The Global Environmental Impact of Dialysis—Go Green for Planet Earth

This blog post was made by Dr. John Agar on September 10, 2014.
The Global Environmental Impact of Dialysis—Go Green for Planet Earth

A little while ago, I wrote a blog on Going Green. I don’t want to sound like a broken record, but I really believe this stuff matters! We (the dialysis community) are profligate users of resources. No single healthcare individual exerts a greater impact on the environment than does a dialysis patient: recurrently, relentlessly, on an ongoing basis...

This is not their fault, but it IS our responsibility. As their healthcare providers, we need to understand the magnitude of the resources we consume, appreciate the mountain of medical trash we create, and do something tangible to address both the up-front impact and the down-back waste we leave behind.

Consider the following excerpt from a paper I currently have ‘in press’:

The Fresenius Medical Care report: ‘ESRD Patients in 2012 - A Global Perspective’ (8) states that “ The number of patients being treated for end stage kidney disease globally was estimated to be 3,010,000 at the end of 2012 . With a ~7% annual growth rate, this is significantly higher than the rate of increase in the world population.

The same report states “At the end of year 2012, HD remained the most common treatment modality, with approximately 2,106,000 patients (89% of all dialysis patients), with around 252,000 patients undergoing PD (11% of all dialysis patients)”.

True, not all of those on HD have 3 treatments a week for a mean of 4 hours/treatment. Some (many) sadly have less, while a lucky few have more. But if we accept these data—for now—as the best we have, then we can estimate global HD water and power usage and waste creation:

  • Based on a mean HD profile of 3 x 4 hour treatments/week at a dialysate flow rate of 500ml/min and an RO reject rate of 66% (= a mean mains water draw of 1500ml/min), the minimum global mains water drawn for HD = 1.5 litres/minute x 240 minutes x 156 treatments/year x 2,106,000 HD patients is 118,272,960,000 litres per year .
  • Based on a mean composite calculation for the machine + RO power drawn per patient per hour (= 1.3 kWh), the minimum global power consumption for HD is 1.3 kWh x 4 x 156 x 2,106,000 = 17,083,872,000 kWh/year.
  • Based on a mean of 2.75 kg disposable waste = currently directed to landfill or incineration, the minimum global waste generation by HD is 2.75 kg x 156 x 2,106,000 = 903,474,000 kg/year.

PD creates waste as well, of course:

  • Based on a PD patient stabilized on CAPD who is exchanging 4 x 2 litre bags/24 hours, theminimum dialysate (water) consumption for CAPD = 8 litres x 365 days/year x 252,000 patients = 735,840,000 litres/year.

These data do not allow for the unmeasured/unknown/unknowable water +/or power used to prepare the equipment we use or to make pre-formed dialysate (eg: PD), or for the waste generation by PD, or the many other unmeasured consumption and waste factors along the dialysis treatment journey.

But, these numbers ARE worth more than passing thought, and there IS much that we could (and can) do to modify this profligate use and abuse of our finite resources and the environment.

We—at my small dialysis service at Barwon Health in Geelong, Australia, have just re-written and re-worked our website with some generous technical and financial assistance of Fresenius Medical Care (Australia).

The site is much more user-friendly now. While it is still ‘growing’ and updating, it is now usable.

The site gives a number of simple ‘how-to’ steps that ANY service can take towards a greener, more sustainable dialysis future. It does NOT profess to have all the answers, but does throw out a challenge to adopt more sustainable practices and gives some easy steps to follow to begin to achieve that.

Please visit us at . Spend some time with us… Blog us… Facebook us... Twitter us… and Instagram us. Help us get the message out that sustainability DOES make sense, and that it also DOES save $$$’s to ‘go green’. Help us get our new and better site out and about in the dialysis world.

It matters.


  • John agar

    Sep 15, 2014 8:59 AM

    It's kind of tragic to 'comment' at one's own blog, but I am rather disappointed in the echoing silence on this topic.

    One day, resource consumption and waste generation in healthcare will come back to bite us all ... and, to think no-one - not one - has an opinion to offer, for or against, is a sad indictment of us all.

    Shame ...!
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    • Dori

      Nov 06, 2014 1:49 AM

      I still find those huge numbers for water and power use STUNNING. Maybe it's guilt that makes folks not want to say anything? To me, the important message is that there ARE things that clinics can do to mitigate the environmental impact of dialysis--and we should get moving on them!
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