Sustainable health care in a renal centre - carbon saving is coupled with cost-efficiency.

Background: Healthcare contributes significantly to global carbon dioxide equivalent emissions, with kidney care contributing disproportionately to this. Renal medicine was one of the first specialities to actively develop a "green" community. This paper is a retrospective review of a series of comprehensive and impactful green initiatives across various aspects of kidney care delivery in a kidney unit from 2007 to 2024.

Methods: The interventions include using e-consultations and virtual clinics, online priming of haemodialysis machines, upgrade of water treatment systems, centralised dialysate acid delivery, use of 1:44 acid concentrate, use of dialysate autoflow function, installation of energy-efficient lighting, and incremental and decremental dialysis practices. Financial and environmental saving estimates for the haemodialysis-related interventions were calculated based on a 40-bed haemodialysis unit. A hybrid carbon footprinting approach was utilised to calculate the greenhouse gas and financial savings.

Results: The cumulative estimated greenhouse gas and financial savings exceed 1,000 tonnes of carbon dioxide equivalent and £2.8 million, respectively. Among sustainable initiatives in haemodialysis, online priming, use of central acid delivery, dialysate autoflow facility, and incremental and decremental haemodialysis showed the most significant savings.

Conclusions: Interventions to facilitate environmental sustainability may require upfront funding and staff investment of time and effort, but the dividend is long-term environmental protection, financial savings, enhanced quality of care, greater staff satisfaction and enhanced service resilience. Sharing these experiences may help other institutions to integrate green initiatives into everyday service planning.