Researchers’ novel ‘3R’ plan may reduce water waste in hemodialysis
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Key takeaways:
- Global hemodialysis water use is approximately 265 million m3 per year.
- Each patient-month of dialysis delay equals approximately 6,000 L in spared water.
Hemodialysis can be a water-heavy treatment that may result in waste and affect the environment. Researchers in a recent review examined the importance of water-saving.
“The environmental impact of dialysis is particularly high; dialysis is water- and energy-hungry and produces an extremely high amount of waste, most of which is not recycled,” Mohamed Ben Hmida, of the department of nephrology at Hédi Chaker University Hospital and lead researcher of the study, and colleagues, wrote. “The aim of this review is to highlight the importance and feasibility of water conservation initiatives and propose solutions.”
According to the review, global hemodialysis water use is approximately 265 million m3 per year, two-thirds of which is discharged reverse osmosis reject water. Water consumption can be higher in hemodiafiltration, according to the report, and peritoneal dialysis water consumption also may add to the cumulative waste.
To address water-saving tactics in hemodialysis, researchers proposed solutions based on circular water management and a “3R” approach: reduce, reuse and recycle.
Reduce: This measure refers to reducing dialysis need, dialysate flow and optimizing reverse osmosis performance, according to the researchers.
“For every patient-month of dialysis delay, the amount of water spared is approximately 6,000 L,” Hmida and colleagues wrote. However, they noted that early dialysis may not increase patient survival and instead increase morbidity and impair quality of life. “A healthy diet, protein-restricted and plant-based whenever possible, is one of the basic tools for safely delaying dialysis start,” they wrote.
They also suggested incremental dialysis and purification of the water needed to produce the dialysate may be potential options to increase water conservation.
Optimizing reverse osmosis systems is also crucial to reduce water consumption, the researchers wrote. “New-generation [reverse osmosis] RO systems recycle part of the wastewater, replacing old-generation water treatment systems with new-generation ones can lead to a significant reduction in water consumption per session,” they wrote.
Reuse and recycle: Reusing wastewater as potable water and recycling dialysis emissions for agriculture and aquaponic use also may be important steps.
Although there is a need for more wastewater study, “there is no theoretical limitation to the reuse of RO reject water for in-hospital services, including rehabilitation hospital pools, sterilization facilities or laundries,” researchers wrote.
They added that RO reject water may have benefits to agriculture, aquaponics and horticulture. Spent dialysate is considered at high microbiological risk. Recent studies suggest it may meet the standards of the Food and Agriculture Organization of the United Nations and WHO.
Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus that, if recovered as soil fertilizers, are opportunities for fertilizer supply, according to recent research from the Center of Hemodialysis 2 Mars.
“Effective communication is crucial for water savings, and innovative policies based on the transition from linear to circular water management may lead to a paradigm shift and establish a sustainable water management model,” Hmida and colleagues wrote.
References:
- Hmida MB, et al. Kidney Int. 2023;doi.org/10.1016/j.kint.2023.04.008.
- Tarrass F, et al. Nefrología. 2023;doi.org/10.1016/j.nefro.2023.02.006.
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