Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment.

RATIONALE & OBJECTIVE Healthcare delivery is associated with considerable greenhouse gas (GHG) and other pollutant emissions. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing across types of KRT. STUDY DESIGN A comparative lifecycle assessment (LCA). SETTING & PARTICIPANTS Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia. EXPOSURE Three KRTs: deceased donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD) OUTCOME: Environmental impacts of KRTs over one year were evaluated using the World ReCiPe (H) 2016 method. ANALYTICAL APPROACH Lifecycle inventory results were transformed into three endpoints and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion RESULTS: Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to GHG emissions. LIMITATIONS Pharmaceuticals were excluded from this study due to a lack of publicly available data. CONCLUSION KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure.