P1092THE ENVIRONMENTAL IMPACT OF DISPOSABLES IN A NEW CONFIGURATION OF HEMODIALYSIS (HD) SYSTEM
Authors: Lodi Carlo Alberto , Malagoli Marcello , Gilioli Maurizio , Bandini Roberta , Goux Nicolas 
Published: June 2020

Abstract

Background and Aims
A new configuration of Artis Dialysis System, namely Artis Physio Plus (AP+), has been recently released for chronic HD market.
The AP+ Dialysis System features 3 stationary ultrafilters integrated in the hydraulic flow path and designed to retain bacteria and endotoxins, in order to provide fluid suitable for infusion to be used for on-line hemodiafiltration (HDF), hemofiltration (HF) or on-line bolus, priming and rinse-back also in HD.
With this new fully internal filtration process, no external single-use filter is needed on the infusion lines, resulting in a simplified configuration of the extra-corporeal circuit (EC).
HD has a considerable environmental impact because it uses large volumes of water, energy and medical supplies, and hence a significant amount of waste is produced. The aim of this study was to provide a comparison of the plastic waste amount between the previous Artis Dialysis System configuration (i.e., Artis Physio, AP) and the new one (AP+).

Method
The weight of the EC components (i.e., the blood tubing set, the related infusion lines for HD or HDF/HF and the dialyzer) after their discharge from dialysis machine was measured. In particular, the EC components for AP includes the Ultra Prime Line for HD (Fig. 1a) and Ultra HDF Line for HDF/HF in Pre or Post dilution (Fig. 2a). The EC components for AP+ includes the ULTRALINE HD for HD (Fig. 1b) and ULTRALINE HDF for HDF/HF in Pre or Post dilution (Fig. 2b).
For simplicity, the same blood tubing set (ArtiSet PrePost) has been assumed for all treatment types. The dialyzers used were Revaclear 400 for HD and Polyflux 210H for HDF/HF.
Other plastic waste, like concentrates and disinfectant cartridges, were not considered since their consumption is the same for AP and AP+.

Results
Table 1 shows the weight of the EC components before (i.e., components dry) and after dialysis (i.e., after patient rinse-back and automatic draining by AP/AP+).
Table 2 reports an estimation of the total weekly amount of plastic waste for a single Artis Dialysis System performing 3 shifts a day with a mix of different dialysis treatments (i.e., 60% of HD, 30% of HDF Post, 10% of HDF/HF Pre).
The results show a significant decrease of the disposable waste weight.

Conclusion
The new AP+ infusion lines, dealing with the ready to use infusion fluid delivered from the machine, are much simpler: this leads not only to a significant usability improvement, but also to a better shipment packing factor for the goods, a better storage in the dialysis unit, and a reduction of plastic waste. In particular, a weight decrease of 10.2% is achieved considering the EC items used on a single Artis Dialysis System during a week. Higher reduction of plastic waste will be achieved in clinics running higher number of HDF treatments.
This contributes to have a more eco-friendly dialysis and to reduce the expenditures for the hospitals, both in terms of goods delivery and of waste disposal.