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There is a paucity of data regarding the carbon footprint of peritoneal dialysis (PD), and studies that have been conducted have failed to consider the impacts of transportation of fluids from the manufacturer to the recipient.
We used attributional process-based life cycle analysis to quantify carbon dioxide equivalents emissions (CO2e) associated with the provision of Baxter home automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Australia. For the two modalities, total daily fluid exchange volumes were 14L and 8L, respectively, including 2L of icodextrin as a last fill. PD fluids were manufactured in Sydney, New South Wales, with all other consumables manufactured overseas and shipped by sea to Australia. Transport from the Sydney factory to state warehouses occurred via 28 tonne trucks, with ferry transport also required to reach the state of Tasmania (Figure 1). Deliveries from state warehouses to patient homes were via 6-8 tonne trucks. Road distances were obtained from Google Maps and shipping distances from sea-distances.org.
Annual per patient carbon emissions attributable to the consumables utilised for the provision of PD (e.g., fluids and packaging, prongs, tubes, drainage bags, gloves, and electricity usage for APD) were 1,992 kg CO2e for APD and 1,245 kg CO2e for CAPD. The higher emissions from APD compared to CAPD was primarily due to the use of a 15L cycler drainage bag, the APD 4 prong cassette, and the electricity needed to run the APD machine. Distribution routes for fluids and consumables in Australia are shown in Figure 1. Average transport distances and average carbon emissions from transport for each Australian state are shown in Table 1. The higher transport emissions from APD compared to CAPD were due to the 70% greater mass of APD fluids and consumables. In both Queensland and the Northern Territory, transport was responsible for more than half of the carbon footprint of peritoneal dialysis due to the large transport distances (Figure 2).
Transport had a substantial impact on PD carbon emissions, more so for APD than CAPD given the greater mass of APD consumables, and particularly where patients lived long distances from major urban centres. These data underscore the need for electrification of road transport and the ongoing development of novel dialysis systems that allow point-of-care dialysate generation to mitigate the carbon impact of PD.