Advanced hemodialysis equipment for more eco-friendly dialysis

Abstract

Healthcare in general and dialysis care in particular are contributing to resource consumption and, thus, have a notable environmental footprint. Dialysis is a life-saving therapy but it entails the use of a broad range of consumables generating waste, and consumption of water and energy for the dialysis process. Various stakeholders in the healthcare sector are called upon to develop and to take measures to save resources and to make healthcare and dialysis more sustainable. Among these stakeholders are manufacturers of dialysis equipment and water purification systems. Dialysis equipment and consumables, together with care processes need to be advanced to reduce waste generation, enhance recyclability, optimize water purification efficiency and water use. Joint efforts should thus pave the way to enable delivering green dialysis and to contribute to environmentally sustainable health care.

Reducing the Environmental Impact of Clinical Care

“…30 This includes the dialysate used during the process of dialysis itself and the water that undergoes reverse osmosis filtration to remove contaminants before becoming dialysate. Many reverse osmosis systems currently in use are inefficient, with between 30% and 50% of the source water passing through the membrane, the remainder being rejected and going back into the water system as wastewater� 30,31 Newer systems have been developed where up to 80% of the source water passes through the membrane� 31 Some newer systems also have, as part of their design, a reduced number of single-use items to be disposed of� 31 Reducing the rate of dialysate flow, where clinically appropriate, can also lead to reduced water consumption and wastage� 15,28,32 Recycling reverse osmosis reject water is the redirection of reject water to somewhere (e�g�, storage tanks, grey water system) other than a wastewater drain� Reject water has been used, for example, for janitorial work, equipment sterilization, and landscape care. 30,32 Home dialysis is not appropriate for all people requiring dialysis, but for those for whom it is a preference and appropriate, it is potentially an option for environmentally sustainable dialysis care� In addition to reducing emissions from travel to and from a dialysis centre, many home dialysis systems have a low rate of flow of dialysate, which reduces the amount of water being used.…”

“…30,32 Home dialysis is not appropriate for all people requiring dialysis, but for those for whom it is a preference and appropriate, it is potentially an option for environmentally sustainable dialysis care� In addition to reducing emissions from travel to and from a dialysis centre, many home dialysis systems have a low rate of flow of dialysate, which reduces the amount of water being used. 31 However, these benefits may not be enough to make home dialysis a more environmentally sustainable treatment option depending on patients' dialysis routines, partly due to the large number of disposables used by currently available home systems� 30…”

“…Waste reduction and diversion is another area ripe for research and redesign� There are opportunities to understand the hazards of waste and explore possibilities for recycling, including developing novel processes for products that currently lack recycling options� 28 By collaborating with manufacturers, health care providers and facilities can, for instance, revise the contents of disposable packs, reduce extraneous items to reduce waste, 23,31 and send signals that environmental considerations, including a life cycle view, are of value� This can include reduced packaging as well as improved product design� 23…”

The climate impact of dialysis

“…Carbon dioxide (CO 2 ) is the most referenced gas in the measure of global warming potential (GWP), expressed as carbon dioxide equivalent (CO 2 -e). It is estimated that between 3–10% of a country's CO 2 emissions originate from the healthcare sector with an average of 0.6 tCO 2 per capita, ranging from 0.06 tCO 2 in India to 1.51 tCO 2 in the United States (U.S.) based on 2014 data [2,15 ▪ ]. In 2010, dialysis contributed to about 65% of healthcare emissions in the U.K. despite patients on dialysis only making up 0.4% of all patients [16].…”

“…A single in-centre HD session uses 6.2kWh of electricity per patient, about 1000 kWh of electricity per year [25]. Electricity in HD is used to start up and prime the machine and RO, in warming the dialysate and in heat disinfection, resulting in higher-than-average use compared to that in regular daily activities [2,25]. Electricity is also needed to power lights, air-conditioning, and computers in a dialysis unit.…”