In our service, 100 000 L/week of previously discarded reverse osmosis reject water – water which satisfies all World Health Organisation criteria for potable (drinking) water – no longer drains to waste but is captured for reuse. Reject water from the hospital-based dialysis unit provides autoclave steam for instrument sterilization,

ward toilet flushing, janitor stations and garden maintenance. Satellite centre reject water is tanker-trucked to community sporting fields, schools and aged-care gardens. Home-based nocturnal dialysis patient reuse reject water for home domestic utilities, Vincristine gardens and animal watering. Although these and other potential water reuse practices should be mandated through legislation for all dialysis services, this is yet to occur. In addition, we now are piloting the use of solar power for the reverse osmosis plant and the dialysis machines in our home dialysis training service. If previously attempted, these have yet to be reported. After measuring the power requirements of both dialytic processes and modelling the projected costs, a programme has begun to solar power all dialysis-related equipment in a three-station home haemodialysis training Saracatinib unit. Income-generation with the national electricity grid via a grid-share and reimbursement arrangement predicts a revenue stream back to the dialysis service. Dialysis services must no longer

ignore the non-medical aspects of their programmes but plan, trial, implement and embrace ‘green dialysis’ resource management practices. “
“Diabetes mellitus is the commonest cause of end-stage renal failure in both Australia and New Zealand. In addition, the burden of diabetes is prominent in those with chronic kidney disease who have not yet reached the requirement for renal replacement therapy. While diabetes is associated with a higher incidence of mortality and morbidity in all populations studied with kidney disease,

little is known about optimal treatment strategies for hyperglycaemia and the effects of glycaemic treatment in this large group of patients. Metformin is recommended as the drug of first choice Chloroambucil in patients diagnosed with type 2 diabetes in the USA, Europe and Australia. There are potential survival benefits associated with the use of metformin in additional to recent studies suggesting benefits in respect to cardiovascular outcomes and metabolic parameters. The use of metformin has been limited in patients with renal disease because of the perceived risk of lactic acidosis; however, it is likely that use of this drug would be beneficial in many with chronic kidney disease. Thus the potential benefits and harms of metformin are outlined in this review with suggestions for its clinical use in those with kidney disease. Diabetes mellitus is the commonest cause of end-stage renal failure in both Australia and New Zealand accounting for 31% and 41%, respectively, of patients starting dialysis in 2008.