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

RATIONALE &

OBJECTIVE

Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. 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 them across types of KRT.

STUDY

DESIGN

A comparative lifecycle assessment (LCA).

SETTING &

PARTICIPANTS

Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada.

EXPOSURE: Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD).

OUTCOME: Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method.

ANALYTICAL APPROACH: Lifecycle inventory results were transformed into 3 end-point 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 greenhouse gas emissions.

LIMITATIONS: Pharmaceuticals were excluded from this study because of a lack of publicly available data.

CONCLUSIONS

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.

PLAIN-LANGUAGE SUMMARY: The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transplant the least impact. This study also explored the sources of these impacts and can inform health systems and health care policymakers regarding opportunities for more environmentally informed practices in kidney care.