Hemodialysis treatment creates ‘substantial’ carbon footprint
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During 2020, emissions from a single hemodialysis treatment were 58.9 kg carbon dioxide equivalents, according to data published in the Journal of the American Society of Nephrology.
Further, investigators found the top contributors to emissions were transportation, natural gas and water.
“Studies have demonstrated that hemodialysis facilities have a high environmental effect because the treatment requires large amounts of energy, water and supplies. However, data regarding how much greenhouse gas emissions from hemodialysis treatment vary across facilities, treatments and emission contributors have been lacking,” Ashwini R. Sehgal, MD, from the division of nephrology at The MetroHealth System in Cleveland, Ohio, and colleagues wrote. They added, “Understanding the magnitude and variation of emissions may help identify measures to reduce the carbon footprint of hemodialysis treatment. Reducing environmental effect is also likely to decrease both facility costs and overall health care expenditures.”
Researchers evaluated a total of 209,481 hemodialysis treatments in the year 2020 from 15 participating freestanding dialysis facilities in northeast Ohio to determine the amount and causes of variation in the carbon footprint of hemodialysis treatment. Specifically, researchers examined emissions from electricity, natural gas, water and supply use; and biohazard and landfill waste during that year at each facility.
Using the amount of carbon dioxide produced per unit of fuel consumed, researchers calculated carbon footprints of hemodialysis treatment. Additionally, researchers utilized descriptive statistics to estimate total emissions per facility, emissions per treatment and emissions per contributor, along with variation across facilities, treatments and contributors.
Overall, the annual emissions per facility averaged 769,374 kg carbon dioxide equivalents (CO2-eq), which equated to emissions from the annual energy use of 93 homes.
Similarly, emissions per treatment were 58.9 kg CO2-eq, with a threefold variation across facilities, and this was the same as driving an average automobile for 149 miles. Researchers identified the top three contributors to emission as patient and staff transportation (28.3%), electricity (27.4%) and natural gas (15.2%). Moreover, contributors with the largest variation in emissions per hemodialysis treatment were transportation, natural gas and water.
Despite the expectation that facilities from the same organization located in the same area would have similar emissions, investigators found significant variation in carbon footprints across facilities, treatments and emission contributors.
“In conclusion, hemodialysis treatment has a sizable carbon footprint that varies substantially across facilities, treatments and emission contributors. The large magnitude of this footprint presents a challenge in addressing climate change, whereas the substantial variation presents potential opportunities to reduce emissions,” Sehgal and colleagues wrote. “Our approach may also be useful to understand and address the carbon footprint of other aspects of health care.”
Perspective
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In this recent article in the Journal of the American Society of Nephrology, Ashwini R. Sehgal, MD, and colleagues looked at the carbon footprint from 15 freestanding clinics in northeast Ohio. They found the top three contributors to emissions were patient and staff transportation, electricity and natural gas. The investigators also found significant variation in carbon footprints across facilities, treatments and emission contributors.
Fresenius Medical Care has a target to reach carbon neutrality by 2040. To get there we have set a goal to reduce direct and indirect emissions, which include natural gas and electricity, by 50% by 2030.
A valuable tool in reducing carbon emissions will be the transition to renewable electricity. Last year we purchased 140,000 MWh worth of Green-e certified Renewable Energy Certificates (RECs). And by 2025 we have an important milestone by which the entire electricity consumption from our in-scope locations (clinics and manufacturing) in the U.S. and Canada, and 80% of electricity use in the European Union, shall be covered by renewable sources.
Transportation emissions remain a top contributor to the environmental impact from outpatient dialysis. We see a reduction potential through the ongoing acceleration of new, innovative home dialysis products.
Finally, we have embedded many recycling initiatives in our outpatient operations. In the U.S., our dialysis machine recycling program diverted 126 net tons of plastics and metals in 2021. Other environmental programs include reusing blue dialysate drums, which kept more than 141 thousand containers from entering a landfill in 2021 and recycling sharps containers which eliminated 1,162 tons of waste from going to landfill.
We celebrate the importance this study placed on expanding efforts to reduce our environmental impact as an industry and look forward to innovations in conservation in the months and years to come.
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