Ultrapure water in haemodialysis: a step towards better quality in Lebanon.

Globally the nephrology community is witnessing an increased use of high-flux membranes and ultrapure water in haemodialysis (HD) units, and in low-and middle-income countries, data are lacking regarding HD water quality. In Lebanon the Ministry of Public Health released a decree calling for a progressive change in the HD water treatment system in order to implement ultrapure water in all dialysis facilities. This article reports on the problems previously encountered regarding water quality in Lebanon. It exposes the recent changes in standards as recommended by the government, especially the mandatory three sessions per week and ultrapure water. In addition, it analyses the cost-effectiveness of ultrapure water implementation in a low/middle-income country and demonstrates that the cost is lower than in high-income countries. Finally, this article summarizes the obstacles met and suggests a practical approach to maintain this high level of water treatment quality.