Endotoxin and bacterial level of dialysate fluid quality

For dialysis fluid quality criteria, several dialysis centers in Japan have put great effort into keeping endotoxin (ET) levels low, although in many countries the bacterial count measurement for dialysis fluid is widely used. The International Organization for Standardization (ISO) suggests an ET and bacterial level for dialysate fluid quality, and Japan currently also measures the bacterial count. Each country presses forward to revise their domestic criteria based on ISO suggestions. In some Japanese cities, guidelines are currently made for dialysate fluid quality control by referring to ISO values. In many countries it is necessary to push forward these domestic guidelines to hemodialysis centers to keep a low level of ET and bacteria. As one of several actual data, we will describe the ET concentration and bacterial count of dialysis fluid in many Japanese dialysis centers to make clear the relation between ET level and bacterial count.