The quality of water used in hemodialysis seriously affects the safety and long-term prognosis of ESRD patients. Reverse osmosis (RO) membrane is the most important core component of water treatment apparatus for producing pure water. With lasting and continuous use of RO membrane and improper maintenance of pre-treatment of water treatment system, foulants' accumulation and biofilm growth onto the membrane surfaces and/or inside the membrane pores is one of the key factors affecting water production and microbial levels. This paper discusses the rationale of the reverse osmosis membrane, the causes of fouling on the membrane surface and the resolving solutions. This paper also combines examples to share our experience in dealing with the reduction of water production of the RO membrane. We explain the importance and necessity of cleaning and disinfection of RO membrane, which is often overlooked in hemodialysis centers.