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How dialysis facilities monitor water quality
A plain look at what's required, what gets tested and when, and where continuous monitoring fits into an existing maintenance plan — written for facilities and biomedical engineering teams.
This page is independent research, not affiliated with, endorsed by, or reviewed by any manufacturer named below. It does not cover bacterial or endotoxin testing, is not a substitute for AAMI-mandated compliance testing, and isn't intended for clinical decision-making.
Water treatment isn't
optional here
Every outpatient dialysis facility in the US treats its water — not as a best practice, but as a condition of Medicare reimbursement. CMS's ESRD Conditions for Coverage, at 42 CFR § 494.40, directly incorporate the AAMI water quality standard. In practice, some form of reverse osmosis treatment is standard equipment in every water room.
Two different jobs,
two different clocks
One confirms compliance on a fixed schedule. The other reads how the RO membrane itself is performing, between those scheduled checks rather than only at them.
Done on a fixed schedule, this is what confirms AAMI compliance: chemical contaminants, bacteria, endotoxin.
A different signal entirely: an ongoing read on how the RO membrane itself is performing, available between those scheduled checks rather than only at them.
Continuous conductivity monitoring provides real-time water quality performance data, while periodic testing verifies that product water meets chemical specifications required by AAMI standards.
What runs in the
water room today
A handful of established central and portable RO platforms, each built to the same AAMI/ANSI/ISO baseline in different configurations, service models, and capacities — drawn from each manufacturer's own published specifications.
AquaA — central, modular double-pass RO, up to 75 stations
BioPure HX2 — central, double-pass, FDA 510(k) cleared
Centurion — portable, single-patient RO with heat disinfect
Rejection-rate drift as a
maintenance flag
A continuous inline TDS/conductivity signal is a natural companion to periodic AAMI testing rather than a competitor to it — a way of catching rejection-rate drift as it happens, so a membrane issue surfaces as a maintenance flag before it becomes a failed test.
TDSBot does not measure bacteria, endotoxins, or the chemical contaminants AAMI testing covers, and it cannot confirm AAMI compliance on its own. Its role is limited to continuous rejection-rate and conductivity monitoring, feeding into a facility's existing maintenance plan alongside, not in place of, mandated testing.
Dialysis water monitoring
— common questions
See TDSBot's monitoring layer
for facilities and biomed teams
Continuous feed-versus-product conductivity on the RO skid — so a declining rejection rate reaches the maintenance queue before the next scheduled test does.
This page is independent research content produced by WaterTDS Inc. and is not sponsored by, affiliated with, or reviewed by Fresenius Medical Care, Mar Cor Purification / Xylem, AmeriWater, or any other manufacturer referenced. All product names are trademarks of their respective owners.
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