Sustainable kidney care: A life cycle assessment of the peritoneal dialysis pathways

Background Peritoneal dialysis (PD) is a home-based treatment for kidney failure, offering significant social, economic and environmental advantages over haemodialysis (HD). It allows patients greater independence and flexibility, can reduce healthcare costs in some settings, and is reported to generate a smaller environmental footprint compared to HD. However, despite this, its environmental impact, particularly in terms of resource use and waste generation, is an area of growing concern. Evaluating PD through a sustainability lens, considering environmental, social, health and economic dimensions is crucial to improving its long-term viability and reducing the healthcare sector's environmental footprint. Methods An LCA of the PD treatment pathway was conducted at the Nephrology Dialysis and Kidney Transplantation Unit, ‘Azienda Ospedaliero-Universitaria (AOU), Policlinico di Modena, Italy. Data were collected between April and July 2024 and was categorised into 17 PD-related procedures. Key activities assessed were electricity use, resource consumption (procurement), water consumption, patient and staff travel and waste disposal. Flow diagrams were created to model the PD pathway and product components were dismantled and weighed to determine material contributions. Environmental impacts were analysed using OpenLCA and the Ecoinvent database. Results Automated peritoneal dialysis (APD) treatments produced greater emissions than continuous ambulatory peritoneal dialysis (CAPD), primarily due to higher electricity consumption and the use of polyvinylchloride. APD generated 3267 kg CO 2 e annually compared to 2975 kg CO 2 e for CAPD. Monthly patient examinations contributed 250 kg CO 2 e per year, largely from travel. CAPD produced more healthcare waste (320 kg), leading to 810 kg CO 2 e emissions, while APD waste emissions were lower at 374 kg CO 2 e. Incremental dialysis approaches showed substantial reductions, with emissions falling to 1642 kg CO 2 e (APD) and 1517 kg CO 2 e (CAPD). The most impactful materials included polyethylene and PVC, with plastic components contributing significantly to overall emissions. Conclusion This comprehensive life cycle assessment (LCA) highlights the environmental challenges associated with PD, particularly in waste generation and resource use. Key areas for improvement include reducing single-use plastic reliance, increasing recycling efforts and integrating energy-efficient solutions. This study provides a foundation for targeted sustainability interventions in PD and contributes to the broader goals of the KitNewCare project, which aims to optimise health outcomes while minimising environmental impacts in kidney care.