Despite significant advancements in kidney replacement therapies (KRTs) over the last decades, hemodialysis (HD) continues to consume vast amounts of water and energy. With increasing global water scarcity, it is crucial to take proactive steps to reduce water consumption in this field. Saudi Arabia is one of the world’s driest countries, making sustainable healthcare practice particularly relevant. Many nations have already implemented a green nephrology program to address environmental challenges. Ultrapure dialysis fluids have been recommended as a new standard for contemporary KRT by the international societies of nephrology. Producing ultrapure water requires a water treatment system utilizing reverse osmosis (RO). Water consumption in dialysis, particularly in HD, is a major concern due to the large water volumes required. The exact amount of water consumption in dialysis is variable and depends on several factors. This review discusses multiple strategies to optimize water consumption in HD, including improving RO performance, managing water temperature and quality standards, calculating treatment-related consumption, and designing efficient water treatment systems for dialysis clinics. By examining the key factors influencing dialysis water usage, we aim to contribute to the development of more sustainable and efficient dialysis practices.
Alharbi et al. (2026) studied this question.