A website calculator to benchmark the carbon footprint of haemodialysis

BACKGROUND: Haemodialysis (HD) contributes vastly to greenhouse gas (GHG) emissions. Recognizing this, the German Society for Nephrology initiated a web-based carbon footprint assessment tool to benchmark emissions. METHODS: This study collected data from five pilot HD centres between 2015 and 2023. Emission categories appropriate for HD were defined and included transportation, energy consumption, manufacturing/disposal and other operational factors. RESULTS: The all-centre, all-period average was 3.72 ± 0.44 tons of carbon dioxide equivalents per patient per year, with manufacturing/disposal, energy consumption and patient transportation as the largest contributions. Over the assessment period, a reduction of 9.1% was achieved, through changes in dialysate flow (-0.16 tons/patient/year), solar power system installation (-0.21 tons/patient/year) and transition to a planetary health-adapted diet (-0.10 tons/patient/year). A best-case scenario with modelled implementation of all ready-to-use measures, including 40% of patients switching to automated peritoneal dialysis and 10% to incremental HD, projected a reduction potential of 38.7% or 1.5 tons/patient/year, substantially less than what is needed to reach net zero. CONCLUSIONS: Using available technology, HD-related GHG emissions were reduced by 9% in the short term. Higher future reductions to meet the targets of a 50% reduction by 2030 and net zero by 2045 might necessitate enhancing prevention and transplantation efforts, technological innovation, support chain adaptations and structural changes like increased use of peritoneal dialysis.