Monitoring water quality in hemodialysis systems is extremely important to maintain adequate quality services for patients suffering from kidney failure. This work aims to examine and evaluate bacteriological characteristics and endotoxin contamination levels in hemodialysis water produced in dialysis centers. Forty‐eight water samples were collected and analyzed from four major hospitals in Baghdad for one year to evaluate seasonal effects. The analysis included the determination of total heterotrophic bacteria using the pour plate method, identification of bacterial isolate using the Vitek2 compact instrument, and the determination of endotoxins levels using Limulus amebocyte lysate (LAL) method. In addition, tap water samples (a source for the hemodialysis water) were also examined bacteriologically. Results showed that 44% of the tested samples for bacterial levels are higher than the maximum value of (100 CFU/ml) set out by the international standards. Endotoxin values for these centers fluctuated during the study period, and 44% of them exceeded the international standards (>0.25 EU/ml). These results call for applying improved technology to modify the existing water treatment units for better control and for national standardization of the microbiological quality of hemodialysis water. Practitioner points Four hemodialysis centers were assessed by measuring the bacteriological and endotoxins levels of their feed and product water. Product water showed elevated levels of bacteria that exceeded the international guideline value of 100 CFU/ml. Most of the identified bacterial species were Gram‐negative that arise the possibility of contributing to endotoxin generation. Product water showed fluctuated values of endotoxins. About 44% of the measured samples were higher than the international guideline values of 0.25 EU/ml.

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Inflammation markers are significantly higher among hemodialysis (HD) patients, which have been associated with chronic activation of the immune system. Hemodialysis centers in Baghdad appear to be taking measures with low adequacy and frequency of dialysis sessions, which can be a reason for decreased kidney functions. Therefore, the objective of this study focuses on the assessment of different aspects of hemodialysis for regular HD patients in Baghdad, including inflammatory markers (serum C-reactive protein, CRP, and erythrocyte sedimentation rate, ESR), dialysis dose, comorbidities, and demographic factors for a period of one year (2018), the assessment covered four major hospitals in Baghdad namely (Al-Kindi, Baghdad Educational, Al-Imamain Al-Jwadian, and Al-Yarmouk). The study involved 320 adult (chronic kidney disease; non hepatitis virus) patients (55% male and 45% female) treated with regular hemodialysis. When compared with the normal values ​​specified by manufacturers for the number of measurement of these indicators. Inflammation markers were high in HD patients were  66.2% of patients recorded elevated of CRP and 87.7% for ESR with no significant difference between males and females, but the origin of chronic inflammation in the patient's remains unclear. Moreover, the majority of HD patients were non-educated; illustring that higher education is possibly associated with lower disease incidence as compared to those who never finished high school. Finally, most of these hospitals, average hemodialysis treatment lasts about three hours and is done two times per week.

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