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Automated peritoneal dialysis (APD) has considerably lower environmental impact than hemodialysis. Continuous ambulatory peritoneal dialysis (CAPD) is less costly than APD, and more resilient to energy disruptions that may occur in low resource settings or climate vulnerable regions. Incremental PD prescriptions are increasing in prevalence. Comparative PD therapies and prescriptions’ environmental performance is not previously described. Lifecycle assessment (LCA) methodology quantifies a broad range of environmental impacts of products, processes, and services throughout all stages from creation, through use, and disposal.
Process-based LCAs as per international standards organizations (ISO 14040 and 14044) were performed for APD and CAPD with a functional unit of one patient receiving one peritoneal dialysis therapy for a period of one year. APD with Baxter Amia and CAPD with Baxter twin bag systems were studied, using standard daily PD prescriptions: APD 10 Litres (L) Dianeal 1.5% over 8 hours cycler time with 2L Extraneal (7.5%) last bag fill (LBF); CAPD three 2L 1.5% exchanges and one 2L 7.5% exchange. A cradle to grave approach was used in which impacts related to all lifecycle stages of a process were calculated for various environmental impact categories.
Yearly atmospheric carbon dioxide equivalent (CO2e) emissions from APD were 1420 kilograms (kg) for APD and 684 kg for CAPD. APD had the highest environmental impact across all categories, including climate change, ozone depletion, air pollution, human toxicity, and water depletion. Among most categories, APD’s environmental impact was double that of CAPD. Consumables had the greatest contribution for each therapy (relative impact 78% and 62% for APD and CAPD, respectively), followed by training (18% and 36%) then waste management (4.2% and 1.1%). Supply transportation had the lowest impact, accounting for less than 1% of emissions for each modality. Incremental prescriptions will be modeled for APD and CAPD.
We describe nearly double the climate change impact of cycler compared to continuous ambulatory peritoneal dialysis therapy. Consumables are the greatest source of CO2e emissions for both PD modalities, hence incremental prescriptions are anticipated to have lower environmental impact than standard PD therapies. Environmental effects of APD were consistently significantly higher than CAPD across all impact categories. When clinically appropriate, CAPD or incremental prescriptions could be selected over a standard cycler dialysis regimen for improved environmental performance.