The Carbon Footprint of Peritoneal Dialysis in Australia

Background As climate change escalates with increasing health impacts, health care must address its carbon footprint. The first critical step is understanding the sources and extent of emissions from commonly utilized clinical care pathways. Methods We used attributional process-based life-cycle analysis to quantify CO2 equivalent emissions associated with the delivery of Baxter's HomeChoice automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Australia. Results The annual per-patient carbon emissions attributable to the manufacture and disposal of peritoneal dialysis (PD) fluids and consumables were 1992 kg CO2 equivalent emissions for APD and 1245 kg CO2 equivalent emissions for CAPD. Transport impacts varied depending on the distance between the site of manufacture of PD fluids and consumables and the state of origin of the patient. Therefore, the total impact of providing PD also differed by Australian state, ranging from 2350 to 4503 kg CO2 equivalent emissions for APD and from 1455 to 2716 kg CO2 equivalent emissions for CAPD. Recycling of polyvinyl chloride (PVC) could reduce emissions by up to 14% for APD and 30% for CAPD depending on the distance between the site of PVC waste generation and the recycling center. Conclusions This study demonstrated higher per-patient carbon emissions from APD compared with CAPD, owing to both higher fluid and consumable requirements and the consequent higher transport impacts. PVC recycling can partially mitigate PD-associated carbon emissions.