Seasonal dynamics of endotoxin in dialysis water: one-year surveillance in Iraq

ABSTRACT Dialysis water quality is critical to patient safety, particularly in relation to bacterial endotoxins, which can pose major health hazards. Environmental variables, such as seasonal flocculation, may influence endotoxin levels in treated water. The purpose of this study was to evaluate the seasonal fluctuation in endotoxin concentrations in dialysis water across a number of hospital-based dialysis centers. Over 12 months, water samples were collected monthly from various places and tested for endotoxin levels using the Limulus Amebocyte Lysate (LAL) assay. The findings demonstrated considerable seasonal changes, with almost 55.5% of the samples surpassing the international threshold of 0.03 EU/mL. Peaks were seen during the warmer months (July–August 2025 and February–March 2025), whereas lower levels were more typical in the winter (November–December 2024). These findings highlight the requirement for seasonally adjusted monitoring and control strategies to maintain water quality and ensure patient safety in dialysis settings.