How to improve the environmental impact in haemodialysis: small actions, big changes.

Background: The burden of chronic kidney disease is increasing, driven by population aging and the increase in risk factors. In-centre haemodialysis (HD), which accounts for most of the environmental impact of kidney replacement therapy, is a power-hungry, water-hungry and a waste-generating intervention.

Methods: Here we characterize the environmental impact of 20 HD centres over 5 years and its modulation by operational changes (centre size, opening days, geographic location, type of water treatment plant and disinfection, dialysis modalities such as HD versus haemodiafiltration, seasonal variations and the impact of various corrective actions throughout time).

Results: Average water and energy consumption per session were lower in larger centres compared with smaller ones, as well as in centres that operated daily compared with those that opened three times a week (both P < .05). Seasonality, which depends on the geographic region, had a marked influence (P < .001) on water and energy consumption, as does the choice of water treatment plant (P < .001). Actions taken in certain centres significantly reduced energy consumption up to 30%, plastic waste up to 65% and hazardous waste up to 63%.

Conclusion: Annual monitoring must be performed to detect variations and plans must be designed to reduce the environmental impact. As it is not possible to reduce HD water and energy consumption to zero, implementing targeted actions offers a promising strategy for reducing the environmental burden.