In 1984, 38 sera from home hemodialysis patients were found with a significant increase of aluminum (Al) from 67.8 +/- 44.3 to 102.0 +/- 45.9 micrograms/l (p less than 0.001) compared to 1983. The only change was an activated charcoal (AC) filter in the water treatment circuit, added downstream of the water softener. Five different home hemodialysis AC filters were tested: Microclean CA Dia Cuno, Traitement Standard des Eaux (TSE)R, Permo, C2R, Gambro. AC was shown to be the main source of Al, its content ranging from 1251 +/- 116 to 7569 +/- 969 mg/kg. Al released in 2000 l of liter rinsing water varied from 1.6 +/- 1.3 to 41.3 +/- 5.5 mg. (mean concentration: 0.8 to 20.6 micrograms/l): Gambro less than or equal to C2R less than TSE less than Permo less than Cuno (p less than 0.01). Al loading of charcoal could occur either before or during the activation process, by contaminated water, other added substances, or during packaging. In conclusion, our study suggests, first, to put AC filters upstream of Al captor to avoid Al intoxication, second, to systematically dose Al and may be other metallic substances in every manufactured AC sold for therapeutic purpose.