{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:49:57Z","timestamp":1791614997278,"version":"4.3.4"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"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":[[2026,10,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Hemodialysis is highly water-intensive, with conventional reverse osmosis systems discarding approximately 40%\u201370% of treated water as reject waste. Although high-recovery reverse osmosis upgrades can mitigate these losses, they are often associated with substantial capital investment. Existing green dialysis models also require considerable physical space and, when combined with additional labor costs, are frequently unsustainable, thereby limiting their feasibility across many dialysis units.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the design and performance of a compact aquaponic reuse system using existing legacy dialysis reverse osmosis reject water, and to compare it with a previous larger-scale model.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A reuse system was implemented within a 39.6\u2005m\u00b2 corridor adjacent to a dialysis unit. Reject water from a reverse osmosis system was channeled to aquaculture tanks and subsequently to hydroponic columns. Performance indicators included fish survival, vegetable yield, labor demand, water-reuse efficiency, economic outcomes, and comparison with an earlier 310\u2005m\u00b2 system.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fish survival was 90% with 180\u2005kg\/year yield, while hydroponics produced 90\u2005kg\/year. Compared with the earlier model, the compact system used a 7.8-fold smaller footprint yet achieved 2.5-fold higher water-reuse efficiency, 2.3\u20134.7-fold higher fish biomass, and 7.3\u201314.7-fold higher crop yield per square meter. Labor requirements were approximately 3-fold lower and operating costs 2.5-fold lower, while net annual surplus was 8.2-fold higher with a 2-fold faster payback period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This compact platform demonstrated that dialysis reverse osmosis reject water can be safely and productively reused within a confined footprint while delivering higher efficiency than a larger-scale model.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/joneph\/aajag050","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:58:04Z","timestamp":1771505884000},"page":"1144-1150","source":"Crossref","is-referenced-by-count":0,"title":["Compact green dialysis: circular economy approach to advancing sustainability in resource-limited health-care settings"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0314-1442","authenticated-orcid":false,"given":"Eason","family":"Chang","sequence":"first","affiliation":[{"name":"Nephrology Unit, Pantai Hospital Laguna Merbok , Sungai Petani, Kedah ,","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6212-6624","authenticated-orcid":false,"given":"Lim Jo","family":"Anne","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Pakar Universiti Sains Malaysia, School of Medical Sciences, Universiti Sains Malaysia , Kota Bharu, Kelantan ,","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"2026101002221293000_aajag050-B1","first-page":"163","volume-title":"Nephrology in the Global Environment","author":"Agar","year":"2019"},{"key":"2026101002221293000_aajag050-B2","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1038\/s41581-019-0245-1","article-title":"Green nephrology","volume":"16","author":"Barraclough","year":"2020","journal-title":"Nat Rev Nephrol."},{"key":"2026101002221293000_aajag050-B3","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1159\/000546034","article-title":"Perspectives on water utilization in hemodialysis: nephrologists' responsibilities","volume":"54","author":"Abraham","year":"2025","journal-title":"Blood Purif"},{"key":"2026101002221293000_aajag050-B4","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1093\/ndt\/gfac160","article-title":"The European green deal and nephrology: a call for action by the European Kidney Health Alliance","volume":"38","author":"Vanholder","year":"2023","journal-title":"Nephrol Dial Transpl"},{"key":"2026101002221293000_aajag050-B5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/hdi.12117","article-title":"Toward green dialysis: focus on water savings","volume":"18","author":"Ponson","year":"2014","journal-title":"Hemodial Int."},{"key":"2026101002221293000_aajag050-B6","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1007\/s40620-020-00734-z","article-title":"Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology","volume":"33","author":"Piccoli","year":"2020","journal-title":"J Nephrol."},{"key":"2026101002221293000_aajag050-B7","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s40620-020-00903-0","article-title":"Reuse of dialysis reverse osmosis reject water for aquaponics and horticulture","volume":"34","author":"Chang","year":"2021","journal-title":"J Nephrol."},{"key":"2026101002221293000_aajag050-B8","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s40620-023-01657-1","article-title":"Open letter: sustainable, environmentally sympathetic dialysis","volume":"36","author":"Agar","year":"2023","journal-title":"J Nephrol."},{"key":"2026101002221293000_aajag050-B9","doi-asserted-by":"publisher","first-page":"1801","DOI":"10.1007\/s40620-024-01989-6","article-title":"Hemodialysis water reuse within a circular economy approach. What can we add to current knowledge? A point of view","volume":"37","author":"Tarrass","year":"2024","journal-title":"J Nephrol."},{"key":"2026101002221293000_aajag050-B10","doi-asserted-by":"publisher","first-page":"6947","DOI":"10.34172\/ijhpm.2023.6947","article-title":"A review of the applicability of current green practices in healthcare facilities","volume":"12","author":"Soares","year":"2023","journal-title":"Int J Health Policy Manag."}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/6\/1144\/69300880\/aajag050.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/6\/1144\/69300880\/aajag050.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:22:19Z","timestamp":1791613339000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/6\/1144\/8737229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,7,18]]},"published-print":{"date-parts":[[2026,10,10]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag050","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]}}}