#2695 THE ENVIRONMENTAL IMPACT OF CHRONIC KIDNEY DISEASE INTERNATIONALLY: RESULTS OF A LIFE CYCLE ASSESSMENT
Authors: Zoccali Carmine , Barraclough Katherine , Eckelman Matthew , Amenos Aleix Cases , Germond-Duret Celine , Pecoits-Filho Roberto , Sanchez Juan Jose Garcia , Selvarajah Viknesh , Hubbert Luke , Nicholson Lindsay 
Published: June 2023

Abstract

Background and Aims
The environmental impact of healthcare is high, and kidney care for chronic kidney disease (CKD) contributes significantly to this. Haemodialysis represents the only viable kidney replacement option for certain patients with CKD, in whom the clinical benefits are lifesaving. Haemodialysis is also resource-intensive, requiring frequent sessions, and energy- and water-intensive equipment. In recognition of this, the ERA has implemented a green nephrology initiative aiming to minimize the environmental impact of kidney care. However, there is a paucity of up-to-date analysis on the environmental impact of different dialysis techniques and CKD overall. This study presents an international, holistic life cycle assessment (LCA) of the environmental impact of CKD in adults at all CKD stages.

Method
LCA methodology was used, conducted according to ISO 14040/14044 international standards, to estimate the annual environmental impacts of each stage (1–5) of CKD per patient. At CKD Stage 5, supportive care, haemodialysis, peritoneal dialysis, and transplantation pathways were considered. A literature review was performed to identify all studies reporting healthcare resource use in CKD, stratified by CKD stage. The study boundary is summarised in Figure 1. GaBi software was used to model the pathway based on ecoinvent Life Cycle Inventory database version 3.8. Environmental impact categories were reported according to the impact assessment methods, ReCiPE 2016 v1.1 and TRACI 2.1 (US only). Here, we describe the preliminary analysis of the international study, presenting results on the annual environmental impact of in-centre haemodialysis in the UK, based on one patient receiving haemodialysis three times weekly for four hours per session. The inputs for in-centre haemodialysis comprised dialysis consumables and their transport, energy/water used by the haemodialysis machine (including reverse osmosis), heating/cooling/lighting of the healthcare area, waste disposal, and patient transport.

Results
A total of 93,600 litres of water and 3,058 kWh electricity was estimated per patient for in-centre haemodialysis annually in the UK. The carbon footprint of in-centre haemodialysis in the UK per patient was estimated to be 3,900 kg CO2 equivalents, comparable to the average UK persons annual greenhouse gas footprint, effectively doubling their yearly greenhouse gas impact. Several other environmental impact categories were measured beyond the carbon footprint, including photochemical oxidation potential (ground-level ozone formation) and fine particulate matter, measured as PM2.5. Across each impact category, the parameters that drove each environmental impact differed (Figure 2). For example, dialysis consumables, haemodialysis machine, and patient transport were the main environmental contributors of fine particulate matter, while patient transport was the main driver of terrestrial ecotoxicity.

Conclusion
The results of this LCA build upon previous published research and demonstrate a high carbon footprint for in-centre haemodialysis, in line with other studies. The results also show that the environmental impact of in-centre haemodialysis goes beyond that of its carbon footprint, to other important environmental aspects such as PM2.5 emissions, in which long-term exposure is associated with health problems, such as cardiovascular and respiratory diseases, and an increased risk of CKD. This study hopes to highlight the need for evidence-based policy interventions around the implementation of green nephrology initiatives such as use of renewable energy to power haemodialysis, utilisation of water conserving reverse osmosis systems, and reduction in waste. Furthermore, healthcare policy initiatives that could help detect patients in the early stages of CKD and thereby enable them to be managed proactively could eventually reduce the need for resource-intensive dialysis therapy.