New Options for Iron Supplementation in Maintenance Hemodialysis Patients.

End-stage renal disease results in anemia caused by shortened erythrocyte survival, erythropoietin deficiency, hepcidin-mediated impairment of intestinal absorption and iron release, recurrent blood loss, and impaired responsiveness to erythropoiesis-stimulating agents (ESAs). Iron malabsorption renders oral iron products generally ineffective, and intravenous (IV) iron supplementation is required in most patients receiving maintenance hemodialysis (HD). IV iron is administered at doses far exceeding normal intestinal iron absorption. Moreover, by bypassing physiologic safeguards, indiscriminate use of IV iron overwhelms transferrin, imposing stress on the reticuloendothelial system that can have long-term adverse consequences. Unlike conventional oral iron preparations, ferric citrate has recently been shown to be effective in increasing serum ferritin, hemoglobin, and transferrin saturation values while significantly reducing IV iron and ESA requirements in patients treated with HD. Ferric pyrophosphate citrate is a novel iron salt delivered by dialysate; by directly reaching transferrin, its obviates the need for storing administered iron and increases transferrin saturation without increasing serum ferritin levels. Ferric pyrophosphate citrate trials have demonstrated effective iron delivery and stable hemoglobin levels with significant reductions in ESA and IV iron requirements. To date, the long-term safety of using these routes of iron administration in patients receiving HD has not been compared to IV iron and therefore awaits future investigations.

In-situ advanced oxidation of sediment iron for sulfide control in sewers.

Sulfide control is a significant problem in urban sewer management. Although in-sewer dosing of chemicals has been widely applied, it is prone to high chemical consumption and cost. A new approach is proposed in this study for effective sulfide control in sewers. It involves advanced oxidation of ferrous sulfide (FeS) in sewer sediment, to produce hydroxyl radical (·OH) in-situ, leading to simultaneous sulfide oxidation and reduction of microbial sulfate-reducing activity. Long-term operation of three laboratory sewer sediment reactors was used to test the effectiveness of sulfide control. The experimental reactor with the proposed in-situ advanced FeS oxidation substantially reduced sulfide concentration to 3.1 ± 1.8 mg S/L. This compares to 9.2 ± 2.7 mg S/L in a control reactor with sole oxygen supply, and 14.1 ± 4.2 mg S/L in the other control reactor without either iron or oxygen. Mechanistic investigations illustrated the critical role of ·OH, produced from the oxidation of sediment iron, in regulating microbial communities and the chemical sulfide oxidation reaction. Together these results demonstrate that incorporating the advanced FeS oxidation process in sewer sediment enable superior performance of sulfide control at a much lower iron dosage, thereby largely saving chemical use.

Electrochemical iron production to enhance anaerobic membrane treatment of wastewater.

Although iron salts such as iron(III) chloride (FeCl3) have widespread application in wastewater treatment, safety concerns limit their use, due to the corrosive nature of concentrated solutions. This study demonstrates that local, electrochemical generation of iron is a viable alternative to the use of iron salts. Three laboratory systems with anaerobic membrane processes were set up to treat real wastewater; two systems used the production of either in-situ or ex-situ electrochemical iron (as Fe2+ and Fe2+(Fe3+)2O4, respectively), while the other system served as a control. These systems were operated for over one year to assess the impact of electrochemically produced iron on system performance. The results showed that dosing of electrochemical iron significantly reduced sulfide concentration in effluent and hydrogen sulfide content in biogas, and mitigated organics-based membrane fouling, all of which are critical issues inherently related to sustainability of anaerobic wastewater treatment. The electrochemical iron strategy can generate multiple benefits for wastewater management including increased removal efficiencies for total and volatile suspended solids, chemical oxygen demand and phosphorus. The rate of methane production also increased with electrochemically produced iron. Economic analysis revealed the viability of electrochemical iron with total cost reduced by one quarter to a third compared with using FeCl3. These benefits indicate that electrochemical iron dosing can greatly enhance the overall operation and performance of anaerobic membrane processes, and this particularly facilitates wastewater management in a decentralized scenario.

Effects of iron dosing used for phosphorus removal at wastewater treatment works; impacts on forms of phosphorus discharged and secondary effects on concentrations and fate of other contaminants.

Iron dosing for phosphorus reduction during wastewater treatment is wide practised across the globe. However, the impacts of this dosing in terms of the speciation of phosphorus discharged and secondary effects on removing or introducing other trace elements from or into the effluent have not been studied. Results are presented for concentrations of a range of contaminants in over 600 wastewater treatment works, reported as mean concentration values derived from 20 effluent samples taken over a period of two years. Approximately half of the treatment works employed iron dosing to reduce concentrations of phosphorus in effluents. In addition to the expected effects on level of phosphorus discharged to surface waters, it is shown that these measures are shown to have unintended and beneficial consequences for concentrations of several other constituents of wastewater. Reductions of more than 40% in the concentrations of dissolved metals (copper, lead) benzo(a)pyrene and hexabromocyclododecane are observed. Lower but still significant decreases in concentration (>30%) are evident for dissolved cadmium, fluoranthene cypermethrin and biochemical oxygen demand. Small but less environmentally important increases are seen for iron and nickel, in the case of the latter this is presumably because nickel is a contaminant of the iron reagent used for dosing. These reductions are shown to offer significant benefits in terms of levels entering surface waters relating to the in-river environmental quality standards.

Centralized iron-dosing into returned sludge brings multifaceted benefits to wastewater management.

Iron salts (i.e. FeCl3) are the most used chemicals in the urban wastewater system. Iron is commonly dosed into sewage or the mainstream system, which provides multiple benefits such as enhanced phosphorus removal and improved sludge settleability/dewaterability. This study reported and demonstrated a new approach that dosed FeCl3 into returned sludge in order to bring two more benefits to wastewater management: short-cut nitrogen removal via the nitrite pathway and less biomass production. This approach is achieved based on our findings that with similar amount of FeCl3, centralized iron dosing into a sidestream sludge unit generated iron concentration two orders of magnitude higher than the common mainstream dosing (e.g. 10-40 mg Fe/L-wastewater), leading to sludge acidification (pH = 2.1) with Fe (III) hydrolysis. Together with accumulated nitrite in the supernatant of the sludge, ppm-level of free nitrous acid was generated and thus enabled sludge disintegration, cell lysis, and selective elimination of nitrite-oxidizing bacteria (NOB). Long-term effects on nitrifying bacteria and overall reactor performance were evaluated using two laboratory reactor experiments for over one year. The experimental reactor showed stable nitrite accumulation with an average NO2-/(NO2- + NO3-) ratio above 80% and ∼30% observed biomass yield reduction compared to those in control reactors. In addition, the centralized sludge dosing strategy still provided benefits such as improved settleability and dewaterability of sludge and enhanced phosphorus removal.

An integrated strategy to enhance performance of anaerobic digestion of waste activated sludge.

Anaerobic digestion (AD) is an essential process in wastewater treatment plants as it can reduce the amount of waste activated sludge (WAS) for disposal, and also enables the recovery of bioenergy (i.e. methane). Here, a new pretreatment method to enhance anaerobic digestion was achieved by treating thickened WAS (TWAS) with ferric (as FeCl3) and nitrite simultaneously for 24-hour at room temperature. Biochemical methane potential tests showed markedly improved degradability in the pretreated TWAS, with a relative increase in hydrolysis rate by 30%. A comparative experiment with the operation of two continuous-flow anaerobic digesters further demonstrated the improvement in biogas quantity and quality, digestate disposal, and phosphorus recovery in the experimental digester. The dosed FeCl3 (i.e. ~6 mM) decreased the pH of TWAS to ~5, which led to the formation of free nitrous acid (FNA, HNO2) at parts per million levels (i.e. ~6 mg N/L), after dosing nitrite at 250 mg NO2--N/L. This FNA treatment caused a 26% increase in methane yield and volatile solids destruction, 55% reduction in the viscosity of sludge in digester, and 24% less polymer required in further digestate dewatering. In addition, the dosed Fe(III) was reduced to Fe(II) which precipitated sulfide and phosphorus, leading to decreased hydrogen sulfide concentration in biogas, and increased percentage of vivianite in the total crystalline iron species in digested sludge. Our study experimentally demonstrated that combined dosing of FeCl3 and nitrite is a useful pretreatment strategy for improving anaerobic digestion of WAS.

A tube-in-tube membrane microreactor for tertiary treatment of urban wastewaters by photo-Fenton at neutral pH: A proof of concept.

This work presents a disruptive approach to promote highly-efficient photo-Fenton process at neutral pH under continuous mode operation. The system consists of a tube-in-tube membrane reactor designed for continuous-flow titration of low iron doses to the annular reaction zone (ARZ). A concentrated acidic ferrous ion (Fe2+) solution is fed by the lumen-side of the membrane, permeating through the membrane pores (inside-out mode), being dosed and uniformly delivered to the membrane shell-side. Polluted water, containing amoxicillin (AMX) and oxidant (H2O2), flows continuously in the reactor annulus (space between the membrane shell-side and an outer quartz tube). The catalyst radial dispersion is enhanced by the helicoidal movement of water around the membrane shell-side, efficiently promoting its contact with H2O2 and UV light. The efficiency of photochemical and photocatalytic oxidation was evaluated as a function of catalyst dose, catalyst injection mode (radial permeation vs injection upstream from the reactor inlet), light source (UVA vs UVC) and aqueous solution matrix (synthetic vs real wastewater). At steady-state, photo-Fenton reaction with Fe2+ radial addition, driven by UVC light, showed the highest AMX removal for synthetic (∼65%, removal rate of 44 µMAMX/min, using [Fe2+]ARZ = 2 mg/L and [H2O2]inlet = 10 mg/L) and real municipal wastewaters (∼45%, removal rate of 31 µMAMX/min, with [Fe2+]ARZ = 5 mg/L and [H2O2]inlet = 40 mg/L), with a residence time of only 4.6 s.

A recurrent neural network approach to predicting hemoglobin trajectories in patients with End-Stage Renal Disease.

The most severe form of kidney disease, End-Stage Renal Disease (ESRD) is treated with various forms of dialysis - artificial blood cleansing. Dialysis patients suffer many health burdens including high mortality and hospitalization rates, and symptomatic anemia: a low red blood cell count as indicated by a low hemoglobin (Hgb) level. ESRD-induced anemia is treated, with variable patient response, by erythropoiesis stimulating agents (ESAs): expensive injectable medications typically administered during dialysis sessions. The dosing protocol is typically a population level protocol based on original clinical trials, the use of which often results in Hgb cycling. This cycling phenomenon occurs primarily due to the mismatch in the time between dosing decisions and the time it takes for the effects of a dosing change to be fully realized. In this paper we develop a recurrent neural network approach that uses historic data together with future ESA and iron dosing data to predict the 1, 2, and 3 month Hgb levels of patients with ESRD-induced anemia. The results of extensive experimentation indicate that this approach generates predictions that are clinically relevant: the mean absolute error of the predictions is comparable to estimates of the intra-individual variability of the laboratory test for Hgb.

Formation, reactivity and aging of amorphous ferric oxides in the presence of model and membrane bioreactor derived organics.

Iron salts are routinely dosed in wastewater treatment as a means of achieving effluent phosphorous concentration goals. The iron oxides that result from addition of iron salts partake in various reactions, including reductive dissolution and phosphate adsorption. The reactivity of these oxides is controlled by the conditions of formation and the processes, such as aggregation, that lead to a reduction in accessible surface sites following formation. The presence of organic compounds is expected to significantly impact these processes in a number of ways. In this study, amorphous ferric oxide (AFO) reactivity and aging was investigated following the addition of ferric iron (Fe(III)) to three solution systems: two synthetic buffered systems, either containing no organic or containing alginate, and a supernatant system containing soluble microbial products (SMPs) sourced from a membrane bioreactor (MBR). Reactivity of the Fe(III) phases in these systems at various times (1-60 min) following Fe(III) addition was quantified by determining the rate constants for ascorbate-mediated reductive dissolution over short (5 min) and long (60 min) dissolution periods and for a range (0.5-10 mM) of ascorbate concentrations. AFO particle size was monitored using dynamic light scattering during the aging and dissolution periods. In the presence of alginate, AFO particles appeared to be stabilized against aggregation. However, aging in the alginate system was remarkably similar to the inorganic system where aging is associated with aggregation. An aging mechanism involving restructuring within the alginate-AFO assemblage was proposed. In the presence of SMPs, a greater diversity of Fe(III) phases was evident with both a small labile pool of organically complexed Fe(III) and a polydisperse population of stabilized AFO particles present. The prevalence of low molecular weight organic molecules facilitated stabilization of the Fe(III) oxyhydroxides formed but subsequent aging observed in the alginate system did not occur. The reactivity of the Fe(III) in the supernatant system was maintained with little loss in reactivity over at least 24 h. The capacity of SMPs to maintain high reactivity of AFO has important implications in a reactor where Fe(III) phases encounter alternating redox conditions due to sludge recirculation, creating a cycle of reductive dissolution, oxidation and precipitation.