Greener dialysis in practice: life cycle assessment of sustainable practice changes in haemodialysis care.

BACKGROUND: Haemodialysis is highly resource-intensive and generates substantial environmental waste. Each treatment can produce up to 8 kg of plastic and biohazardous waste per session and cumulatively yields multiple tonnes of CO₂-eq emissions per patient per year. To address this burden, nephrology guidelines now emphasise life cycle assessment (LCA) strategies to reduce healthcare's carbon footprint. We evaluated two low-cost operational changes: (1) replacing a standard sterile access kit with non-sterile materials for aseptic arteriovenous access cannulation, and (2) automating bloodline and dialyser drainage to improve the sustainability of routine dialysis - two interventions grounded in guideline-supported aseptic technique, though clinical outcomes were not formally assessed in this study.

METHODS: At the University Medical Centre Utrecht dialysis unit (Netherlands), we performed a comparative cradle-to-grave LCA following ISO 14,040/44 standards. The interventions were: (1) replacing the disposable sterile vascular access kit with Kleenex-brand non-sterile protection sheets plus Klinipress compresses (aseptic working procedure); and (2) configuring the dialysis machines to automatically drain and retain spent bloodlines and dialysers before disposal. Using the EU's Environmental Footprint v3.1 (EF 3.1) impact method, we quantified the changes in environmental impact across categories (e.g. climate change, ecotoxicity, energy use) relative to standard practice.

RESULTS: The LCA showed that the Kleenex/Klinipress substitution reduced impacts across all environmental categories. Compared to the conventional sterile kit, environmental burdens were up to 87% lower (including carbon footprint, freshwater ecotoxicity, and cumulative energy demand) for the non-sterile Kleenex/Klinipress. Automated drainage of the extracorporeal circuit also lowered impacts: climate change impact per session decreased by more than 9%, and freshwater ecotoxicity by about 8%, owing to reduced infectious waste volume.

CONCLUSION: This case study demonstrates that routine haemodialysis can be made substantially greener through practical workflow changes. Substituting sterile kits for non-sterile consumables, and draining dialysis sets before disposal, led to major reductions in waste and carbon emissions, without requiring additional infrastructure or deviation from established clinical workflows. These findings highlight simple yet effective actionable strategies for dialysis centres to advance healthcare sustainability goals: by applying existing technologies and process changes, clinics can markedly shrink their carbon footprint while remaining consistent with current evidence-based clinical guidelines.