Introduction to Sustainable Dialysis


… in 2012, an estimated 2,358,000 people are undergoing dialysis treatment. 89% (2,106,000) are estimated to be on haemodialysis, 11% (252,000) on peritoneal dialysis, and with the annual growth in global dialysis (7%) out-stripping world population growth rates, extreme and unsustainable pressure is placed on global dialysis services”     …. Edited excerpt


Dialysis is a life sustaining treatment for people with end stage kidney disease.

It can be provided in a different of settings depending on a patient’s choice and capability:

  • in healthcare facilities – either in hospital-based care or in freestanding ‘satellite’ community dialysis facilities.
  • in the home.

There are two main dialysis modalities:

  1. Haemodialysis (HD) either in facilities, or at home
  2. Peritoneal dialysis (PD), primarily at home

While all forms of dialysis are resource intensive and create complex waste disposal pathways, the environmental impact can vary depending on modality and/or treatment setting.

Centralised (facility-based) HD services are particularly resource greedy and waste generative … more than any other individual patient-centred healthcare activity.

As an example, a study in Geelong, Australia found the annual dialysis-generated carbon footprint for each satellite-based patient was about half the total annual greenhouse gas emissions created by an average Australian citizen.

While home dialysis modalities offer a number of advantages for health outcomes, patient lifestyles, and service cost benefits, home care also adds significant financial and environmental burden for home-based dialysis patients.

The resource conservation and management measures described within this site can help to significantly lift this burden from both health care facilities and home patients.


The seventh dimension of quality care

In the United Kingdom, both the British Renal Society and British Renal Association have adopted sustainability policies that acknowledge ‘sustainability’ as ‘the seventh dimension of quality care’. Dr Charlie Tomson, President Elect, British Renal Association stated: …

“Sustainability is the seventh dimension of quality of care, alongside safety, timeliness, effectiveness, efficiency, equity, and patient experience. It is important to realise that working to improve sustainability will seldom be in conflict with the other dimensions; in particular, low carbon healthcare is likely to improve cost efficiency and patient empowerment.”


Our UK friends at the Centre for Sustainable Healthcare and at Green Nephrology have long been ‘the light on the hill’ for environmental sustainability in the health sector.

GNAT seeks to follow their path but there is much to be done.

A recent survey from Victoria, Australia, defines a general lack of sustainability practice, despite an acceptance that it is important.

Little has been done in the carbon footprint space with only one UK HD, one ANZ HD, and one Chinese PD study as yet in the literature.


We hope this website will stimulate thought, discussion, and action in this much neglected space.