A cost-benefit and sustainability model for high-efficiency reverse osmosis implementation in Moroccan Dialysis...

Standard reverse osmosis systems for hemodialysis operate at 60-75% recovery rates, wasting 25-40% 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 m³ per capita by 2030.

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%.

Upgrading to high-efficiency reverse osmosis systems could reduce annual reject water by 576 850 m³ (52.4%) relative to baseline, conserve 1.92 × 106 m³ of freshwater, cut 1340 t CO₂-eq annually, and generate 13.15 million Moroccan Dirhams (MAD) (€1.2 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 (±20%) and equipment lifespan variations, confirming Riv-ROS and DWA-MS as the best financially viable options.

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.