What drives the environmental footprint of in-centre haemodialysis? A multicentre European life cycle assessment.

BACKGROUND: Haemodialysis (HD) is among the most resource-intensive long-term therapies in medicine. Comparative life cycle assessment evidence across European in-centre HD settings remains limited. METHODS: Cradle-to-grave life cycle assessment was conducted at four European HD centres in Spain (FJD), Netherlands (UMCU), Italy (UNIMORE), and Poland (WUM); functional unit: one patient-year (156 sessions, 4 hours). Primary data covered consumables, electricity, water, travel, and waste; Environmental Footprint 3.1 in OpenLCA v2.5 with EcoInvent v3.11. Sensitivity analyses modelled patient transport modal shift to 75% (S1b) or 100% public transport (S1c), and battery electric vehicle adoption for car-using patients (S2), at fixed distances. RESULTS: Annual climate change impacts ranged from 1829 to 4894 kg CO2e per patient-year (2.7-fold difference). Consumables ranged from 953 (UNIMORE) to 1975 (WUM) kg CO2e per patient-year, electricity from 149 (FJD) to 659 (UMCU) kg CO2e, patient travel from 265 (FJD) to 2548 (UNIMORE) kg CO2e, staff travel from 80 (FJD) to 615 (UNIMORE) kg CO2e, and waste from 97 (FJD) to 146 (WUM) kg CO2e. Modal shift to public transport (S1c) reduced patient travel emissions by 57.9 to 64.7%, while electrification (S2) achieved smaller reductions of 3.9 to 30.6%. Public transport delivered two- to fivefold larger absolute carbon savings than electrification at every centre. CONCLUSIONS: The HD carbon footprint varies nearly threefold across European settings. Centre-specific emission hotspots identified through absolute life cycle stage comparisons define the most actionable intervention priorities. Where public transport is structurally feasible, modal shift is the single largest modifiable lever.