Potential environmental toxicity from hemodialysis effluent

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.

Water implications in dialysis therapy, threats and opportunities to reduce water consumption: a call for the planet

Water 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. We propose that circular water management may comply with the "3R" concept: reduce (reduce dialysis need, reduce dialysate flow, and optimize reverse osmosis performance), reuse (reuse wastewater as potable water), and recycle (dialysis effluents for agriculture and aquaponic use). Awareness and sustainability should be integrated to create positive behaviors. Effective communication is crucial for water savings because local perspectives may lead to global opportunities. Besides the positive environmental impacts, planet-friendly alternatives may have significant financial returns. Innovative policies based on the transition from linear to circular water management may lead to a paradigm shift and establish a sustainable water management model. This review seeks to support policymakers in making informed decisions about water use, avoiding wasting, and finding solutions that may be planet friendly and patient friendly in dialysis, especially in hemodialysis treatments.

Application of Sequential Combination of Electro-Coagulation/Electro-Oxidation and Adsorption for the Treatment of Hemodialysis Wastewater for Possible Reuse

Reusing hemodialysis wastewater (HWW) is more difficult due to its higher conductivity (salinity) and the need for an iterative RO or adsorption process. It can therefore be challenging and technologically laborious. In this context, this study aimed to investigate the possibility of treating HWW by combining electro-coagulation (EC) and electro-oxidation (EO) processes and adsorption as the best technologies to achieve efficient removal of dissolved micropollutants. In this work, the application of electro-coagulation/electro-oxidation processes using, respectively, aluminum and platinum electrodes combined with adsorption onto active carbon to treat HWW was studied. In the EC process, high removal of phosphate ions and chemical oxygen demand (COD) was observed. In the EO process, the COD removal performance, total nitrogen, and Mg were significant and reached 100, 83, and 89%, respectively, after 100 min of treatment. The estimated energies required to treat HWW by EC and/or EO were approximately 0.7 kWh/m3 and 0.05 kWh/m3, respectively. While the EO and EC processes used for COD removal from HWW showed almost similar performances, the EO process seems to consume less energy. Therefore, electrochemical removal of HWW can be successfully performed using the EO process and activated carbon (AC) for the complete removal of COD and the mineralization of pharmaceutical residues. The experimental results showed that the coupling of the three processes (EC–EO–AC) provides treated water that can be reused in agriculture due to its less sodium absorption ratio (SAR) value and might be an alternative method of wastewater treatment responding to the concept of green dialysis.

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.

Toxicity Abatement of Wastewaters from Tourism Units by Constructed Wetlands

The present research intended to investigate the toxicity abatement of domestic wastewater after passing a biosystem composed of a constructed wetland (CW) followed by a pond. The wastewater was generated in a tourism house in a rural and mountainous context and passed through a septic tank before being diverted to a CW followed by a pond. A battery of ecotoxicological tests, comprising microalgae (Raphidocelis subcapitata), macrophytes (Lemna minor), cladocerans (Daphnia magna), and bacteria (Aliivibrio fischeri), was used to assess the toxicity of the wastewater collected before and after the CW and the water of the pond. Physicochemical parameters (pH, conductivity, chemical oxygen demand, biochemical oxygen demand, total suspended solids, phosphates, ammonium, and nitrate) were also determined. The CW was able to remove carbon and nutrients from the water with a concomitant reduction of its toxicity. This study, reinforced the added value of using toxicity tests as a complement to CW operational monitoring to validate the solution and to analyze possible readjustments that may be required to improve efficiency. This study lends further support to the claim that CWs can be a sustainable solution for treating small volumes of domestic wastewater in a rural context.

Eco-dialysis: the financial and ecological costs of dialysis waste products: is a 'cradle-to-cradle' model feasible for planet-friendly haemodialysis waste management?

BACKGROUND

Approximately 2 million chronic haemodialysis patients produce over 2,000,000 tons of waste per year that includes about 600,000 tons of potentially hazardous waste. The aim of the present study was to analyse the characteristics of the waste that is produced through chronic haemodialysis in an effort to identify strategies to reduce its environmental and financial impact.

METHODS

The study included three dialysis machines and disposables for bicarbonate dialysis, haemodiafiltration (HFR) and lactate dialysis. Hazardous waste is defined as waste that comes into contact with bodily fluids. The weight and cost of waste management was evaluated by various policies of differentiation, ranging from a careful-optimal differentiation to a careless one. The amount of time needed for optimal management was recorded in 30 dialysis sessions. Non-hazardous materials were assessed for potential recycling.

RESULTS

The amount of plastic waste that is produced per dialysis session ranges from 1.5 to 8 kg (from 1.1 to 8 kg of potentially hazardous waste), depending upon the type of dialysis machine and supplies, differentiation and emptying policies. The financial cost of waste disposal is high, and is mainly related to hazardous waste disposal, with costs ranging from 2.2 to 16 Euro per session (2.7-21 USD) depending on the waste management policy. The average amount of time needed for careful, optimal differentiation disposal is approximately 1 minute for a haemodialysis session and 2 minutes for HFR. The ecological cost is likewise high: less than one-third of non-hazardous waste (23-28%) is potentially recyclable, while the use of different types of plastic, glues, inks and labels prevents the remaining materials from being recycled.

CONCLUSION

Acknowledging the problem of waste management in dialysis could lead to savings of hundreds of millions of Dollars and to the reuse and recycling of hundreds of tons of plastic waste per year on a world-wide scale with considerable financial and ecological savings.

Comparative toxicity of physiological and biochemical parameters in Euglena gracilis to short-term exposure to potassium sorbate

Potassium sorbate is the potassium salt of sorbic acid, is a widespread and efficient antioxidant that has multiple functions in plants, traditionally associated with the reactions of photosynthesis; however, it has moderate toxicity to various species including rat, fish, bacteria and human health. The effects of potassium sorbate on the movement and photosynthetic parameters of Euglena gracilis were studied during short-term exposure. Potassium sorbate showed acute toxicity to the green flagellate E. gracilis affecting different physiological parameters used as endpoints in an automatic bioassay such as motility, precision of gravitational orientation (r-value), upward movement and alignment, with mean EC50 values of 2867.2 mg L(-1). The concentrations above 625 mg L(-1) of potassium sorbate induce an inhibition of the photosynthetic efficiency and electron transport rate and, in concentrations more than 2500.0 mg L(-1), the Euglena cells undergo a complete inhibition of photosynthesis even at low light irradiation.

Green dialysis: the environmental challenges ahead

The US Environmental Protection Agency Resource Conservation website begins: "Natural resource and energy conservation is achieved by managing materials more efficiently--reduce, reuse, recycle," yet healthcare agencies have been slow to heed and practice this simple message. In dialysis practice, notable for a recurrent, per capita resource consumption and waste generation profile second to none in healthcare, efforts to: (1) minimize water use and wastage; (2) consider strategies to reduce power consumption and/or use alternative power options; (3) develop optimal waste management and reusable material recycling programs; (4) design smart buildings that work with and for their environment; (5) establish research programs that explore environmental practice; all have been largely ignored by mainstream nephrology. Some countries are doing far better than others. In the United Kingdom and some European jurisdictions, exceptional recent progress has been made to develop, adopt, and coordinate eco-practice within dialysis programs. These programs set an example for others to follow. Elsewhere, progress has been piecemeal, at best. This review explores the current extent of "green" or eco-dialysis practices. While noting where progress has been made, it also suggests potential new research avenues to develop and follow. One thing seems certain: as global efforts to combat climate change and carbon generation accelerate, the environmental impact of dialysis practice will come under increasing regulatory focus. It is far preferable for the sector to take proactive steps, rather than to await the heavy hand of government or administration to force reluctant and costly compliance on the un-prepared.