Incremental Hemodialysis: A Road to a Greener and Personalized Nephrology

Abstract

Introduction: Healthcare facilities are among the greatest contributors to resource consumption and waste generation. Nephrology is one of the most polluting medical areas, mostly due to hemodialysis (HD). Incremental hemodialysis (iHD) has gained attention due to several clinical advantages, by decreasing the number of sessions while the patient still has residual kidney function. Beyond these benefits, this regimen might also be both more economical and environmentally friendly. The aim of this study was to evaluate the potential reduction of resource consumption, waste generation and carbon footprint associated with the implementation of iHD. Methods: We conducted a single-center retrospective analysis of 157 incidental patients initiating HD in our centre in 2019 (pre-pandemic). Retrospectively, a set of criteria identifying eligibility for an iHD program were applied to those patients. Results: Twenty-three patients (15%) would have been eligible for iHD instead of starting a standard HD program. In that scenario, iHD implementation would have reduced from 36 to 85 tons of CO2 equivalent emissions and 4186 kg of contaminated waste yearly, at our unit. iHD would also allow savings of almost 60 000€ and a reduction in water consumption of 418 600 L in one year. Conclusion: This study shows that iHD can significantly attenuate the environmental and economic impact of HD. These findings encourage kidneycare programs and policymakers to adopt greener options but should never be detrimental to the clinical decision of referencing a patient to iHD.

Keywords

• carbon footprint
• medical waste
• nephrology
• peritoneal dialysis
• precision medicine