Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil

In the past 30 years, knowledge about end-stage renal disease and the use of maintenance hemodialysis for patients with the disease have both increased dramatically, and technological developments in dialyzer membranes, dialysis machines, and vascular access have made hemodialysis a common procedure. Nonetheless, it remains potentially hazardous, because of mechanical malfunctions and human error. 1 Hemodialysis may be especially hazardous in places where municipal water treatment or appropriate infection-control practices are inadequate. 2 Furthermore, water used for hemodialysis may contain various harmful agents, including toxins produced by naturally occurring cyanobacteria (i.e., blue-green algae). These toxins can have anticholinesterase activity (e.g., anatoxin-a(s)) or . . .