A life cycle assessment of peritoneal dialysis procurement in Italy: environmental burden and opportunities for improvement.

Abstract

Background: Procurement activities in healthcare, especially within nephrology, contribute significantly to the environmental footprint. In peritoneal dialysis (PD), procurement of consumables such as dialysis bags, tubing, and machines plays a critical role in driving environmental impacts. Previous studies, including those by the National Health Service (NHS), have shown that procurement can account for up to 72% of the healthcare sector's carbon emissions.

Methods: A life cycle assessment (LCA) was conducted from April to July 2024 at the Nephrology Dialysis and Kidney Transplantation Unit of AOU Policlinico di Modena, Italy, in accordance with ISO 14040/14044 standards. The study focused on procurement-related environmental impacts in automated peritoneal dialysis (APD), based on a standard prescription of two 5L bags overnight and one 2L daytime dwell per day. Products were dismantled to assess materials and modelled using OpenLCA with the Ecoinvent v3.10 database. Transportation, manufacturing, and waste disposal were included within system boundaries.

Results: The 5L Dialysate Bag (used twice daily) had the highest carbon footprint (1515 kg carbon dioxide equivalent [CO₂-eq/year]), followed by the 2L Bag (457 kg) and Automated Drainage System (286 kg). Primary drivers were long-distance transport, plastic production (especially polyethylene and PVC), and energy-intensive manufacturing. Although the 5L bags are used in greater quantities due to the APD prescription (typically two bags per night), it still showed a lower carbon footprint per litre of dialysate delivered (0.415 kg CO₂-eq/L) compared to the 2L bag (0.626 kg CO₂-eq/L). Smaller items like disinfectant sprays and medical kits contributed less individually but were used frequently. Across all categories, plastic production, packaging, electricity use, and incineration were key contributors.

Conclusion: The environmental impact of PD procurement is concentrated in a few high-use, high-impact items. Reduction strategies should target material substitutions, modular product design, and lower-emission transport and energy use. Innovations such as local dialysate mixing, improved waste segregation, and increased recyclability could substantially reduce the environmental burden of PD.