The Carbon Footprint of Peritoneal Dialysis in Australia

Scott McAlister; Ben Talbot; John Knight; Susan Blair; Forbes McGain; Stephen McDonald; Craig Nelson; Richard Knight; Katherine A Barraclough

doi:10.1681/ASN.0000000000000361

The Carbon Footprint of Peritoneal Dialysis in Australia

J Am Soc Nephrol. 2024 Apr 26. doi: 10.1681/ASN.0000000000000361. Online ahead of print.

Authors

Scott McAlister^{1

2}, Ben Talbot^{3

4}, John Knight^{3

5}, Susan Blair⁶, Forbes McGain^{7

8

9}, Stephen McDonald^{10

11

12}, Craig Nelson^{8

13

14

15}, Richard Knight⁶, Katherine A Barraclough^{16

17}

Affiliations

¹ Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
² Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia.
³ George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ School of Population Health, University of New South Wales, Sydney, Australia.
⁵ Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
⁶ Department of Renal Medicine, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
⁷ Departments of Anaesthesia and Intensive Care Medicine, Western Health, Footscray, Victoria, Australia.
⁸ Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.
⁹ School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁰ ANZDATA Registry, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia.
¹¹ Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
¹² Central Adelaide Renal and Transplantation Service, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
¹³ Department of Nephrology, Western Health, Sunshine, Victoria, Australia.
¹⁴ Western Health Chronic Disease Alliance, Western Health, Sunshine, Victoria, Australia.
¹⁵ Department of Medicine, Deakin University, Burwood, Victoria, Australia.
¹⁶ Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁷ Department of Medicine, University of Melbourne, Parkville, Australia.

PMID: 38671537
DOI: 10.1681/ASN.0000000000000361

Abstract

Background: As climate change escalates with increasing health impacts, healthcare must address its carbon footprint. A critical first step is understanding the sources and extent of emissions from commonly utilised clinical care pathways.

Methods: We used attributional process-based life cycle analysis to quantify CO2 equivalent emissions associated with the delivery of Baxter home automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Australia.

Results: Annual per patient carbon emissions attributable to the manufacture and disposal of PD fluids and consumables were 1,992 kg CO2equivalent emissions for APD and 1,245 kg CO2equivalent emissions for CAPD. Transport impacts varied depending on the distance between site of manufacture of PD fluids and consumables and the home state of the patient. As a result, the total impact of providing PD also differed by Australian state, ranging from 2,350-4,503 kg CO2 equivalent emissions for APD and from 1,455-2,716 kg CO2 equivalent emissions for CAPD. Recycling of polyvinyl chloride (PVC) could reduce emissions by up to 14 per cent for APD and 30 per cent for CAPD, depending on the distance between the site of PVC waste generation and the recycling centre.

Conclusions: This study demonstrated higher per patient carbon emissions from APD compared to CAPD, due to both higher fluid and consumable requirements, and the consequent higher transport impacts. PVC recycling can partially mitigate PD associated carbon emissions.

Grants and funding

Victorian Department of Health