ABSTRACT
The ongoing climate change and the ecological challenges call for sustainable medicine and, in our field, sustainable kidney care. Dialysis is life-saving and resource-consuming, and high water consumption is one of the main concerns. Circular water economy, meaning reuse and recycling of water, and recovering resources can help reducing emissions and enhancing resilience to climate change. Several actions are possible including reusing reverse osmosis reject water, employable for gardening, aquaponics or even simply for toilet flushing, or in sterilization settings, reusing spent dialysate, at least for toilet flushing, but with wider use if microbiologically purified, recovering thermal energy from spent dialysate, that can probably be done with simple devices, or using phosphate-rich spent dialysate for producing fertilizers, namely struvite. All these options may be economically sound, and all help reducing the final dialysis carbon footprint. There is room for open-minded innovative approaches to improve water-related sustainability in hemodialysis, ultimately reducing ecological impact and increasing availability.
ABSTRACT
INTRODUCTION: Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus. Recovery of these nutrients as soil fertilizers represents an interesting opportunity to ensure a sustainable fertilizer supply. METHODS: In this paper, a simple method for recovering phosphorous and nitrogen as crystalline struvite [MgNH4PO4·6H2O] is presented. An integrated cost model is also presented in order to create a positive business case. RESULTS: Recovery rates in form of struvite of 95% of PO43--P and 23% of NH4+-N were achieved with a profit. CONCLUSION: To the best of our knowledge, this paper is the first to study the recovery of these naturally occurring minerals from hemodialysis wastewater. This offers great potential for the valorization of this type of wastewater.
Subject(s)
Phosphorus , Wastewater , Struvite/chemistry , Fertilizers , Phosphates , NitrogenABSTRACT
Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions. (AU)
La escasez de agua y energía, y los requisitos legales para la descarga de desechos y aguas residuales están obligando a las instalaciones de hemodiálisis a cambiar su enfoque hacia un concepto más integrado de conectar la salida residual (en términos de desechos, aguas residuales y pérdida de energía) con la entrada (en términos de agua y energía). La descarga de líquido cero es una filosofía de tratamiento de agua en expansión en la que las aguas residuales de hemodiálisis se purifican y se reciclan, dejando poco o ningún efluente cuando se completa el proceso, lo que ahorra dinero y es beneficioso para el medio ambiente. Este artículo explora las posibles formas de tratar las aguas residuales de hemodiálisis, logrando así las condiciones de descarga de líquidos cero. (AU)
Subject(s)
Humans , Renal Dialysis , Water Purification , Wastewater , Conservation of Water Resources , Dialysis SolutionsABSTRACT
Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions.
ABSTRACT
Scarcity of water and energy, and legal requirements for discharge of waste and wastewater are forcing hemodialysis facilities to change their approach to a more integrated concept of connecting the residual output (in terms of waste, wastewater and energy loss) to the input (in terms of water and energy). Zero liquid discharge is an expanding water treatment philosophy in which hemodialysis wastewater is purified and recycled, leaving little to no effluent remaining when the process is complete, thereby saving money and being beneficial to the environment. This article explores the possible ways to treat hemodialysis wastewater, thus achieving ZLD conditions.
Subject(s)
Wastewater , Water Purification , Humans , Renal DialysisABSTRACT
Shortages of water could become a major obstacle to public health and development. Currently, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) estimate that 1.1 billion people lack access to a water supply and 2.6 billion people lack adequate sanitation. The global health burden associated with these conditions is staggering, with an estimated 1.6 million deaths every year from diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene. In this paper we review the impact of water shortages on health and human development.
Subject(s)
Developing Countries/economics , Drinking Water/standards , Health Status Disparities , Sanitation/standards , Water Supply/standards , Developing Countries/statistics & numerical data , Female , Gender Identity , Humans , Sanitation/statistics & numerical data , United Nations , Water Microbiology , Water Supply/statistics & numerical data , Women's Health , World Health OrganizationABSTRACT
Water conservation refers to reducing the usage of water and recycling of wastewater for different purposes such as irrigation, laundry and sanitation. As water scarcity increases worldwide, dialysis facilities should be focused on salvaging water. However, most of them still ignorantly discard to the sewer huge volumes of this reusable resource. This article reviews the current water conservation techniques in hemodialysis and the potential benefits drawn when using this technology.
Subject(s)
Conservation of Natural Resources , Waste Disposal, Fluid/methods , Water Purification/methods , Water Supply , Cost-Benefit Analysis , Humans , Recycling , Renal Dialysis/methodsABSTRACT
BACKGROUND: Water treatment systems are susceptible to microbial contaminations and periodical disinfection procedures are mandatory to obtain results requested from international standards. According to the Association for the Advancement of Medical Instrumentation, ozone is the most effective method to destroy microorganisms, and to prevent, reduce or remove the biofilm. This study aims to review the literature on the application of ozone in the disinfection of water treatment systems for hemodialysis. METHODS: Data were obtained from databases (Ovid MEDLINE, Cochrane, EMBASE, and others). RESULTS: Ozone is quite effective in killing bacteria and degrading endotoxins and biofilm, with efficacy being concentration- and time-dependent. However, being a strong oxidant, appropriately compatible materials should be used. Also ozone production should be monitored and its level in ambient air should also be checked periodically to maintain a contamination air standard of 0.1 ppm. CONCLUSION: Ozone appears to be promising in hemodialysis. However, further investigations are necessary to approve its wider use.
Subject(s)
Equipment Safety/methods , Ozone/chemistry , Renal Dialysis/methods , Water Purification/methods , Water/chemistry , Equipment Contamination/prevention & control , Hemodialysis Solutions/therapeutic use , Humans , Ozone/pharmacology , Renal Dialysis/instrumentation , Water MicrobiologyABSTRACT
Marked enlargement of the jaws is a rare complication of renal osteodystrophy. This report describes a localized enlargement of the mandible due to a brown tumor in a patient undergoing chronic hemodialysis. Literature on jaw involvement in secondary hyperparathyroidism is reviewed.
Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder/complications , Hyperparathyroidism, Secondary/etiology , Kidney Failure, Chronic/complications , Mandible/pathology , Mandibular Diseases/etiology , Adolescent , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Humans , Hyperparathyroidism, Secondary/pathology , Hyperparathyroidism, Secondary/surgery , Kidney Failure, Chronic/therapy , Male , Mandibular Diseases/pathology , Renal Dialysis , Severity of Illness Index , Uremia/complications , Uremia/therapyABSTRACT
Water is a vital aspect of hemodialysis. During the procedure, large volumes of water are used to prepare dialysate and clean and reprocess machines. This report evaluates the technical and economic feasibility of recycling hemodialysis wastewater for irrigation uses, such as watering gardens and landscape plantings. Water characteristics, possible recycling methods, and production costs of treated water are discussed in terms of the quality of the generated wastewater. A cost-benefit analysis is also performed through comparison of intended cost with that of seawater desalination, which is widely used in irrigation.
Subject(s)
Hemodialysis Solutions/economics , Kidney Failure, Chronic/therapy , Waste Disposal, Fluid/methods , Water Supply/economics , Conservation of Natural Resources/economics , Cost Savings , Developing Countries , Female , Humans , Kidney Failure, Chronic/diagnosis , Male , Morocco , Renal Dialysis/methods , Waste Disposal, Fluid/economics , Water Pollution/prevention & controlSubject(s)
Arterioles/pathology , Calcinosis/pathology , Gangrene/surgery , Renal Dialysis/adverse effects , Uremia/pathology , Arterioles/surgery , Disease Progression , Fingers/blood supply , Fingers/pathology , Fluid Therapy , Gangrene/etiology , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Male , Middle Aged , Treatment OutcomeSubject(s)
Abdomen, Acute/etiology , Cysts/therapy , Hemoperitoneum/complications , Hemorrhage/complications , Polycystic Kidney, Autosomal Dominant/therapy , Renal Dialysis , Abdomen, Acute/surgery , Cysts/complications , Cysts/surgery , Hemoperitoneum/etiology , Hemoperitoneum/surgery , Hemorrhage/etiology , Hemorrhage/surgery , Humans , Male , Middle Aged , Nephrectomy , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/surgery , Rupture, Spontaneous , Severity of Illness IndexSubject(s)
Calcinosis/diagnostic imaging , Kidney Failure, Chronic/therapy , Adult , Calcinosis/etiology , Elbow Joint , Female , Glomerulonephritis/complications , Humans , Hypercalcemia/etiology , Hyperphosphatemia/etiology , Kidney Failure, Chronic/complications , Parathyroid Hormone/blood , Parathyroidectomy , Radiography , Renal DialysisABSTRACT
Renal failure secondary to carboplatin therapy is due to acute tubular necrosis and is usually reversible. However, acute renal failure with rapid progression to end-stage renal disease is an exceedingly rare complication of carboplatin therapy. The authors report a case of definitive renal failure secondary to carboplatin chemotherapy for a nasopharyngeal carcinoma. The mechanisms that give rise to the chronic nephropathy are discussed.
