‘Green’ nephrology can reduce the environment footprint of the industry
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The kidney community needs to recognize the impact of dialysis on the environment, particularly its dependence on Earth’s limited fresh water, a speaker at the virtual Innovations in Dialysis: Expediting Advances Symposium said.
“While the Earth is 71% water, only 3% of that is fresh water, two-thirds of which is tucked away in frozen ice,” Katherine Barraclough, MBBS (Hons), FRACP, PhD, from Royal Melbourne Hospital, told attendees. “So the water we need is hardly an abundant resource.”
Water shortages will be amplified by climate change over time, Barraclough said. “It is predicted by 2025, two-thirds of the world’s population will face water shortages.”
In her native country, Australia, Barraclough said 70% of the land is arid. “We have gotten used to that, but it is becoming an increasing issue,” she said. Water use has increased substantially around the globe at more than twice as much as growth in the general population, she said.
In dialysis, a center will use approximately 450 liters – or 118 gallons – of water per 4-hour treatment, including priming and post-dialysis rinse back of the machine, Barraclough said. “Not everyone dialyzes for 4 hours of treatment, but many patients do,” she said. Some reverse osmosis systems can be used for water purification after dialysis, but these are expensive, she said.
At her clinic at Melbourne Hospital, where conservation strategies are in place, staff still use up to 9,000 liters of water per day treating patients, or up to 3 million liters per year. “Even with the best of the best, we still have a problem with water usage,” she said.
To conserve water, Barraclough suggested that dialysis facilities consider slowing the dialysate flow. “Since the 1960s, the flow rate of dialysate worldwide has been routinely maintained at 500 mL/min, sometimes higher,” she said. ”This was considered the optimum flow rate.
“But new dialyzers today create a better dialysate flow distribution. If we reduce that to 400 mL/min we could conserve around 24 liters of water per treatment,” she said.
“That may not sound like much, but if you expand that globally, we could see significant savings,” she said.
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Barraclough K. Green dialysis. Presented at: Innovations in Dialysis: Expediting Advances Symposium; Aug. 22-24, 2021 (virtual meeting).
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