Carbon Emissions From Different Dialysis Modalities: A Life Cycle Assessment

RATIONALE & OBJECTIVE: As the health impacts of climate change intensify, the health care sector faces growing pressure to minimize its carbon footprint. Achieving this goal requires understanding of the carbon impact of widely used medical treatments. This study evaluated and compared the carbon footprints of in-center hemodialysis, home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD). STUDY DESIGN: Comparative life cycle assessment. SETTING & PARTICIPANTS: In-center hemodialysis, home-based hemodialysis, CAPD, and APD treatments provided by the Royal Melbourne Hospital Kidney Care Service, Melbourne, Victoria, Australia. OUTCOME: e) from the annual provision of dialysis to a single patient. ANALYTICAL APPROACH: Attributional process-based comparative life cycle assessment methodology was used to identify the sources and extent of carbon emissions for all dialysis modalities. RESULTS: In-center hemodialysis had the highest annual per patient carbon impact, at 4,814kg CO2e. In comparison, emissions from home hemodialysis were 41% lower (2,938kg CO2e), APD 29% lower (3,339kg CO2e), and CAPD 59% lower (1,969kg CO2e). Across all 4 modalities, consumables were the largest source of emissions. For in-center hemodialysis, patient travel was the main factor contributing to its higher carbon footprint compared with home-based dialysis options. LIMITATIONS: Single dialysis provider in an urban setting. CONCLUSIONS: In-center hemodialysis has a substantially higher carbon footprint than all home dialysis options, informing the choice of home dialysis when feasible and appropriate for individual patients. PLAIN-LANGUAGE SUMMARY: As climate change intensifies, there is growing pressure on health care systems to reduce their greenhouse gas emissions. To do this effectively, it is important to understand the carbon footprint of different treatment options and identify key areas where emissions are highest. This study compared greenhouse gas emissions from 4 types of dialysis: hemodialysis performed in a health care facility (in-center hemodialysis), home hemodialysis, automated peritoneal dialysis (APD), and continuous ambulatory peritoneal dialysis (CAPD). We found that in-center hemodialysis had the highest carbon footprint, primarily due to the impact of patient travel. Among the home therapies, APD was responsible for higher emissions than home hemodialysis while CAPD had the lowest carbon footprint. Across all treatment types, consumables were the largest source of carbon emissions.