Molano-Triviño Alejandra, Wancjer Benjamin, Neri Mauro M, Karopadi Akash N, Rosner Mitchell, Ronco Claudio
Internal Medicine and Nephrology, RTS - Fundaciòn Cardioinfantil, Bogotà - Colombia.
International Renal Research Institute, San Bortolo Hospital, Vicenza - Italy.
Int J Artif Organs. 2017 Nov 8:0. doi: 10.5301/ijao.5000660.
Hemodialysis (HD) is an expensive therapy in economic and in ecological terms, owing to a high carbon footprint and significant consumption of natural sources, especially water. Our aim was to review strategies to diminish waste of water in maintenance dialysis, exploring previously described water reuse trends and less known strategies for reducing the dialysate flow.
We conducted a systematic review of water-sparing strategies, including the reuse of reverse osmosis rejected water and the reduction of dialysate flux. We performed a search in Medline, Pubmed, Scielo, OVID and Biblioteca Redentor, using key words: Dialysate flow rate, Dialysate flux, and decrease; excluding: online, peritoneal, continuous, blood access, needle, hemodiafiltration, acute, pharmacokinetics, increase. We limited our search to adult humans or in vitro trials in English, Spanish, Italian and Portuguese, between January 1980 and June 2017. We found 816 trials. 37 articles were retrieved for review, and 11 articles were analyzed.
Conservation of water in chronic HD should be considered an important responsibility of healthcare practitioners all over the world. We present a wider usage of dialysate flow rates, considering that it would lead to significant water conservation without much compromise on dialysis efficacy in small patients. We believe that further investigation into the utility of reduced dialysate flux in different populations is needed to broaden our understanding of how we can use these techniques in order to significantly reduce water consumption during chronic HD while still ensuring optimum efficacy and efficiency of the therapy.
血液透析（HD）在经济和生态方面都是一种昂贵的治疗方法，因为其碳足迹高，且大量消耗自然资源，尤其是水。我们的目的是回顾维持性透析中减少水资源浪费的策略，探讨先前描述的水再利用趋势以及鲜为人知的减少透析液流量的策略。
我们对节水策略进行了系统综述，包括反渗透浓水的再利用和透析液通量的降低。我们在Medline、Pubmed、Scielo、OVID和Biblioteca Redentor数据库中进行检索，使用关键词：透析液流速、透析液通量、降低；排除：在线、腹膜、持续、血液通路、针头、血液透析滤过、急性、药代动力学、增加。我们将检索范围限制在1980年1月至2017年6月期间以英文、西班牙文、意大利文和葡萄牙文发表的关于成年人类或体外试验的文献。我们共找到816项试验。检索到37篇文章进行综述，分析了其中11篇文章。
慢性血液透析中的节水应被视为全世界医疗从业者的一项重要责任。我们提出更广泛地使用透析液流速，因为这将在不显著影响小患者透析疗效的情况下实现显著节水。我们认为，需要进一步研究降低透析液通量在不同人群中的效用，以加深我们对如何使用这些技术的理解，从而在慢性血液透析期间显著减少水消耗，同时仍确保治疗的最佳疗效和效率。
