Impact of the Type of Dialysate Acid Concentrate Container on the Environmental Footprint of Hemodialysis Centers.

RATIONALE &

OBJECTIVE

Hemodialysis is the most common form of kidney replacement therapy and has a significant environmental footprint, raising sustainability concerns as demand increases. This study aimed to assess the environmental impact of one aspect of the hemodialysis procedure, the type of container used to hold the acid concentrate that is used to prepare dialysate.

STUDY

DESIGN

A retrospective cross-sectional life cycle assessment (LCA) of acid concentrate containers used in hemodialysis was conducted.

SETTING &

PARTICIPANTS

15 hemodialysis centers in 3 Spanish regions participated, representing approximately 5% of the national hemodialysis population.

EXPOSURE: 4 acid concentrate container types from 2 manufacturers were assessed: canisters (3.9 L), flexible bags (4.2 L), and centralized storage tanks (300 L and 600 L).

OUTCOMES: The primary outcome was the environmental impact of each container measured by carbon footprint (measured in kilograms of CO2 equivalent [CO2eq]) and 16 additional environmental impact categories.

ANALYTICAL APPROACH: LCA was performed using openLCA software and the ecoinvent v3.10 database, considering the full life cycle of the containers, including production, transport, and waste disposal.

RESULTS

The 3.9-L canister had a CO2eq 1.63 times higher than the 4.2-L flexible bag and 2.63 times higher than the storage tanks (P < 0.001). The main contributors to the carbon footprint were container production and waste disposal, particularly plastic use and canister production and disposal. Storage tanks had the lowest CO2eq (P < 0.001), with no difference between the 300-L and 600-L storage tanks. There were also significant differences in the environmental impact of different containers across 16 impact categories, with the greatest differences observed for freshwater ecotoxicity, nonrenewable energy use, and freshwater eutrophication.

LIMITATIONS: Assumptions regarding transport and disposal processes may introduce some variability. Additionally, financial costs were not assessed, which could influence container selection.

CONCLUSIONS

The choice of dialysate acid concentrate container is associated with a differential environmental impact. Thus, this study has identified a key potential approach to decrease the environmental impact of kidney replacement therapy.

PLAIN-LANGUAGE SUMMARY: Hemodialysis is a lifesaving treatment for people with kidney failure, but it also has a significant environmental impact. One overlooked factor is the variety of formats in which the acidic solution used in dialysis is delivered: small plastic canisters, flexible bags, and large storage tanks. This study examined the environmental impact of these container options across multiple dialysis centers in Spain. We found that storage tanks had the lowest environmental footprint, whereas plastic canisters had the highest. These findings highlight a practical way for dialysis providers and consumers to reduce waste and carbon emissions by selecting more sustainable container options, improving the environmental impact of kidney care.