Nitrogen and phosphorus recovery from hemodialysis wastewater to use as an agricultural fertilizer.

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.

Towards zero liquid discharge in hemodialysis. Possible issues / Hacia el vertido cero de líquidos en hemodiálisis. Posibles problemas

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)

Towards zero liquid discharge in hemodialysis. Possible issues.

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.

Towards zero liquid discharge in hemodialysis. Possible issues.

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.

The effects of water shortages on health and human development.

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.

Water conservation: an emerging but vital issue in hemodialysis therapy.

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.

Current understanding of ozone use for disinfecting hemodialysis water treatment systems.

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.

Severe jaw enlargement associated with uremic hyperparathyroidism.

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.

Recycling wastewater after hemodialysis: an environmental analysis for alternative water sources in arid regions.

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.

End-stage renal disease following carboplatin chemotherapy for a nasopharyngeal carcinoma.

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.

Optimizing hypertension control in hemodialysis patients: a proposed management strategy.

OBJECTIVE: The purpose of the study was to assess the efficiency of a goal-oriented therapeutic strategy in lowering blood pressure and reducing the need for antihypertensive medications in 168 patients undergoing long-term hemodialysis. METHODS: Patients were managed initially by achieving optimal dry weight. After reduction of the dry weight, patients with uncontrolled arterial hypertension were dialyzed using a 1.25 mmol/L calcium concentration buffer. RESULTS: The predialysis mean arterial blood pressure (PDBP) was 127.4/74.2 mmHg for the total population. Fifty (29.76%) of the total study population were hypertensive. Of them, 88% (44 patients) were receiving antihypertensive drugs, while the others were not on such medications. Twenty patients (40% of the hypertensives) were receiving one antihypertensive drug, 17 (34%) were receiving two antihypertensive drugs, while 7 patients (14%) were receiving three or more drugs. There was a significant increase in the number of patients with good control of PDBP in the second data collection [45 patients (90%)] compared to the first data collection of 40 patients (80%). Similarly, there was a significant reduction in the number of patients with uncontrolled PDBP in the second data collection (5 patients (10%) compared to the first data collection of 10 patients (20%). The average blood pressure in the first data collection was 137.2/76.3 and 167.4/87.1 mmHg in the controlled and uncontrolled blood pressure groups respectively. In the second data collection, the average blood pressure was 136.4/75.1 and 161.6/86.3 mmHg in the controlled and uncontrolled groups respectively. CONCLUSION: Therapeutic approach using combination of dry weight reduction and dialysis with low calcium dialysate provides acceptable long-term results in patients with arterial hypertension and reduces the need for antihypertensive medication.