{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:35:29Z","timestamp":1787236529341,"version":"build-2736575974"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Standard reverse osmosis systems for hemodialysis operate at 60\u201375% recovery rates, wasting 25\u201340% of feed water as brine. This inefficiency poses a critical challenge in water-scarce regions like Morocco, where freshwater availability is projected to fall below 500\u2005m\u00b3 per capita by 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study assessed all 437 dialysis centers across Morocco, analyzing current reverse osmosis system capacity, water rejection rates, and operating hours to calculate the potential benefits of switching to high-efficiency systems with rejection rates below 15%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Upgrading to high-efficiency reverse osmosis systems could reduce annual reject water by 576 850\u2005m\u00b3 (52.4%) relative to baseline, conserve 1.92 \u00d7 106 m\u00b3 of freshwater, cut 1340 t CO\u2082-eq annually, and generate 13.15 million Moroccan Dirhams (MAD) (\u20ac1.2 million) in yearly savings. Comparative analysis of various manufacturers revealed investment payback periods of 8.36 years for Riv-ROS, 10.24 years for DWA-MS, and 12.11 years for Nip-Ph1, with sensitivity analyses accounting for water price fluctuations (\u00b120%) and equipment lifespan variations, confirming Riv-ROS and DWA-MS as the best financially viable options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings present a compelling case for nationwide implementation, offering Morocco's healthcare sector a scalable solution to address water sustainability and operational costs while maintaining treatment quality standards. The projected 52.4% reduction in reject water and associated savings support urgent policy action to modernize hemodialysis water purification systems as a model for water-scarce regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajaf011","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:51:41Z","timestamp":1782384701000},"page":"726-732","source":"Crossref","is-referenced-by-count":0,"title":["A cost-benefit and sustainability model for high-efficiency reverse osmosis implementation in Moroccan Dialysis Centers"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9867-2096","authenticated-orcid":false,"given":"Faissal","family":"Tarrass","sequence":"first","affiliation":[{"name":"Center of Hemodialysis 2 Mars , Casablanca ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Benjelloun","sequence":"additional","affiliation":[{"name":"Center of Hemodialysis 2 Mars , Casablanca ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostapha","family":"Habib Allah","sequence":"additional","affiliation":[{"name":"Center of Hemodialysis Targa , Marrakech ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meryem","family":"Benjelloun","sequence":"additional","affiliation":[{"name":"Center of Hemodialysis 2 Mars , Casablanca ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"2026082009363642000_aajaf011-B1","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1007\/s40620-025-02295-5","article-title":"Sustainable reuse of hemodialysis reject water for potato farming: a large-scale feasibility study in Morocco","volume":"38","author":"Tarrass","year":"2025","journal-title":"J Nephrol"},{"key":"2026082009363642000_aajaf011-B2","doi-asserted-by":"crossref","DOI":"10.5772\/intechopen.1008182","volume-title":"Environmental Challenges and Management of Vital Resources in Urban Moroccan Cities","author":"Dahchour","year":"2025"},{"key":"2026082009363642000_aajaf011-B3","doi-asserted-by":"publisher","first-page":"889","DOI":"10.2215\/CJN.0000000731","article-title":"Green, sustainable nephrology: state of the art needs for education and implementation","volume":"20","author":"Piccoli","year":"2025","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026082009363642000_aajaf011-B4","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1159\/000321485","article-title":"Water conservation: an emerging but vital issue in hemodialysis therapy","volume":"30","author":"Tarrass","year":"2010","journal-title":"Blood Purif"},{"key":"2026082009363642000_aajaf011-B5","first-page":"13","article-title":"Water supply challenges in poor districts and suburbs of Fez, Morocco","volume":"34","author":"Akdim","year":"2012","journal-title":"Social Develop Iss"},{"key":"2026082009363642000_aajaf011-B6","doi-asserted-by":"publisher","first-page":"100079","DOI":"10.1016\/j.cesys.2022.100079","article-title":"Carbon footprint of drinking water over treatment plant life span (2025\u20132075) is probably dominated by construction phase","volume":"5","author":"Hofs","year":"2022","journal-title":"Cleaner Environ Sys"},{"key":"2026082009363642000_aajaf011-B7","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1108\/SAMPJ-11-2013-0048","article-title":"Carbon sequestered in the trees on a university campus: a case study","volume":"5","author":"De Villiers","year":"2014","journal-title":"Sustain Account Manag Policy J"},{"key":"2026082009363642000_aajaf011-B8","doi-asserted-by":"publisher","first-page":"3456","DOI":"10.2166\/ws.2024.216","article-title":"Electric energy consumption (EEC) in groundwater-based drinking water supply systems: analysis and comparison of seven Italian case studies","volume":"24","author":"Gibellni","year":"2024","journal-title":"Water Sci Technol Water Supply."},{"key":"2026082009363642000_aajaf011-B9","author":"Valev"},{"key":"2026082009363642000_aajaf011-B10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.apenergy.2018.09.043","article-title":"A review of key environmental and energy performance indicators for the case of renewable energy systems when integrated with storage solutions","volume":"231","author":"Kourkoumpas","year":"2018","journal-title":"Appl Energy"},{"key":"2026082009363642000_aajaf011-B11","doi-asserted-by":"publisher","first-page":"e14908","DOI":"10.1016\/j.heliyon.2023.e14908","article-title":"Fouling in reverse osmosis membranes: monitoring, characterization, mitigation strategies and future directions","volume":"9","author":"Ahmed","year":"2023","journal-title":"Heliyon"},{"key":"2026082009363642000_aajaf011-B12","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1080\/09535314.2020.1756228","article-title":"Water content in trade: a regional analysis for Morocco","volume":"32","author":"Haddad","year":"2020","journal-title":"Econ Syst Res"},{"key":"2026082009363642000_aajaf011-B13","doi-asserted-by":"publisher","first-page":"100715","DOI":"10.1016\/j.dwt.2024.100715","article-title":"Evaluation of drinking water quality and potential health risks on the population in Morocco","volume":"320","author":"Hind El Baroudi","year":"2024","journal-title":"Desal Water Treat"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/4\/726\/68611620\/aajaf011.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/4\/726\/68611620\/aajaf011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:36:54Z","timestamp":1787233014000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/4\/726\/8716097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":13,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,6,25]]},"published-print":{"date-parts":[[2026,8,20]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajaf011","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,5]]}}}