The carbon footprint of dialysis therapies in Victoria, Australia

As climate change escalates with increasing health impacts, healthcare must address its own carbon footprint. A critical first step is understanding the sources and extent of emissions from commonly utilised clinical care pathways such as dialysis.

We used attributional process-based life cycle analysis to quantify carbon dioxide equivalents emissions (CO2e) associated with the delivery of facility-based haemodialysis (FHD), home haemodialysis (HHD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in the state of Victoria, Australia. Both FHD and HHD were performed thrice weekly for 4 hours per treatment session, while the total daily fluid exchange volumes for APD and CAPD were 14L and 8L respectively. For FHD, the comparative impact of delivery in Melbourne compared to the regional town of Geelong was examined.

Annual per patient carbon emissions were higher for FHD compared with all forms of home dialysis (Table 1). FHD had a greater impact when delivered in Geelong compared to Melbourne due to longer distances travelled by patients to receive care and Geelong’s less efficient reverse osmosis water purification system (Figure 1). APD had a higher impact than CAPD due to more carbon heavy fluids and consumables and the electricity needed to run the APD machine (Figure 2).

Table 1: Annual greenhouse gas impacts per patient 

To reduce carbon emissions from dialysis, policy interventions should aim to increase home-based care delivery. The ‘carbon hotspots’ identified for each dialysis modality allow for targeted improvement initiatives undertaken by environmentally informed clinicians and patients.