Prioritizing water stewardship in kidney replacement therapies

We read with interest Ben Hmida et al.’s article, Water Implications in Dialysis Therapy, Threats and Opportunities to Reduce Water Consumption: A Call for the Planet, and we laud the authors’ system-focused approach to global stewardship of this most precious resource. 1 Ben Hmida M. Mechichi T. Piccoli G.B. Ksibi M. Water implications in dialysis therapy, threats and opportunities to reduce water consumption: a call for the planet. Kidney Int. 2023; 104: 46-52 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar We suggest the following 2 additional measures to minimize dialysis water consumption: sorbent-based systems capable of dialysate regeneration; and economization of water use by working with water-treatment providers to optimize system settings in existing hemodialysis infrastructure (noting that optimizing existing systems also yields carbon-emissions savings). Sorbent systems have been described to use as little as 6 L of water. 2 Agar J.W. Understanding sorbent dialysis systems. Nephrology. 2010; 15: 406-411 Crossref PubMed Scopus (63) Google Scholar In contrast, in some settings, reductions of up to 50% in water and energy consumption have been realized through simple measures, such as minimizing reverse osmosis unit operation times and ceasing unnecessary disinfection (K. Barraclough, MD, PhD, personal verbal communication, May 11, 2023). Water implications in dialysis therapy, threats and opportunities to reduce water consumption: a call for the planetKidney InternationalVol. 104Issue 1PreviewWater is a dwindling natural resource, and potable water is wrongly considered an unlimited resource. Dialysis, particularly hemodialysis, is a water-hungry treatment that impacts the environment. The global annual water use of hemodialysis is approximately 265 million m3/yr. In this reference estimate, two-thirds of this water is represented by reverse osmosis reject water discharged into the drain. In this review, we would like to draw attention to the complexity and importance of water saving in hemodialysis. Full-Text PDF Open AccessThe authors replyKidney InternationalVol. 104Issue 4PreviewWe are extremely grateful to Stigant et al. for their letter highlighting additional aspects of the complexities around the water issue in dialysis,1 as discussed in our article.2 We agree with them that wise use of existing resources, minimizing unnecessary procedures, and adapting operation times could result in further gains, and we thank them for reminding us of elements that should be implicit in hospital management in general. Full-Text PDF