Introduction: Hemodialysis has a large environmental impact because it uses large volumes of water, medical supplies and energy. A patient undergoing weekly dialysis treatment (three times a week for 4 hours) utilizes about 18,000 liters of water and 800-925 KWh a year. In the United States there are 450,000 patients in hemodialysis and 2.5 billion dialyzers and blood lines are disposed every year, this represents over 7 billion pounds of carbon-based medical waste.

Methods: We used Life Cycle Assessment methodologies to compare 3 forms of providing 15 years of blood conditioning to remove toxic metabolites for patients that suffered from diminished or inexistent kidney function: hemodialysis vs peritoneal dialysis vs kidney transplantation. We modeled each case using SimaPro Life Cycle Assessment software and estimated the environmental effects of materials, processes and energy expenditure using the EcoInvent 2.2 damage database. The model considered average amount of energy, water, tubing equipment, electrolyte solutions and other supplies used in both types of dialysis and all of the required energy and operating room equipment (including its cleaning process) in the case of transplantation.

Results: Kidney transplantation is the most sustainable option to provide 15 years of kidney-function equivalent years. It reduces overall environmental impacts by 95.7% compared to the hemodialysis and by 90.9% compared to peritoneal dialysis. Although transplantation produces the highest initial environmental impacts, it doesn't produce a lot of damages after year 1. The most substantial contributors to environmental damages are energy consumption and consumables in both types of dialysis.

Discussion: Transplantation is the most sustainable option to re-establish partial kidney function to people that have lost it. Additionally, this intervention has additional co-benefits such as improved post-operatory survival, a better quality of life and considerable time savings for the patient which are not considered when estimating environmental benefits. The environmental impact of hemodialysis is the highest of all of the analyzed options and unfortunately this is the most widely used medical treatment to substitute renal function. Therefore, a change in policy towards transplantation should be promoted by medical professionals and policy makers to improve survival and quality of life for the patients while maximizing protection of the natural environment.

CITATION INFORMATION: Grafals M, Sanchez R. The Environmental Impact of Dialysis vs Transplantation. Am J Transplant. 2016;16 (suppl 3).

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