#3286 ENVIRONMENTAL PERFORMANCE OF HEMODIALYSIS THROUGH LIFECYCLE ASSESSMENT (LCA): IN-CENTRE HEMODIALYSIS VS HOME-HEMODIALYSIS
Authors: Saleem Saba , Rajan Tasleem , Macneill Andrea , Stigant Caroline , Copland Michael , Hewage Kasun , Sadiq Rehan , Nguan Christopher 
Published: June 2023

Abstract

Background and Aims
Despite being energy and resource-intensive, hemodialysis (HD) is the most common therapy for end stage kidney disease. Considering the extensive amount of energy, water, and consumables involved, this modality is expected to have a significant environmental impact. Through a comparative lifecycle assessment (LCA), this study aims to analyze the environmental impacts of hemodialysis in British Columbia, Canada.

Method
A process-based life cycle assessment was performed for three hemodialysis modalities: i) in-centre HD (ICHD), ii) home HD with NxStage machine (HHD-Nx), and iii) home HD with Baxter AK-98 machine (HHD-B). The scope of study included patient and staff commute, supply transportation, dialysis services, patient training for home hemodialysis, and waste management. The functional unit considered is HD energy and material consumption for one patient per year. Based on the patient's record, two prescriptions including standard (three dialysis sessions per week for 4 hours daily) and extended (six HD sessions per week for 8 hours daily) were considered. LCAs were performed using ISO 14040, 14041 standards in which ReCiPe (world) midpoint method and a cut-off criterion of 0.5% was used to assess the environmental impacts of selected impact categories.

Results
For both prescriptions, ICHD had highest impact on all environmental impact categories (climate change, human toxicity, freshwater eutrophication, particulate matter formation, marine ecotoxicity and water depletion), except ozone depletion in which HHD-B had highest impact. The fewest impacts were associated with HHD-Nx. CO2 emissions observed for a standard HD prescription are 3590 kg carbon dioxide equivalents (CO2eq) per patient/year by ICHD, 1350 kg CO2eq/patient/year by HHD-B and 733 kg CO2eq/patient/year by HHD-Nx. For extended prescriptions, the highest impact observed is from HHD-B (2210 kg CO2eq/patient/year) followed by HHD-Nx (1110 kg CO2eq/patient/year). With respect to ICHD, HHD-Nx only accounts for 13% (standard) and 18% (extended) of total environmental impact. Patient and staff commute in ICHD (40% of total impact) and dialysis services in HHD (75% in HHD-B and 63% in HHD-Nx) are the highest contributors to the majority of environmental impacts.

Conclusion
Our study demonstrates the environmental impacts of various modes of HHD through LCA. HD modalities have substantial differences in their environmental impacts as compared to ICHD, both HHD systems have lower impact, with NxStage having less impact than Baxter. Our results also demonstrate that a shift from standard to extended prescriptions increases overall environmental impact by 5%. Combined with existing clinical and economic data, these results could assist policy and decision-makers to optimize the provision of kidney replacement therapies. Lower environmental impact of HHD may add to the patient and provider appeal of these therapies, and when clinical equipoise exists, NxStage may be preferred over Baxter in eligible patients.