Hemodialysis (HD) is an expensive therapy in economic and in ecological terms, owing to a high carbon footprint and significant consumption of natural sources, especially water. Our aim was to review strategies to diminish waste of water in maintenance dialysis, exploring previously described water reuse trends and less known strategies for reducing the dialysate flow.
We conducted a systematic review of water-sparing strategies, including the reuse of reverse osmosis rejected water and the reduction of dialysate flux. We performed a search in Medline, Pubmed, Scielo, OVID and Biblioteca Redentor, using key words: Dialysate flow rate, Dialysate flux, and decrease; excluding: online, peritoneal, continuous, blood access, needle, hemodiafiltration, acute, pharmacokinetics, increase. We limited our search to adult humans or in vitro trials in English, Spanish, Italian and Portuguese, between January 1980 and June 2017. We found 816 trials. 37 articles were retrieved for review, and 11 articles were analyzed.
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.
Post author correction
Article Type: REVIEW
AuthorsAlejandra Molano-Triviño, Benjamin Wancjer, Mauro M. Neri, Akash N. Karopadi, Mitchell Rosner, Claudio Ronco
- • Accepted on 18/10/2017
- • Available online on 08/11/2017
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- Molano-Triviño, Alejandra [PubMed] [Google Scholar] 1, 2, * Corresponding Author (email@example.com)
- Wancjer, Benjamin [PubMed] [Google Scholar] 1
- Neri, Mauro M. [PubMed] [Google Scholar] 2
- Karopadi, Akash N. [PubMed] [Google Scholar] 2, 3
- Rosner, Mitchell [PubMed] [Google Scholar] 4
- Ronco, Claudio [PubMed] [Google Scholar] 2, 5
Internal Medicine and Nephrology, RTS – Fundaciòn Cardioinfantil, Bogotà - Colombia
International Renal Research Institute, San Bortolo Hospital, Vicenza - Italy
Dr. Nayak Dialysis Centres Pvt. Ltd, Hyderabad - India
Department of Nephrology, University of Virginia, Charlottesville, Virginia - USA
Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza - Italy