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Hemodialysis (HD) patients are exposed to large volumes of water and any contamination may cause potential health risks. A multicenter study was aimed at evaluating and comparing the physicochemical, bacterial quality and endotoxin levels of dialysis water of eight HD centers consisting of seven in Algeria and one center in France. A total of 576 and 1,440 samples were examined for physico-chemical and bacterial analysis respectively and 192 samples for endotoxins, from April 2016 to March 2019. The results indicated that the dialysis water quality in some centers did not comply with the international standards for calcium, potassium, total and free chlorine, lead, cadmium, copper, and aluminum. Surprisingly, the conductivity was significantly higher than the allowed limits among all centers. Regarding the efficiency of the dialysis water treatment system, significant differences (p < 0.05) were recorded between tap water and dialysis water samples with the exception for cadmium in one of the centers where a low rejection rate of 8% was obtained. All removal rates were higher than 50% except for two participant centers. Total microbial counts at 22°C were present at levels higher than the maximum value of 100 CFU/mL in 75% of samples for one center while endotoxin levels were below the international standards (<0.25 IU/mL) in =65% of dialysis water samples. These data imply possible risks to hemodialysis patients and more efforts are needed to improve water quality management practices in dialysis centers. National standards for dialysis water should be developed. [ABSTRACT FROM AUTHOR]