Mp461the Impact of Disposables Towards More Eco-Friendly and Less Costly Haemodialysis

Schleser, Andreas; Fleck, Nicole; Tsobanelis, Theoharis

doi:10.1093/ndt/gfw194.16

Cited by 3 publications

(7 citation statements)

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“…A thorough quantitative analysis of dialysis-associated waste based on four different HD systems resulted in between 1.5 and 8 kg of waste per treatment depending on the HD system and the emptying policies of the extracorporeal systems after treatment [17]. Other sources have assessed an average weight of solid waste generated per patient and treatment of 2.5 kg [18,19], without considering outer cardboard packaging material. Assuming this number as an average, a mean number of 156 HD treatments per patient and year and a current worldwide number of 3,160,000 HD patients in 2019 [8], this corresponds to an estimated yearly global waste production of approximately (approx.)…”

Section: Waste Reduction Through Advanced Dialysis Systemsmentioning

confidence: 99%

“…For those components, which are incinerated-this includes often the extracorporeal system in HD, it would be desirable that, as for many medical consumables, the use of polyvinyl chloride (PVC) is replaced by chlorine-free polymers in order to minimize during combustion the formation of dioxins and furans, which are generated at insufficiently high temperatures [26]. Moreover, the use of medical devices containing PVC should be limited over the patient's time on dialysis due to health risks associated with plasticizers integrated in PVC polymers, that potentially migrate depending on the type of plasticizer [19,27]. Although technologies are emerging to recycle PVC [28], extracorporeal blood circuits are rather prone to be incinerated as clinical waste with previous blood contact.…”

Section: Waste Reduction Through Advanced Dialysis Systemsmentioning

confidence: 99%

“…There is data on daily waste amounting to between approx. 0.6 [40, 41] to 1.69 kg/day [19], depending on modality, PD system, number and size of prescribed bags. Accordingly, PD can be advantageous compared to HD in view of produced waste and water used.…”

Section: Reducing Carbon Footprint Through Home Dialysismentioning

confidence: 99%

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Advanced hemodialysis equipment for more eco-friendly dialysis

2021

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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.

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Section: Waste Reduction Through Advanced Dialysis Systemsmentioning

confidence: 99%

Section: Waste Reduction Through Advanced Dialysis Systemsmentioning

confidence: 99%

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Advanced hemodialysis equipment for more eco-friendly dialysis

2021

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“…For example, minimization of the blood-air interface in the extracorporeal circuit is possible by combining a very short circuit with a blood cassette and avoidance of the venous bubble trap. 130,131 Incorporation of antithrombotic agents within the core polymer bulk or on the surface of dialyzer fibers and blood lines is also being explored, 132,133 as is the use of citric-acidified bicarbonate dialysate as an adjunct to antithrombotic-treated polymer. [134][135][136] Finally, methods are being developed to prevent or reduce microbubble formation within the extracorporeal circuit.…”

Section: Extracorporeal Circuitmentioning

confidence: 99%

Dialysis-Induced Cardiovascular and Multiorgan Morbidity

Canaud

Kooman

Selby

et al. 2020

Kidney International Reports

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Hemodialysis has saved many lives, albeit with significant residual mortality. Although poor outcomes may reflect advanced age and comorbid conditions, hemodialysis per se may harm patients, contributing to morbidity and perhaps mortality. Systemic circulatory "stress" resulting from hemodialysis treatment schedule may act as a disease modifier, resulting in a multiorgan injury superimposed on preexistent comorbidities. New functional intradialytic imaging (i.e., echocardiography, cardiac magnetic resonance imaging [MRI]) and kinetic of specific cardiac biomarkers (i.e., Troponin I) have clearly documented this additional source of end-organ damage. In this context, several factors resulting from patienthemodialysis interaction and/or patient management have been identified. Intradialytic hypovolemia, hypotensive episodes, hypoxemia, solutes, and electrolyte fluxes as well as cardiac arrhythmias are among the contributing factors to systemic circulatory stress that are induced by hemodialysis. Additionally, these factors contribute to patients' symptom burden, impair cognitive function, and finally have a negative impact on patients' perception and quality of life. In this review, we summarize the adverse systemic effects of current intermittent hemodialysis therapy, their pathophysiologic consequences, review the evidence for interventions that are cardioprotective, and explore new approaches that may further reduce the systemic burden of hemodialysis. These include improved biocompatible materials, smart dialysis machines that automatically may control the fluxes of solutes and electrolytes, volume and hemodynamic control, health trackers, and potentially disruptive technologies facilitating a more personalized medicine approach.

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“…The major source of waste relates to the disposables (bloodlines and dialyzers), so that newly designed, integrated disposables can facilitate a reduction of disposable waste, for example, of approximately 0.2 kg/session as reported by Schleser et al [29], which, given an average of 10,000 treatments yearly delivered by a dialysis unit, translates into 2000 kg less waste. In terms of carbon footprint, one should also consider the consumption of water and energy and how this can be limited, for example, by having a more efficient water treatment system.…”

Section: Other Machine-related Variablesmentioning

confidence: 99%

Update on Clinical Evidence Supporting Hemodiafiltration

Canaud¹,

Grassmann²,

Scatizzi³

et al. 2016

Advances in Hemodiafiltration

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The aim of this chapter is to define hemodiafiltration target efficiency, to clarify the concept of "optimal convective dose," and to facilitate hemodiafiltration (HDF) implementation in clinical practice by addressing the need for the establishment of best clinical practices for HDF. The approach taken was to conduct a comprehensive summary of clinical evidence supporting HDF. Convective dose is the total ultrafiltered volume and is complementary to diffusive dose (urea Kt/V) as a dose-dependent parameter. It can be quantified and adjusted to patient characteristics. Factors affecting convective dose are discussed: patient characteristics, prescription-dependent factors, and technical and machine-dependent factors. The key issue of HDF prescription and implementation of best practices is addressed as are intermediary and endpoint clinical outcomes. The main messages are as follows: (1) HDF is safe and effective provided that best clinical practices are followed and the right convective dose is delivered; (2) HDF is easy to perform with new technology; and (3) depending on the convection volume, HDF reduces all-cause and cardiovascular mortality. Open challenges remain, namely, the implementation of best practices to (a) achieve optimal convection volume, (b) define patient subsets that would benefit more from HDF, and (c) evaluate new tools that fine-tune HDF prescription according to individual patient needs.

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Mp461the Impact of Disposables Towards More Eco-Friendly and Less Costly Haemodialysis

Cited by 3 publications

References 0 publications

Advanced hemodialysis equipment for more eco-friendly dialysis

Advanced hemodialysis equipment for more eco-friendly dialysis

Dialysis-Induced Cardiovascular and Multiorgan Morbidity

Update on Clinical Evidence Supporting Hemodiafiltration

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