Exploring Patients' Perceptions About Chronic Kidney Disease and Their Treatment: A Qualitative Study.

BACKGROUND: Unhelpful illness perceptions can be changed by means of interventions and can lead to improved outcomes. However, little is known about illness perceptions in patients with chronic kidney disease (CKD) prior to kidney failure, and no tools exist in nephrology care to identify and support patients with unhelpful illness perceptions. Therefore, this study aims to: (1) identify meaningful and modifiable illness perceptions in patients with CKD prior to kidney failure; and (2) explore needs and requirements for identifying and supporting patients with unhelpful illness perceptions in nephrology care from patients' and healthcare professionals' perspectives. METHODS: Individual semi-structured interviews were conducted with purposive heterogeneous samples of Dutch patients with CKD (n = 17) and professionals (n = 10). Transcripts were analysed using a hybrid inductive and deductive approach: identified themes from the thematic analysis were hereafter organized according to Common-Sense Model of Self-Regulation principles. RESULTS: Illness perceptions considered most meaningful are related to the seriousness (illness identity, consequences, emotional response and illness concern) and manageability (illness coherence, personal control and treatment control) of CKD. Over time, patients developed more unhelpful seriousness-related illness perceptions and more helpful manageability-related illness perceptions, caused by: CKD diagnosis, disease progression, healthcare support and approaching kidney replacement therapy. Implementing tools to identify and discuss patients' illness perceptions was considered important, after which support for patients with unhelpful illness perceptions should be offered. Special attention should be paid towards structurally embedding psychosocial educational support for patients and caregivers to deal with CKD-related symptoms, consequences, emotions and concerns about the future. CONCLUSIONS: Several meaningful and modifiable illness perceptions do not change for the better by means of nephrology care. This underlines the need to identify and openly discuss illness perceptions and to support patients with unhelpful illness perceptions. Future studies should investigate whether implementing illness perception-based tools will indeed improve outcomes in CKD.

Drainage during Condensation on Microgrooved Biphilic Surfaces.

In this work, we investigate and compare the condensation behavior of hydrophilic, hydrophobic, and biphilic microgrooved silicon samples etched by reactive ion etching. The microgrooves were 25 mm long and 17-19 µm deep with different topologies depending on the etching process. Anisotropically etched samples had 30 µm wide rectangular microgrooves and silicon ridges between them. They were either left hydrophilic or covered with a hydrophobic fluorocarbon or photoresist layer. Anisotropically etched samples consisted of 48 µm wide semicircular shaped microgrooves, 12 µm wide silicon ridges between them, and a 30 µm wide photoresist stripe centered on the ridges. The lateral dimensions were chosen to be much smaller than the capillary length of water to support drainage of droplets by coalescence rather than droplet sliding. Furthermore, to achieve a low thermal resistance of the periodic surface structure consisting of water-filled grooves and silicon ridges, the trench depth was also kept small. The dripped-off total amount of condensate (AoC) was measured for each sample for 12 h under the same boundary conditions (chamber temperature 30 °C, cooling temperature 6 °C, and relative humidity 60%). The maximum increase in AoC of 15.9% (9.6%) against the hydrophilic (hydrophobic) reference sample was obtained for the biphilic samples. In order to elucidate their unique condensation behavior, in situ optical imaging was performed at normal incidence. It shows that the drainage of droplets from the stripe's surface into the microgrooves as well as occasional droplet sliding events are the dominant processes to clear the surface. To rationalize this behavior, the Hough Circle Transform algorithm was implemented for image processing to receive additional information about the transient droplet size and number distribution. Postprocessing of these data allows calculation of the transient water load on the stripe's surface, which shows an oscillatory behavior not previously reported in the literature.

Barriers and facilitators of meaningful patient participation at the collective level in healthcare organizations: A systematic review.

INTRODUCTION: Collective patient participation, such as patient participation in policy making, has become increasingly important to achieve high-quality care. However, there is little knowledge on how to let patients participate in a meaningful manner at this level. The aim of this systematic literature review was to provide an overview of barriers, facilitators, and associated impact of collective patient participation. METHODS: PubMed and EMBASE were searched until May 2023 for studies that evaluated collective patient participation. Study characteristics, methods for patient participation, barriers and facilitators, and impact (if measured) of patient participation were extracted from the articles. RESULTS: We included 59 articles. Identified barriers and facilitators of collective patient participation were grouped into five categories: (1) preconditions for patient participation, (2) strategy for patient participation, (3) preparation of patients and staff for patient participation, (4) support for patients and staff during patient participation, and (5) evaluation of patient participation. Impact of patient participation was reported in 34 included studies at three levels: quality of care and research, the team and organization, and the participants themselves. Only three studies reported quantitative outcomes. CONCLUSION: Interestingly, similar challenges were experienced during a period of twenty years, indicating that little progress has been made in structuring patient participation. Our overview of barriers and facilitators will therefore help to improve and structure collective patient participation.

Development of a standard set of PROs and generic PROMs for Dutch medical specialist care : Recommendations from the Outcome-Based Healthcare Program Working Group Generic PROMs.

PURPOSE: The added value of measuring patient-reported outcomes (PROs) for delivering patient-centered care and assessment of healthcare quality is increasingly evident. However, healthcare system wide data collection initiatives are hampered by the proliferation of patient-reported outcome measures (PROMs) and conflicting data collection standards. As part of a national initiative of the Dutch Ministry of Health, Welfare and Sport we developed a consensus-based standard set of generic PROs and PROMs to be implemented across Dutch medical specialist care. METHODS: A working group of mandated representatives of umbrella organizations involved in Dutch medical specialist care, together with PROM experts and patient organizations worked through a structured, consensus-driven co-creation process. This included literature reviews, online expert and working group meetings, and feedback from national patient- and umbrella organizations. The 'PROM-cycle' methodology was used to select feasible, valid, and reliable PROMs to obtain domain scores for each of the PROs included in the set. RESULTS: Eight PROs across different domains of health were ultimately endorsed: symptoms (pain & fatigue), functioning (physical, social/participation, mental [anxiety & depression]), and overarching (quality of life & perceived overall health). A limited number of generic PROMs was endorsed. PROMIS short forms were selected as the preferred instruments for all PROs. Several recommendations were formulated to facilitate healthcare system level adoption and implementation of the standard set. CONCLUSIONS: We developed a consensus-based standard set of Generic PROMs and a set of recommendations to facilitate healthcare system wide implementation across Dutch medical specialist care.

Development of an online patient decision aid for kidney failure treatment modality decisions.

BACKGROUND: Patient decision aids (PtDAs) support patients and clinicians in shared decision-making (SDM). Real-world outcome information may improve patients' risk perception, and help patients make decisions congruent with their expectations and values. Our aim was to develop an online PtDA to support kidney failure treatment modality decision-making, that: 1) provides patients with real-world outcome information, and 2) facilitates SDM in clinical practice. METHODS: The International Patient Decision Aids Standards (IPDAS) development process model was complemented with a user-centred and convergent mixed-methods approach. Rapid prototyping was used to develop the PtDA with a multidisciplinary steering group in an iterative process of co-creation. The results of an exploratory evidence review and a needs-assessment among patients, caregivers, and clinicians were used to develop the PtDA. Seven Dutch teaching hospitals and two national Dutch outcome registries provided real-world data on selected outcomes for all kidney failure treatment modalities. Alpha and beta testing were performed to assess the prototype and finalise development. An implementation strategy was developed to guide implementation of the PtDA in clinical practice. RESULTS: The 'Kidney Failure Decision Aid' consists of three components designed to help patients and clinicians engage in SDM: 1) a paper hand-out sheet, 2) an interactive website, and 3) a personal summary sheet. A 'patients-like-me' infographic was developed to visualise survival probabilities for each treatment modality on the website. Other treatment outcomes were incorporated as event rates (e.g. hospitalisation rates) or explained in text (e.g. the flexibility of each treatment modality). No major revisions were needed after alpha and beta testing. During beta testing, some patients ignored the survival probabilities because they considered these too confronting. Nonetheless, patients agreed that every patient has the right to choose whether they want to view this information. Patients and clinicians believed that the PtDA would help patients make informed decisions, and that it would support values- and preferences-based decision-making. Implementation of the PtDA has started in October 2020. CONCLUSIONS: The 'Kidney Failure Decision Aid' was designed to facilitate SDM in clinical practice and contains real-world outcome information on all kidney failure treatment modalities. It is currently being investigated for its effects on SDM in a clinical trial.

Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms-results from the RENINE/PROMs registry.

BACKGROUND: Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. METHODS: Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018 and 2020. Itching, sleep problems and psychological symptoms were assessed with the Dialysis Symptom Index (DSI) and HRQOL with the 12-item Short Form Health Survey. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally using linear regression and linear mixed models. RESULTS: Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL {-3.35 [95% confidence interval (CI) -4.12 to -2.59) and -3.79 [95% CI -4.56 to -3.03]}. HRQOL remained stable during 2 years and trajectories did not differ between patients with or without itching. Sleep problems (70% versus 52%) and psychological symptoms (36% versus 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL but did not interact with itching. CONCLUSIONS: The persistence of itching, its impact on HRQOL over time and the additional effect on HRQOL of sleep problems and psychological symptoms emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.

Routinely measuring symptom burden and health-related quality of life in dialysis patients: first results from the Dutch registry of patient-reported outcome measures.

BACKGROUND: The use of patient-reported outcome measures (PROMs) is becoming increasingly important in healthcare. However, incorporation of PROMs into routine nephrological care is challenging. This study describes the first experience with PROMs in Dutch routine dialysis care. METHODS: A pilot study was conducted in dialysis patients in 16 centres. Patients were invited to complete PROMs at baseline and 3 and 6 months. PROMs consisted of the 12-item short-form and Dialysis Symptom Index to assess health-related quality of life (HRQoL) and symptom burden. Response rates, HRQoL and symptom burden scores were analysed. Qualitative research methods were used to gain insight into patients' views on using PROMs in clinical practice. RESULTS: In total, 512 patients (36%) completed 908 PROMs (24%) across three time points. Response rates varied from 6 to 70% among centres. Mean scores for physical and mental HRQoL were 35.6 [standard deviation (SD) 10.2] and 47.7 (SD 10.6), respectively. Patients experienced on average 10.8 (SD 6.1) symptoms with a symptom burden score of 30.7 (SD 22.0). Only 1-3% of the variation in PROM scores can be explained by differences between centres. Patients perceived discussing their HRQoL and symptom scores as insightful and valuable. Individual feedback on results was considered crucial. CONCLUSIONS: The first results show low average response rates with high variability among centres. Dialysis patients experienced a high symptom burden and poor HRQoL. Using PROMs at the individual patient level is suitable and may improve patient-professional communication and shared decision making. Further research is needed to investigate how the collection and the use of PROMs can be successfully integrated into routine care to improve healthcare quality and outcomes.

Characterization of an Isostructural MOF Series of Imidazolate Frameworks Potsdam by Means of Sorption Experiments with Water Vapor.

Sorption measurements of water vapor on an isoreticular series of Imidazolate Frameworks Potsdam (IFP), based on penta-coordinated metal centers with secondary building units (SBUs) connected by multidentate amido-imidate-imidazolate linkers, have been carried out at 303.15 K. The isotherm shapes were analyzed in order to gain insight into material properties and compared to sorption experiments with nitrogen at 77.4 K and carbon dioxide at 273.15 K. Results show that water vapor sorption measurements are strongly influenced by the pore size distribution while having a distinct hysteresis loop between the adsorption and desorption branch in common. Thus, IFP-4 and -8, which solely contain micropores, exhibit H4 (type I) isotherm shapes, while those of IFP-1, -2 and -5, which also contain mesopores, are of H3 (type IV) shape with three inflection points. The choice of the used linker substituents and transition metals employed in the framework has a tremendous effect on the material properties and functionality. The water uptake capacities of the examined IFPs are ranging 0.48 mmol g-1 (IFP-4) to 6.99 mmol g-1 (IFP-5) and comparable to those documented for ZIFs. The water vapor stability of IFPs is high, with the exception of IFP-8.

Thermally Conductive Polyethylene/Expanded Graphite Composites as Heat Transfer Surface: Mechanical, Thermo-Physical and Surface Behavior.

Composites of high-density polyethylene (HDPE) and expanded graphite (EG) are prepared for heat exchangers in multi-effect distillation (MED) desalination. At 50 wt.% EG loading, the thermal conductivity of HDPE was increased by 372%. Moreover, the surface wettability of the HDPE/EG composite was enhanced by corona and RF plasma treatment as demonstrated by the increase in surface free energy from 28.5 mJ/m2 for untreated HDPE/EG to 55.5 and 54.5 mJ/m2 for HDPE/EG treated by corona and RF plasma, respectively. This enhanced surface wettability was retained over a long time with only a 9% and 18% decrease in RF and corona plasma-treated samples' surface energy after two months. The viscoelastic moduli and the complex viscosity profiles indicated that EG content dictates the optimum processing technique. At loading below 30 wt.%, the extrusion process is preferred, while above 30 wt.% loading, injection molding is preferred. The plasma treatment also improved the HDPE/EG composite overall heat transfer coefficient with an overall heat transfer coefficient of the composite reaching about 98% that of stainless steel. Moreover, the plasma-treated composite exhibited superior resistance to crystallization fouling in both CaSO4 solution and artificial seawater compared to untreated composites and stainless-steel surfaces.

Patient-reported outcome measures: selection of a valid questionnaire for routine symptom assessment in patients with advanced chronic kidney disease - a four-phase mixed methods study.

BACKGROUND: Patient-reported outcome measures (PROMs) are becoming increasingly important in healthcare. In nephrology, there is no agreement on which chronic kidney disease (CKD) symptom questionnaire to use. Therefore, the aim of this study is to select a valid symptom questionnaire for routine assessment in patients with advanced CKD. METHODS: A four-phase mixed methods approach, using qualitative and quantitative research methods, was applied. First, a systematic literature search was conducted to retrieve existing symptom questionnaires. Second, a symptom list was created including all symptoms in existing questionnaires and symptoms mentioned in interviews with patients with CKD, from which symptom clusters were identified. Next, questionnaires were selected based on predefined criteria regarding content validity. Last, two online feedback panels of patients with CKD (n = 151) and experts (n = 6) reviewed the most promising questionnaires. RESULTS: The literature search identified 121 questionnaires, of which 28 were potentially suitable for symptom assessment in patients with advanced CKD. 101 unique symptoms and 10 symptom clusters were distinguished. Based on predefined criteria, the Dialysis Symptom Index (DSI) and Palliative Care Outcome Scale-Renal Version (IPOS-Renal) were selected and reviewed by feedback panels. Patients needed 5.4 and 7.5 min to complete the DSI and IPOS-Renal, respectively (p < 0.001). Patients experienced the DSI as more specific, complete and straightforward compared to the IPOS-Renal. CONCLUSIONS: The DSI was found to be valid and reliable, the most relevant, complete, and comprehensible symptom questionnaire available for routine assessment in patients with advanced CKD. Routine PROMs collection could be of great value to healthcare, both at individual patient and national level. Feedback on scores and involvement of healthcare providers may promote adaptation and implementation in healthcare.

A metal-organic framework for efficient water-based ultra-low-temperature-driven cooling.

Efficient use of energy for cooling applications is a very important and challenging field in science. Ultra-low temperature actuated (Tdriving < 80 °C) adsorption-driven chillers (ADCs) with water as the cooling agent are one environmentally benign option. The nanoscale metal-organic framework [Al(OH)(C6H2O4S)] denoted CAU-23 was discovered that possess favorable properties, including water adsorption capacity of 0.37 gH2O/gsorbent around p/p0 = 0.3 and cycling stability of at least 5000 cycles. Most importantly the material has a driving temperature down to 60 °C, which allows for the exploitation of yet mostly unused temperature sources and a more efficient use of energy. These exceptional properties are due to its unique crystal structure, which was unequivocally elucidated by single crystal electron diffraction. Monte Carlo simulations were performed to reveal the water adsorption mechanism at the atomic level. With its green synthesis, CAU-23 is an ideal material to realize ultra-low temperature driven ADC devices.

Exploiting Direct Laser Writing for Hydrogel Integration into Fragile Microelectromechanical Systems.

The integration of chemo-responsive hydrogels into fragile microelectromechanical systems (MEMS) with reflective surfaces in the micron to submicron range is presented. Direct laser writing (DLW) for 3D microstructuring of chemoresponsive "smart" hydrogels on sensitive microstructures is demonstrated and discussed in detail, by production of thin hydrogel layers and discs with a controllable lateral size of 2 to 5 µm and a thickness of some hundred nm. Screening results of polymerizing laser settings for precision microstructuring were determined by controlling crosslinking and limiting active chain diffusion during polymerization with macromers. Macromers are linear polymers with a tunable amount of multifunctional crosslinker moieties, giving access to a broad range of different responsive hydrogels. To demonstrate integration into fragile MEMS, the gel was deposited by DLW onto a resonator with a 200 nm thick sensing plate with high precision. To demonstrate the applicability for sensors, proof of concept measurements were performed. The polymer composition was optimized to produce thin reproducible layers and the feasibility of 3D structures with the same approach is demonstrated.

Is dropwise condensation feasible? A review on surface modifications for continuous dropwise condensation and a profitability analysis.

The interest in surface treatments promoting dropwise condensation has grown exponentially in the past decades. Savings in the operating and maintenance costs of steam processes involving phase changes are promised. Numerous surface preparation methods allow the formation of droplets during condensation. However, stable dropwise condensation has been hardly realized in industrial applications. This review aims to highlight the surface preparation techniques that promote dropwise condensation. It emphasizes on their durability and the resulting stability of dropwise condensation. Furthermore, the possibilities of implementation at an industrial level are discussed, apart from evaluating the economic feasibility through a case study. Despite years of research and numerous surface design possibilities, dropwise condensation cannot be maintained: coating deterioration and fluctuating process conditions commonly lead to surface flooding within hours or weeks. A more profound understanding of the mechanisms of dropwise condensation and innovative design concepts for self-renewing heat transfer surfaces may diminish encountered challenges.

Development of an International Standard Set of Value-Based Outcome Measures for Patients With Chronic Kidney Disease: A Report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD Working Group.

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use. The considered outcomes and patient-reported outcome measures were generated from systematic literature reviews. Feedback was sought from patients and health professionals. Patients with very high-risk CKD (stages G3a/A3 and G3b/A2-G5, including dialysis, kidney transplantation, and conservative care) were selected as the target population. Using an online modified Delphi process, outcomes important to all patients were selected, such as survival and hospitalization, and to treatment-specific subgroups, such as vascular access survival and kidney allograft survival. Patient-reported outcome measures were included to capture domains of health-related quality of life, which were rated as the most important outcomes by patients. Demographic and clinical variables were identified to be used as case-mix adjusters. Use of these consensus recommendations could enable institutions to monitor, compare, and improve the quality of their CKD care.

Electroosmotic flow and Joule heating in preparative continuous annular electrochromatography.

An openFOAM "computational fluid dynamic" simulation model was developed for the description of local interaction of hydrodynamics and Joule heating in annular electrochromatography. A local decline of electrical conductivity of the background eluent is caused by an electrokinetic migration of ions resulting in higher Joule heat generation. The model equations consider the Navier-Stokes equation for incompressible fluids, the energy equation for stationary temperature fields, and the mass transfer equation for the electrokinetic flow. The simulations were embedded in commercial ANSYS Fluent software and in open-source environment openFOAM. The annular gap (1 mm width) contained an inorganic C8 reverse-phase monolith as stationary phase prepared by an in situ sol-gel process. The process temperature generated by Joule heating was determined by thermal camera system. The local hydrodynamics in the prototype was detected by a gravimetric contact-free measurement method and experimental and simulated values matched quite well.

Exploring the relationships between patient characteristics and their dialysis care experience.

BACKGROUND: Previous studies have shown that it is possible for patient experience to be influenced by factors that are not attributable to health-care. Therefore, if patient experience is to be used as an accurate indicator of clinical performance, then it is important to understand its determinants. METHODS: We used data from 840 dialysis patients who completed a validated patient experience survey. We created a potential theoretical framework based on available clinical knowledge to hypothesize the relationships between 13 demographic, socio-economic and health status factors and three outcome measures: global rating of the dialysis centre and the patient experience with the nephrologist's and nurses' care. The theoretical framework guided the selection of confounding variables for each determinant, which were then entered as terms in multivariable linear regression models. RESULTS: Patients who were of older age, of non-European decent, and who had a lower educational level, lower albumin level, with better self-rated health and who were without co-morbidities reported higher global ratings with the dialysis centre than their counterparts. Past myocardial infarction and better self-rated health were found to be determinants of a more positive experience while in the nephrologist's care. A more positive experience with nurses' care was associated with factors including older age, Dutch origin background, lower educational level, lower albumin levels and better self-rated health. CONCLUSIONS: Several characteristics of dialysis patients influence the way they rate and experience their care. When using the patient experience and ratings as indicators of clinical performance, they should be adjusted for such factors as identified in our study. This will facilitate a meaningful comparison of dialysis centres, and enable informed decision making by patients, insurers and policy makers.

Non-ionic surfactant modified ligand exchange chromatography using copper (II) complex of N,N-dimethyl-L-phenylalanine as the chiral additive for enantioselective amino acids separation.

The influence of non-ionic surfactants on the selectivity and retention in the ligand exchange chromatography for the enantioselective separation of racemic mixtures of the amino acids dl-methionine, dl-leucine, dl-valine and dl-tyrosine applying chiral mobile phases was investigated, whereas five different surfactants were tested as modifiers. The experiments were carried out using a commercially available non-chiral RP-C8 column and the copper (II) complex of N,N-dimethyl-l-phenylalanine as the chiral additive. Varying the surfactant concentrations the retention factors and the selectivity could be controlled and in general no negative influence on the separation (due to surfactant adsorption on the non-chiral stationary phase) occurred. Changing the temperature the van't Hoff plots were obtained and the thermodynamic parameters calculated. Temperature had influence on the selectivity for each surfactant and lowered the retention times as expected.

Construction of health preferences: a comparison of direct value assessment and personal narratives.

BACKGROUND: Most terminally ill patients prefer to die at home rather than at an institution. However, patients are often insufficiently aware of the downsides of staying at home, which signals a need for effective decision aids. OBJECTIVES: The main purpose of the present study was to compare indirect methods of value elicitation (personal narratives["stories"] in text or video) with a direct method (assessment of the subjective importance of each attribute). METHODS: The authors asked 183 participants to evaluate 3 possible places to die: home, hospice, and nursing home. The participants received 1 of 3 value elicitation methods. The main dependent variable was participants' evaluations of the choice options before and after value elicitation, measured on a 100-point scale. RESULTS: A shift occurred between pre- and posttest, F(4, 342) = 4.11, P = 0.003, only with the indirect methods. When text and videos were used, participants became more positive about a hospice (text: 41.9 to 49.1; video: 52.9 to 60.3). In the video condition, participants also became more positive about a nursing home (from 20.9 to 24.9). CONCLUSION: Stories have more impact in shaping people's preferences than merely asking for an assessment of attribute importance. The most straightforward explanation for this effect is that stories, particularly when presented in video, provide a better image of potential consequences.

Phosphate removal from wastewater by model-La(III) zeolite adsorbents.

Phosphorus is one of the primary nutrients which leads to eutrophication and accelerates aging process in enclosed water bodies. Because of the poor phosphorus selectivity of other adsorbents, the novel La(III)-modified zeolite adsorbent (LZA) was prepared by modifying 90 nm zeolite with lanthanide to selectively remove phosphate in the presence of various omnipresent anions, such as sulfates, bicarbonates, and chlorides. Through batch and fixed bed operation, the following optimum conditions were obtained: concentration of lanthanum chloride solution 0.05 mol/L; solid/liquor ratio 1/25; pH 10; calcination temperature 550 degree C time 1 h. The value of the Freundlich model constants Kf and 1/n were found to be 16.76 mg/L and 0.2209, respectively. In addition, when calculated at pH 6.0, distribution coefficient K(D) could be as high as 36.6. Furthermore, in the alkaline pH range, solution of 0.8 mol/L NaCl was used to regenerate the saturated LZA, which could reach the high regeneration efficiency as high as 100%. Because of the good selectivity and regenerability of LZA, it might serve as a potential way for advanced phosphate removal from the sewage containing other anions.