcomes among hemodialysis patients. Patients undergoing hemodialysis are required to adhere to an intricate treatment plan that consists of regular hemodialysis treatments, dietary and fluid restrictions, and a multi-drug regimen. Investigate the relationship between adherence to a therapeutic regimen and sleep quality among chronic renal failure patients undergoing maintenance hemodialysis. A descriptive correlational research design was followed. The study was conducted at the hemodialysis units in Hafr Albatin City, specifically at Hafr Albatin Central Hospital and King Khaled Hospital, Saudi Arabia. A convenience sample of 100 adult patients was selected for the study. The Hemodialysis Patients Adherence Questionnaire and Pittsburgh Sleep Quality Index were utilized to collect the data in 5 months from September 20, 2023 to February 15, 2024. The study revealed that more than half of the studied patients adhered to the therapeutic regimen, while (46%) did not adhere to it. More than half of the patients had poor sleep quality and were nonadherent to diet and fluid restrictions. Overall adherence score is negatively correlated with the global sleep quality score (r = -0.368, p < 0.001), indicating that poorer sleep quality is associated with lower overall adherence to the therapeutic regimen. While a significant proportion of the patients demonstrated adherence to overall therapeutic regimens, including dialysis sessions and medication intake, there was notable nonadherence to fluid and diet restrictions. Poor sleep quality, prevalent among two-thirds of the participants, correlates negatively with adherence to therapeutic regimens.

Hepatitis B virus infection among hemodialysis patients in Aden-Yemen

HBV infection is one of major global health problems worldwide. It increases the morbidity and mortality rates among hemodialysis patients which make the management process more complicated. This study was aimed to determine the prevalence of HBV infection among hemodialysis patients and assessment the risk factors associated with infection. An analytical cross-sectional study was conducted on 50 HD patients. Blood samples were collected and serum HBsAg was analyzed using ELISA technique. The overall prevalence of HBV was 6 (12.0%). The males had highest rate. There were statistically significant recorded between the prevalence of HBV infection and age group 30 – 39 years and duration of hemodialysis from 1-2 years and more than 2 years (p=0.02, 0.001 and 0.001) respectively. It can be concluded that the HBV prevalent rate among HD patients was common and lower than that reported among most general population in Yemen. Increasing of the duration and long standing in hemodialysis unit may increase the risk of HBV infection. Hepatitis B vaccine should be given to all HBV negative HD patients before HD process and health education programs about the transmission routes of HBV and preventive measures should be implemented for general population.

Assessment and management of emergencies during haemodialysis.

The haemodialysis unit is a complex clinical environment. Medical emergencies complicating haemodialysis treatment are relatively infrequent but are associated with high morbidity and mortality. The management of intradialytic emergencies is challenging and relevant to the practice of all nephrology and critical care clinicians. There are no dedicated resuscitation guidelines for this unique patient population. This review article provides an outline of the assessment and treatment of important intradialytic emergencies(hypotension, hypertension, haemorrhage, hypoxia, neurologic disturbances, cardiac arrest) based on the best available evidence.

The Effect Combined Of Intradialytic Exercise: Static Stretching And Dynamic Streching Lower Limb, Increase Physical Funtion In Chronic Kidney Diseases On Haemodialysis Patients Quasi Experiment

Background: Individuals with end-stage kidney disease (ESKD) usually engage in minimal physical activity, as renal failure progresses in chronic kidney disease (CKD), muscle mass and physical function decrease. Physical activity (PA) is important in maintaining/improving health in all population. Aim of this study to evaluate effect exercise of combine static stretching and dynamic stretching increasing Physical Function in CKD on HD patients. Methods: design of this study was quasi experiment in one group 39 respondents CKD on HD patients meet inclusion criteria. Implementation 12 weeks intradialytic exercise combine static and dynamic stretching lower limbs include leg, ankles, knee, femoral and hip. During exercise evaluate using Borg Skill to know level of fatigue. Comparing with before-after test Time Up and Go 3 meters return measurement. Result: The results of this study demonstrate that the mean values of functional balance, which are much lower in this population than in their healthy counterparts, can be improved by a video-based intradialytic exercise program that includes stretching and endurance activities. In particular, notable advancements were noted in the average TUG test 3 meter return result, which is a reliable indicator of hospitalization, cardiovascular events, and mortality in dialysis patients. Conclusion all participants reported after 12 weeks static and dynamic stretching felt more flexible range of motion knee and leg, walking stronger than before and felt more conformable in walking reported, significant different before and after given static and dynamic stretching, both Static and dynamic stretching effective for improving functional balance and physical performance, Recommended static and dynamic stretching to be rutine activity in Hemodialysis unit.

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment.

Monitoring and maintaining quality in the paediatric haemodialysis unit.

Chronic kidney disease in children is being increasingly recognised and reported worldwide, and the focus of paediatric dialysis planning has changed from acute care alone to encompass chronic care. In many parts of the world, haemodialysis for children is performed in adult units and is based on standards established for adults. This review proposes standards for paediatric haemodialysis, incorporating special requirements for children while simultaneously drawing from the adult experience. We discuss the optimum requirements, including space utilisation, equipment needed, water treatment facilities, disposables, safety standards, staffing needs, monitoring and maintenance, infection prevention, waste disposal and quality indicators. We also review recent advancements in the field that should be incorporated into future dialysis units and the steps required for achieving carbon neutrality and protecting the environment.

The effect of using a local skin cooling device on arteriovenous fistula cannulation pain and comfort level of patients on hemodialysis: A single-blind randomized controlled study.

The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients. The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the "Patient Information Form," the "Verbal Category Scale," and the "General Comfort Scale." Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801). The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients' comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001). It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

Blood osteoprotegerin is associated with arteriovenous access thrombosis in hemodialysis patients.

A functioning arteriovenous (AV) access is essential for hemodialysis efficiency and the quality of life in hemodialysis patients. Blood osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa B ligand (RANKL) have been linked to cardiovascular diseases and vascular calcification. This study investigated the relationship between blood OPG, RANKL, and the occurrence of AV access thrombosis. This prospective cohort study was conducted from August 2016 to August 2021 and included patients undergoing prevalent hemodialysis in two hospital-based hemodialysis units. Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the association between blood OPG, RANKL, and AV access (AV fistula [AVF] and AV graft [AVG]) outcomes. A total of 333 hemodialysis patients were enrolled, with an AV access thrombosis rate of 22.2%. Cox regression identified several factors associated with AV access thrombosis: AV access type (AVF vs. AVG; hazard ratio [HR], 0.24; p < 0.001), C-reactive protein (HR, 1.07; p = 0.002), and log-transformed OPG (HR, 5.52; p = 0.005). Subgroup analysis revealed high log-transformed OPG and RANKL were associated with AVF thrombosis (HR, 10.77; p = 0.002 and HR, 3.26; p = 0.009, respectively), while high C-reactive protein increased the risk of AVG thrombosis (HR, 1.31; p < 0.001). Kaplan-Meier analysis showed that patients with AVF in the highest tertile of log OPG (>402 pg/mL) had the highest AVF thrombosis incidence (p = 0.03). High blood OPG was associated with AV access thrombosis, particularly in the AVF.

Involvement of healthcare staff in hospital hygiene during emergency hemodialysis.

Healthcare-associated infections are still a worrying health problem that complicates patient care and increases morbidity and mortality. The incidence of infections in hemodialysis patients is still high and they constitute the second cause of hospitalization and death in this category. The study's objective was to evaluate nursing and medical staff's involvement in hospital hygiene. This is an observational study that took place within the hemodialysis unit of a Moroccan university hospital from March 2021 to June 2021. A surface swabbing technique for bacteriological examination was also carried out. The study revealed some shortcomings regarding hand hygiene which was respected by the nurses in only 17.5% of sessions and in 42.2% by the doctors. Other shortcomings in asepsis measures, were also noted such as the non-change of gloves after skin preparation (1.03%) and before manual compression. The serological status of patients concerning HBV, HVC, and HIV was also not always known (31.1%). The bacteriological samples from the surfaces also showed colonization of the medical devices and the ultrasound scanner used for the ultrasound-guided introduction of the central catheters. The results of the study showed some deviations concerning the recommendations; however, they are comparable to other studies conducted internationally, especially in terms of hand hygiene. Our study results highlight some shortcomings adherence to hygiene measures like inconsistent disinfection of medical devices and dialysis stations, as well as insufficient hand hygiene practices among some staff members. However, we observed an improvement in practices following the implementation of awareness-raising sessions. To maintain improved hygiene practices and prevent infections, it is crucial to provide ongoing training for staff, ensure adequate resources, and regularly monitor compliance with hygiene standards.

Hand hygiene as a part of infection control at haemodialysis unit

Hand hygiene as a part of infection control at haemodialysis unit

Associated Factors of Viral Hepatitis Transmission among Hemodialysis Adult Patients

Background: Individuals suffering from chronic kidney disease (CKD) are more likely to die, particularly those with end-stage kidney disease. Surprisingly, these deaths are related to many diseases, and this mortality rate motivates us to identify additional risk factors that can be modified to improve survival in patients requiring hemodialysis. Hepatitis virus infection has been associated with many comorbidities other than the liver, such as kidney disease, cardiovascular disease, insulin resistance, diabetes mellitus, and lymphoproliferative disease. Objective: To estimate the hepatitis prevalence in hemodialysis units and assess the risk factors contributing to viral hepatitis infection in hemodialysis centers. Materials and Methods: Cohort study design conducted in dialysis centers-Najaf AL Ashraf\ Iraq , , May 2023. The sample was collected by questionnaire and by referring to patient records to measure the prevalence of viral hepatitis. Results: 72 patients with hepatitis in hemodialysis centers responded to study. Their ages ranged from 20-78 years. The group of participants (41-60 years old) constituted approximately half of sample, and the percentage of sex was males more than females. The prevalence of viral hepatitis was 10.3 %. Among patients with hemodialysis treatment, hepatitis B virus is less than C.

Quality of Life and Complications Among Hemodialysis Patients.

Background Patients with renal impairment who require frequent hospitalizations or dialysis must undergo the rigorous process known as hemodialysis (HD). Hemodialysis is a complex treatment for people who require frequent hospital or dialysis appointments, typically three times each week. We aim to explore the quality of life of hemodialysis patients and their complications. Methodology This case-control study focuses on renal failure patients in Riyadh's hemodialysis units. The case group included 50 hemodialysis patients with 50 healthy individuals medically free in the control group who were the same gender and age as the case group. The comparison was made using a quality of life (QoL) short form 36 questionnaire conducted by a trained physician via Google Forms. The data was obtained in February and March 2023. Results The majority of participants were male (68; 68%), aged 40-50 years (42; 42%), 53 (53%) were non-Saudi, 76 (76%) began hemodialysis one year ago, and 30 (30%) developed an infection as a complication. There was a significant statistical relationship between our results and the results of a medical outcome study in the emotional problem and energy/fatigue domains. Conclusion In all domains, HD patients performed worse on subscales than healthy people of the same age and socioeconomic status. The average QoL score for HD patients was lower than that of healthy individuals. There was a statistically significant relationship between healthy people and hemodialysis patients in two domains: emotional problems and energy/fatigue levels.

Effect of Nutritional Status and Haemodialysis Parameters on Health Related Quality of Life and Post Dialysis Recovery Time in Prevalent Haemodialysis Patients

Abstract Background The majority of patients with an impaired renal function may be classified as to a certain stage of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) and requiring renal replacement therapy (RRT). Aim of the Work To study the effect of current nutritional status of haemodialysis patients and other variables (socio-demographic, physical, biochemical and dialysis treatment parameters) on health related quality of life and post dialysis recovery time among haemodialysis patients in haemodialysis units in Desouq general hospital, Kafr-Elshiekh Governorate. Patients and Methods Type of Study: We conducted an observational cross-sectional study. Study Setting: The study was conducted in haemodialysis units in Desouq general hospital, Kafr-Elshiekh governorate. Study Period: from July to September in 2021. Study Population: 100 prevalent End Stage Renal Disease (ESRD) patients on regular haemodialysis 3 times per week in Desouq general hospital. Results The result of this study concluded that the factors affecting nutritional status for those patients were age &amp; dialysis wintage, serum HB, serum calcium, both serum albumin &amp; serum pre-albumin, intake of: (carbohydrate, potassium, calcium, phosphorous &amp; magnesium) &amp; anthropometric measurement of; (Weight, BMI, calf circumference, BSF, TSF, MAMC &amp; MAC). Also, our study concluded that the factors affecting QOL for our patients were; SGA score (as a surrogate for nutritional status), duration of session, serum albumin &amp; prealbumin, height, MAC, MAMC &amp;calf circumference. Patients with poor nutrition have a poor physical and mental quality of life. Hence, it becomes important (not only for us but also for them) to identify such patients and intervene earlier, in order to improve their quality of life and also reduce morbidity which in turn helps in reducing mortality. Conclusion Malnutrition is one of the most commonly encountered (&amp;treatable) problems in haemodialysis population in Egypt as it increases the morbidity and mortality. SGA (M- SGAS) and HRQOL SF 36 (Kidney Disease and Quality of Life--Short Form (KDQOL- SF™) version 1.3) are simple to use, bedside and readily available tools for nutritional &amp; QOL assessment of MHD patients, respectively.

Enhancing infection control in dialysis at a resource limited public healthcare institute: A cross-sectional study on microbiological quality assessment of dialysis water and dialysate

PurposeTo evaluate the microbiological quality of dialysis water and dialysate samples from hemodialysis units at a tertiary care government hospital and to assess the use of culture, endotoxin and periodicity of testing these assays to guide the actions of monitoring the quality of hemodialysis fluids, implement preventive and corrective actions, and improve the safety and outcomes of the dialysis process. MethodsA cross-sectional study was conducted at a 250-bedded super-specialty government hospital with a 24/7 hemodialysis unit equipped with 40 dialysis machines. Dialysis water and dialysate samples were collected monthly and analysed for microbial contamination and endotoxin levels as per AAMI guidelines. Bacterial cultures were done using Reasoner's Agar plates, and endotoxin analysis was performed using gel clot assay. Interpretation of results was based on predefined thresholds. ResultsAmong the 740 samples processed for microbial culture 19.6 % and 80.4% were unacceptable and acceptable respectively.Among the acceptable samples 10.5 % were at action level. At the end of 2 days of incubation, 15.2%dialysis water samples and 5.1%dialysate samples had unacceptable levels of bacterial colonies and at 5days additional 10.6 % dialysis water samples and 7.7%dialysate samples were unacceptable. 21.5 % of the samples tested for endotoxin had unacceptable levels. ConclusionsRegular monitoring of water quality in government healthcare hemodialysis units is crucial for quality of care, timely preventive and corrective actions for mitigating adverse outcomes. Processing cultures for 5–7 days is essential for detecting all contaminated specimens. While there might be a link between endotoxin levels and bacterial contamination, both endotoxin testing and bacterial culture independently are vital for evaluating water quality in dialysis settings. A comprehensive approach integrating various testing methods is necessary to uphold patient safety and enable necessary improvements.