Impact of the Type of Dialysate Acid Concentrate Container on the Environmental Footprint of Hemodialysis Centers.

RATIONALE & OBJECTIVE Hemodialysis is the most common form of kidney replacement therapy and has a significant environmental footprint, raising sustainability concerns as demand increases. This study aimed at assessing the environmental impact of one aspect of the hemodialysis procedure, the type of container used for holding the acid concentrate that is used to prepare dialysate. STUDY DESIGN A retrospective cross-sectional life cycle assessment (LCA) of acid concentrate containers used in hemodialysis was conducted. SETTING & PARTICIPANTS Fifteen hemodialysis centers in three Spanish regions participated, representing approximately 5% of the national hemodialysis population. EXPOSURE Four acid concentrate container types from two manufacturers were assessed: canisters (3.9 L), flexible bags (4.2 L), and centralized storage tanks (300 L and 600 L). OUTCOMES The primary outcome was the environmental impact of each container, measured by carbon footprint (CO2eq in kg) and 16 additional environmental impact categories. ANALYTICAL APPROACH LCA was performed using OpenLCA software and Ecoinvent v3.10 database, considering the full life cycle of the containers, including production, transport, and waste disposal. RESULTS The 3.9 L canister had a carbon footprint 1.63-fold higher than the 4.2 L flexible bag and 2.63-fold higher than storage tanks (p<0.001). The main contributors to the carbon footprint were container production and waste disposal, particularly plastic usage and canister production and disposal. Storage tanks had the lowest carbon footprint (p<0.001), with no difference between 300 L and 600 L storage tanks. There were also significant differences in the environmental impact of different containers across 16 impact categories, with the largest differences observed for freshwater ecotoxicity, non-renewable energy use, and freshwater eutrophication. LIMITATIONS Assumptions regarding transport and disposal processes may introduce some variability. Additionally, financial costs were not assessed, which could influence container selection. CONCLUSION The choice of dialysate acid concentrate container is associated with a differential environmental impact. Thus, this study has identified a key potential approach to decrease the environmental impact of KRT.