The carbon footprints of home and in‐center maintenance hemodialysis in the United Kingdom

Abstract

Climate change presents a global health threat. However, the provision of healthcare, including dialysis, is associated with greenhouse gas emissions. The aim of this study was to determine the carbon footprints of the differing modalities and treatment regimes used to deliver maintenance hemodialysis (HD), in order to inform carbon reduction strategies at the level of both individual treatments and HD programs. This was a component analysis study adhering to PAS2050. Emissions factors were applied to data that were collected for building energy use, travel and procurement. Thrice weekly in-center HD has a carbon footprint of 3.8 ton CO2 Eq per patient per year. The majority of emissions arise within the medical equipment (37%), energy use (21%), and patient travel (20%) sectors. The carbon footprint of providing home HD varies with the regime. For standard machines: 4 times weekly (4 days, 4.5 hours), 4.3 ton CO2 Eq; 5 times weekly (5 days, 4 hours), 5.1 ton CO2 Eq ; short daily (6 days, 2 hours), 5.2 ton CO2 Eq; nocturnal (3 nightly, 7 hours), 3.9 ton CO2 Eq; and nocturnal (6 nightly, 7 hours), 7.2 ton CO2 Eq. For NxStage equipment: short daily (5.5 days, 3 hours), 1.8 ton CO2 Eq; 6 nightly nocturnal (2.1 ton CO2 Eq). The carbon footprint of HD is influenced more by the frequency of treatments than by their duration. The anticipated rise in the prevalence of home HD patients, dialyzing more frequently and for longer than in-center patients, will increase the emissions associated with HD programs (despite reductions in patient travel emissions). Emerging technologies, such as NxStage, might offer a solution to this problem.

The carbon footprint of cataract surgery

“…This finding is in keeping with the results of the few published carbon footprinting studies undertaken within the health care setting to have included both direct and indirect emissions. 4,6,7,10 The message is becoming increasingly clear: While carbon reduction strategies outside of the health care sector often focus upon the emissions arising from building energy use and travel, such strategies, although valuable, will prove insufficient to meet the targets set by the NHS Carbon Reduction Strategy. 5 Instead, attempts to reduce GHG emissions arising within the health care setting must also target procurement emissions by, for example, working with industry partners to achieve carbon reduction.…”

“…However, the emissions associated with waste management represent a smaller contribution (1.88%) than has been reported for other health care services and treatments. [5][6][7] The introduction of strategies to recycle components of the waste generated by the cataract pathway is therefore likely to have a limited impact upon the overall carbon footprint. However, such strategies remain desirable; not only will the introduction of recycling reinforce staff awareness of the importance of sustainability within health care but also such measures are likely to be costeffective.…”

“…The emissions attributable to the travel of staff and patients have been included to maintain consistency with previous studies undertaken within the health care setting, [6][7][8] including the NHS England Carbon Footprinting Study, 5 although PAS2050 would suggest the exclusion of those emissions associated with the travel of employees and consumers. 19 Exclusions To maintain consistency with PAS2050, 19 the following sources of GHG emissions were excluded from the analysis: buildings and construction; sterilisation procedures; human inputs into processes; the capital cost of machinery used repeatedly; food and beverages for staff; scientific research; staff training; business services; and immaterial emissions sources (those anticipated to be o1% of the total emissions).…”

“…Carbon footprinting studies with varying methodological approaches and complexity are now being reported within the medical literature. [6][7][8][9][10][11][12][13] The importance of sustainability within the delivery of ophthalmic care has been considered previously, 14,15 and the emissions attributable to small incision cataract surgery have been argued to be smaller than those arising from phacoemulsification. 16 Cataract surgery is a commonly performed surgical procedure within the NHS in England with over 300 000 operations undertaken annually making it an ideal target for reducing emissions.…”

Harmonizing Climate Change Adaptation and Mitigation in the Health Sector

“…Telemedicine has been shown to improve access to and even quality of care, and in some cases to cut costs [6][7][8]. What most people don't even reflect upon is that telemedicine services also has a great carbon reduction potential by reducing the need for travelling [9][10][11][12] and the positive effects remains when accounting for the carbon costs of manufacturing, using and disposing of the technology used to facilitate such virtual meetings (Holmner et al, submitted for publication). Travel represents as much as 18% of the carbon emissions of the UK health sector [13] and telemedicine could theoretically make a notable contribution to climate change mitigation, at least in developed countries.…”