Hemodialysis is a water-intensive treatment that generates a significant amount of waste and has a detrimental impact on the environment. In a recent review, researchers highlighted the urgent need for water-saving initiatives in hemodialysis. The study revealed that global hemodialysis water use amounts to approximately 265 million m3 per year, with two-thirds of it being discharged as reverse osmosis reject water. Hemodiafiltration and peritoneal dialysis also contribute to cumulative waste. To combat this issue, the researchers proposed a “3R” approach: reduce, reuse, and recycle. Reducing dialysis need, optimizing reverse osmosis performance, and adopting a protein-restricted plant-based diet were suggested as ways to reduce water consumption. Delaying dialysis by one month can save around 6,000 L of water per patient. Incremental dialysis and purifying the water used for dialysate production were also recommended. Optimizing reverse osmosis systems, especially by using new-generation systems that recycle wastewater, can significantly reduce water consumption per session. Reusing wastewater for potable purposes and recycling dialysis emissions for agriculture and aquaponics were identified as crucial steps in water conservation. Despite the need for further study, researchers believe that reusing reverse osmosis reject water in healthcare facilities and using it for agriculture can have numerous benefits. Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus, which can be recovered as soil fertilizers.

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