This highly sensitive laboratory test measures the level of endotoxin in treated water used for dialysis or in final dialysis fluids. Endotoxin is a toxic component of the outer membrane of Gram-negative bacteria and is measured in units of EU/mL. Even if the water is sterile (free of live bacteria), it may contain endotoxins released from dead bacteria. The test is typically based on a sensitive reaction using horseshoe crab blood cells (Limulus Amebocyte Lysate - LAL assay).