Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment.

Abstract

RATIONALE & OBJECTIVE As the health impacts of climate change intensify, the healthcare sector faces growing pressure to minimize its carbon footprint. Achieving this goal requires understanding of the carbon impact of widely used medical treatments. This study aimed to evaluate and compare the carbon footprints of in-center hemodialysis, home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD). STUDY DESIGN Comparative life cycle assessment. SETTING & PARTICIPANTS In-center hemodialysis, home-based hemodialysis, CAPD, and APD treatments provided by the Royal Melbourne Hospital Kidney Care Service, Melbourne, Victoria, Australia. OUTCOME Carbon emissions in kilograms of carbon dioxide equivalents (kg CO2e) from the annual provision of dialysis to a single patient. ANALYTICAL APPROACH Attributional process-based comparative life cycle assessment methodology was used to identify the sources and extent of carbon emissions for all dialysis modalities. RESULTS In-center hemodialysis had the highest annual per patient carbon impact, at 4,814 kg CO2e. In comparison, emissions from home hemodialysis were 41% lower (2,938 kg CO2e), APD 29% lower (3,339 kg CO2e), and CAPD 59% lower (1,969 kg CO2e). Across all four modalities, consumables were the largest source of emissions. For in-center hemodialysis, patient travel was the main factor contributing to its higher carbon footprint compared to home-based dialysis options. LIMITATIONS Single dialysis provider in an urban setting. CONCLUSIONS In-center hemodialysis has a substantially higher carbon footprint than all home dialysis options, informing the choice of home dialysis when feasible and appropriate for individual patients.