Potassium chloride 0.15% (potassium 20mmol/1litre) / Magnesium sulfate 0.2% (magnesium 8mmol/1litre) / Sodium chloride 0.9% infusion 1litre bags

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease. Salt substitutes may reduce sodium intake while maintaining palatability, but comparative effects across formulations remain uncertain. METHODS: We conducted a systematic review and frequentist random-effects network meta-analysis of randomised controlled trials in adults comparing salt substitutes with regular salt, other substitutes or no intervention. Databases (PubMed, Embase, CENTRAL, CNKI, Wanfang), WHO-ICTRP and ClinicalTrials.gov were searched from inception to Oct 3, 2025 (PROSPERO CRD42023451859). We assessed the risk of bias using a modified Cochrane tool and conducted a random-effects network meta-analysis, with evidence certainty evaluated through the GRADE approach. RESULTS: We included 34 randomised controlled trials involving 37,063 participants across 15 countries (17 from China, 17 from other countries; mean age 62.3 years). Our results indicate that moderate-potassium and low-sodium salt substitutes (25-40% KCl, 60-79% NaCl) probably reduce all-cause mortality, cardiovascular mortality, non-fatal cardiovascular events and systolic blood pressure (SBP) compared to regular salt, with reductions of 7-17 deaths per 1000 individuals and 4.39-4.64 mmHg for SBP, based on moderate to high certainty evidence. Mortality and cardiovascular benefits are predominantly driven by one large Chinese trial (SSaSS, n = 20,995); excluding this trial eliminated statistical significance for all-cause mortality. Among non-Chinese studies, none contributed mortality data. Substitutes with higher potassium or very low sodium showed similar blood pressure reductions but provided less certain evidence regarding mortality and events. No substitute increased adverse events or withdrawals, and acceptability was comparable to regular salt. CONCLUSIONS: Salt substitutes, particularly moderate-potassium and low-sodium formulations, represent a promising sodium reduction strategy. However, current evidence for mortality and cardiovascular event benefits is dominated by one large Chinese trial and has very limited generalisability beyond Chinese populations with high discretionary salt use. These products appear acceptable and safe in people without renal impairment, but clinicians should rule out kidney disease and hyperkalaemia risk before recommending them, and large trials in non-Chinese populations are needed.

Abstract licence: CC BY-NC-ND

Safeguarding drinking water is a major public health and environmental concern because it is essential to human life but may contain pollutants that can cause illness or harm the environment. Therefore, continuous research is necessary to improve water treatment methods and guarantee its quality. As part of this study, the effectiveness of coagulation–flocculation treatment using aluminum sulfate (Al2(SO4)3) was evaluated on a very polluted site. Samplings were taken almost every day for a month from the polluted site, and the samples were characterized by several physicochemical properties, such as hydrogen potential (pH), electrical conductivity, turbidity, organic matter, ammonium (NH+4), phosphate (PO43−), nitrate (NO3−), nitrite (NO2−), calcium (Ca2+), magnesium (Mg2+), total hardness (TH), chloride (Cl−), bicarbonate (HCO3−), sulfate (SO42−), iron (Fe3+), manganese (Mn2+), aluminum (Al3+), potassium (K+), sodium (Na+), complete alkalimetric titration (TAC), and dry residue (DR). Then, these samples were treated with Al2(SO4)3 using the jar test method, which is a common method to determine the optimal amount of coagulant to add to the water based on its physicochemical characteristics. A mathematical model had been previously created using the support vector machine method to predict the dose of coagulant according to the parameters of temperature, pH, TAC, conductivity, and turbidity. This Al2(SO4)3 treatment step was repeated at the end of each month for a year, and a second characterization of the physicochemical parameters was carried out in order to compare them with those of the raw water. The results showed a very effective elimination of the various pollutions, with a very high rate, thus demonstrating the effectiveness of the Al2(SO4)3. The physicochemical parameters measured after the treatment showed a significant reduction in the majority of the physicochemical parameters. These results demonstrated that the coagulation–flocculation treatment with Al2(SO4)3 was very effective in eliminating the various pollutions present in the raw water. They also stress the importance of continued research in the field of water treatment to improve the quality of drinking water and protect public health and the environment.

Abstract licence: CC BY

Lakes are vital freshwater ecosystems that sustain biodiversity, support livelihoods, and drive socio-economic growth globally. However, they face escalating threats from anthropogenic activities, including urbanization, agricultural runoff, and pollution, which are exacerbated by climate change. Phewa Lake in Nepal was selected for this study due to its increasing rates of nutrient enrichment, sedimentation, and pollution. This study evaluated seasonal and spatial water quality variations within the lake by analyzing water samples from 30 sites during the pre-monsoon and post-monsoon seasons. Twenty physicochemical parameters, including the potential of hydrogen (pH), dissolved oxygen (DO), electrical conductivity (EC), and major ions, e.g., calcium (Ca2+), magnesium (Mg2+), sodium (Na+), potassium (K+), bicarbonate (HCO3−), chloride (Cl−), sulfate (SO42−), nitrate (NO3−), phosphate (PO43−), and ammonium (NH4+), were measured. The average pH ranged from 8.06 (pre-monsoon) to 8.24 (post-monsoon), reflecting dilution from monsoon rains and increased carbonate runoff. Furthermore, the DO levels in Phewa Lake averaged 7.46 mg/L (pre-monsoon) and 8.62 mg/L (post-monsoon), with higher values observed post-monsoon due to rainfall-driven oxygenation. Nutrient concentrations were shown to be elevated, with the nitrate concentration reaching 2.31 mg/L during the pre-monsoon period, and the phosphate concentration peaking at 0.15 mg/L in the post-monsoon period, particularly near agricultural runoff zones. The dominant cations in the lake’s hydrochemistry were Ca2+ and Mg2+, while HCO3− was the primary anion, reflecting the influence of carbonate weathering. Cluster analysis identified the lake outlet as a high-pollution zone, with the total dissolved solids (TDS) reaching 108–135 mg/L. Additionally, Principal component analysis revealed agricultural runoff and sewage effluents as the main pollution sources. Seasonal dynamics highlighted monsoon-induced dilution and pre-monsoon pollution peaks. These findings underscore the need for targeted pollution control and eutrophication management. By aligning with the sustainable development goals (SDGs) relevant to clean water and climate action, this research provides a replicable framework for sustainable lake management that is applicable to freshwater ecosystems worldwide.

Abstract licence: CC BY

Seawater desalination has emerged as a crucial solution for addressing global freshwater scarcity. However, it generates significant volumes of concentrated brine waste. This brine is rich in dissolved salts and minerals, primarily, chloride (55%), sodium (30%), sulfate (8%), magnesium (4%), calcium (1%), potassium (1%), bicarbonate (0.4%), and bromide (0.2%), which are often discharged into marine environments, posing ecological challenges. This study presents a comprehensive global review of innovative technologies for recovering these constituents as valuable products, thereby enhancing the sustainability and economic viability of desalination. The paper evaluates a range of proven and emerging recovery methods, including membrane separation, nanofiltration, electrodialysis, thermal crystallization, solar evaporation, chemical precipitation, and electrochemical extraction. Each technique is analyzed for its effectiveness in isolating salts (NaCl, KCl, and CaSO4) and minerals (Mg(OH)2 and Br2), with a discussion of process-specific constraints, recovery efficiencies, and product purities. Furthermore, the study incorporates a detailed techno-economic assessment, highlighting revenue potential, capital and operational expenditures, and breakeven timelines. Simulated case studies of a 100,000 m3/day seawater reverse osmosis (SWRO) facility demonstrates that a sequential brine recovery process and associated energy balances, supported by pilot-scale data from ongoing global initiatives, can achieve over 90% total salt recovery while producing marketable products such as NaCl, Mg(OH)2, and Br2. The estimated revenue from recovered materials ranges between USD 4.5 and 6.8 million per year, offsetting 65–90% of annual desalination operating costs. The analysis indicates a payback period of 3–5 years, depending on recovery efficiency and product pricing, underscoring the economic viability of large-scale brine valorization alongside its environmental benefits. By transforming waste brine into a source of commercial commodities, desalination facilities can move toward circular economy models and achieve greater sustainability. A practical integration framework is proposed for both new and existing SWRO plants, with a focus on aligning with the principles of a circular economy. By transforming waste brine into a resource stream for commercial products, desalination facilities can reduce environmental discharge and generate additional revenue. The study concludes with actionable recommendations and insights to guide policymakers, engineers, and investors in advancing brine mining toward full-scale implementation.

Abstract licence: CC BY

Background: Different types of kidney stones are associated with distinct changes in urine chemistry. Methods: We assessed urinary parameters of 98 patients with calcium oxalate (CaOx) stones one month following endoscopic stone removal. The 24 h urine analysis encompassed the assessment of various parameters, including volume, sodium, chloride, sulfate, nitrate, fluoride, phosphate, calcium, potassium, magnesium, oxalate, uric acid, citrate, creatinine, and pH levels. Results: Hypocitraturia was the most prevalent urinary abnormality (61.2%, n = 63), followed by low urine volume (53%, n = 52) and hypercalciuria (50%, n = 49). We did not find any statistically significant differences between patients with whewellite (COM) (n = 69) and weddellite (COD) stones (n = 29) (p > 0.05). However, oxalate concentration was the only parameter with a statistically significant intergroup difference (p = 0.0297). Additionally, in univariate linear regression analysis, urinary phosphate levels ≥ 48.0 mmol/d showed a trend towards significance (OR 0.17, 95% CI 0.02–1.15, p = 0.0692), indicating that phosphaturia is associated with a significant increase in the odds ratio of COD stones. To further explore metabolic heterogeneity among stone formers, we conducted cluster analysis, which revealed three distinct metabolic subgroups. Cluster 1 was predominantly associated with COM stones (80.5%) and exhibited significantly higher urinary excretion of sodium, calcium, oxalate, phosphate, and uric acid compared to Cluster 2, which had a more balanced distribution of monohydrate and dihydrate stones. Conclusions: These findings suggest that a specific metabolic phenotype may be linked to COM stone formation, providing a framework for risk stratification and personalized prevention strategies in calcium oxalate stone formers.

Abstract licence: CC BY