Water treatment systems consisting of a pretreatment section, reverse osmosis module, a water distribution system loop and strict hygienic rules are required to comply with the new target. Dialysis water and ultrapure dialysis fluids are established as a prerequisite for online convective therapies (e.g. hemodiafiltration), to improve biocompatibility of the dialysis system and to reduce inflammation profile of dialysis patients, and further, to anticipate new dialysis options (automatic priming and flushing, IV bolus e.g. to compensate for hypovolemia). Ultrapure dialysis fluid is now accepted as a new standard therapy in modern hemodialysis treatment.
Water is needed for the preparation of dialysis fluids or substitution fluids, e.g. in hemodiafiltration or hemofiltration, or for rinsing a dialyzer prior to use. For all these applications, adequate water quality is mandatory. Current opinions among nephrologists indicate that water quality is even more important for the long term clinical success of hemodialysis therapy than the biocompatibility of dialysis membranes.