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In the early years of hemodialysis, the importance of treating the water used in hemodialysis was not sufficiently understood, and serious poisoning caused by substances such as bacterial endotoxins, chlorinated compounds, excessive calcium, magnesium, fluorine, aluminum, etc., which can always be found in small amounts in city municipal water, has been observed in patients. While the presence of these substances in water may not cause a noticeable problem in people who drink and use this water, they can cause serious poisoning in hemodialysis patients. In end-stage renal disease patients, toxic substances can easily accumulate in the body due to the dysfunction of the kidneys to remove toxins from the body. However, while a normal person drinks 10-15 liters of water per week, a hemodialysis patient comes into contact with 300-800 ml per minute, i.e. 300-400 liters per week, of water in the dialysis solution during hemodialysis and with all kinds of toxic substances contained in this amount of water. This contact occurs directly at the blood level, and the gastrointestinal system and other sensory organs are not able to use any defense mechanisms such as bad taste sensation, nausea and vomiting against these toxins. Dialysis water must therefore be much purer than drinking water and much more pure and free of harmful substances.

The current legislation on the control of water used for the dilution of hemodialysis solutions is based on the European Union Pharmacopoeia. According to this, the chemical, microbiological and toxicological parameters of hemodialysis water quality must comply with the criteria in the pharmacopoeia.

The Water Treatment Directive dated 28.10.2011 and numbered 44047, issued by the Ministry of Health in accordance with the provisions of the Regulation Amending the Regulation on Dialysis Centers dated 14.02.2012 and numbered 28204, covers all dialysis centers without distinction between public and private.