Using water wisely: New, affordable, and essential water conservation practices for facility and home hemodialysis

Abstract

Despite a global focus on resource conservation, most hemodialysis (HD) services still wastefully or ignorantly discard reverse osmosis (R/O) "reject water" (RW) to the sewer. However, an R/O system is producing the highly purified water necessary for dialysis, it rejects any remaining dissolved salts from water already prefiltered through charcoal and sand filters in a high-volume effluent known as RW. Although the RW generated by most R/O systems lies well within globally accepted potable water criteria, it is legally "unacceptable" for drinking. Consequently, despite being extremely high-grade gray water, under current dialysis practices, it is thoughtlessly "lost-to-drain." Most current HD service designs neither specify nor routinely include RW-saving methodology, despite its simplicity and affordability. Since 2006, we have operated several locally designed, simple, cheap, and effective RW collection and distribution systems in our in-center, satellite, and home HD services. All our RW water is now recycled for gray-water use in our hospital, in the community, and at home, a practice that is widely appreciated by our local health service and our community and is an acknowledged lead example of scarce resource conservation. Reject water has sustained local sporting facilities and gardens previously threatened by indefinite closure under our regional endemic local drought conditions. As global water resources come under increasing pressure, we believe that a far more responsible attitude to RW recycling and conservation should be mandated for all new and existing HD services, regardless of country or region.

Solar-Assisted Hemodialysis

“…To correct this oversight, we first addressed dialysisrelated water use and introduced reuse practices for reverse osmosis reject water (2)(3)(4). Concurrently, researchers from Morocco reported using postdialysis reverse osmosis of the dialyzer effluent to create water suitable for agricultural reuse (5,6).…”

Water Conservation: An Emerging but Vital Issue in Hemodialysis Therapy

“…Including priming and rinsing volumes, and depending on the efficiency of the RO system, approximately 500 liters of tapwater are required to produce sufficient high-grade water [2,12] . However, despite the increasing scarcity of water, most dialysis facilities still ignorantly discard huge volumes of this reusable resource to the sewer daily [2,3,6,7,13] .…”

Water for Haemodialysis and Related Therapies: Recent Standards and Emerging Issues

“…In most dialysis units, the waste component of reverse osmosis-treated water passes to the drain. This water contains high concentrations of dissolved solutes and is unsuitable for use as drinking water; it can nevertheless be diverted to a recovery tank for use in non-drinking applications [15] . The recycling of used dialysis fluid remains in its infancy possibly because of concerns that such fluid may cause environmental bacterial or viral contamination.…”