Worldwide guidelines for the preparation and quality management of dialysis fluid and their implementation

Quality standards for dialysis water have existed for more than 25 years. Current standards generally agree concerning the maximum allowable levels of chemical contaminants; however, significant differences exist concerning the maximum allowable levels of microbiological contaminants and the methods used to measure them. While quality standards for dialysis water are common, there are relatively few standards or recommendations for dialysis fluid quality and these also differ markedly in the maximum allowable level for microbiological contaminants. Compliance with quality standards for dialysis water and dialysis fluid appears to have improved over the past 20 years, although the actual extent of compliance is difficult to assess. A universal standard for fluid quality might be of benefit to the wider dialysis community; however, progress towards that goal will depend on resolution of important issues, including how the standard is to be applied, if it should be limited to substances with documented toxicity for hemodialysis patients, and how to address microbiological contaminants.