#6793 TOWARDS SUSTAINABLE HEMODIALYSIS: FIRSTS STEPS TO CHANGE THE PARADIGM
Authors: Guillen Marta Arias , Quintela Marta , Gomez Miquel , Clemente Nuria , Maduell Francisco 
Published: June 2023

Abstract

Background and Aims
In the field of nephrology, environmental awareness is booming and we claim that it is responsible for our impact. Hemodialysis treatment generates an excessive burden owing to the high consumption of water and energy, as well as the production of a large amount of waste. On the part of the European Kidney Health Alliance (EKHA), several proactive suggestions have been proposed worldwide. To this regard, we implemented different improvements in our dialysis unit, including the reverse osmosis (RO) treatment plant automation upgrade. However, to change the paradigm, it was still necessary to first know the reality from which we start to identify opportunities for improvement. The objective of our study was to determine the environmental impact of care activities in our hemodialysis center over the last 5 years.

Method
A retrospective analysis of key environmental indicators derived from hemodialysis treatments, from January 2018 to December 2022 was performed. Energy consumption (kWh/dialysis), water expenditure (L/dialysis), technical operator (TO) required time as well as the generation of sanitary waste (SW, Kg/dialysis) derived from the activity were monitored according to their classification: GI (unspecific non-hazardous waste), GII (patient care non-hazardous waste such as disposable items, used empty bloodlines and hemodialyzers) and GIII (sharp material, needles or anatomical waste). All of these data were compared with the treatment sessions carried out during the analyzed period, and the costs of the environmental impact were calculated.

Results
Table 1 summarizes the average generated waste, energy and water expenditure as well as TO required working time at the beginning and at the end of the study period. Additionally, an estimated Co2 footprint of each activity is calculated. The increase in SW was associated with a change in format of presentation of certain materials by the producer, which allowed the reduction of the hazardous GIII amount of waste as was reassigned to non-hazardous GI or GII group. Regarding the upgrade in the RO plant, a slight increase in energy consumption due to the implementation of improved sensors allowed a substantial reduction of water required (with a high 75% efficiency) and a prominent reduction of TO time needed and traveled distance, which severely reduced the environmental impact. In addition, the remotely monitored RO reduced TO costs by 7101 €/year and material resources by 2892 €/year.

Conclusion
The first step in achieving ‘green’ dialysis should be to measure key indicators that determine the environmental impact of our activity, establishing our standards to easily analyze the possible deviation factors. Technological improvements and the remotely monitoring in our water treatment plant have made water consumption more efficient and overall reduced the environmental impact. To address the viability of hemodialysis, we need to raise awareness among professionals to minimize the carbon footprint derived from our care activities, designing action plans to reduce the environmental impact such as:
1. Use of moderated dialyzate flows (&lt;600 mL/min). 2. Post-treatment bloodline and hemodialyzer drainage to reduce waste weight. 3. Initiate both awareness campaigns and specific training on the correct management of waste, and assess the costs of waste management before the acquisition of new materials. 4. Potentiate home based treatments whenever possible.