Blue Planet dialysis: novel water-sparing strategies for reducing dialysate flow

Abstract

Conservation of water in chronic HD should be considered an important responsibility of healthcare practitioners all over the world. We present a wider usage of dialysate flow rates, considering that it would lead to significant water conservation without much compromise on dialysis efficacy in small patients. We believe that further investigation into the utility of reduced dialysate flux in different populations is needed to broaden our understanding of how we can use these techniques in order to significantly reduce water consumption during chronic HD while still ensuring optimum efficacy and efficiency of the therapy.

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

“…To give an idea of the potential savings that ensued, one dialysis service in the UK has reported savings of up to 4 million litres of water per year with a new ergonomic water system [ 32 ]. UK, Australian and French data show that adding water-conserving devices to an existing reverse osmosis system can be water saving, as well as economically sound [ 58 , 61 – 64 ].…”

“…As brilliantly demonstrated by our Australian colleagues, the reject water never contacts the dialyser or the patient and bears no more infectious risk (in fact far less) than tap water. Apart from a mild increase in conductivity, the quality of this water falls within the limits set by the World Health Organisation for potable water [31,58]. The inventive Australian team found several ways to reuse this reject water.…”

“…To produce the dialysate (120 L per session for a dialysis session of 4 h with a standard dialysate flow of 500 mL/ min) the total water consumption with a standard reverse osmosis can be over 300 L and, according to an Australian study, when pre-treatment priming, rinsing and sterilisation of the system are added in, a single haemodialysis session can consume up to 500 L of water [31,58].…”

“…Independently from its quantity, the reject water produced by reverse osmosis is purified tap water that has already passed through a depuration cycle, during which particulate matter, chlorine, chloramines and other potentially harmful substances are removed; this water is commonly considered unfit for human intake due to lack of chlorine [58]. As brilliantly demonstrated by our Australian colleagues, the reject water never contacts the dialyser or the patient and bears no more infectious risk (in fact far less) than tap water.…”

Eco-dialysis: fashion or necessity

“…We need more studies in different populations (e.g. in obese patients) and studies into the effectiveness of HDF taking into account different Qd to be sure that water saving during hemodialysis/hemodiafiltration does not affect the quality of the therapy [28,29]. We currently do not have enough data to assume that Qd reduction is safe and effective for hemodialysis patients.…”