Emodialisi e sostenibilità ambientale
The healthcare system is great producer of greenhouse gases, and user of natural resources as well. Any dialysis-related activity, from procurement of materials to organization of patient transport, from administration of dialysis therapy itself to inevitable production of large amounts of waste, makes dialysis one of the health activities using most natural resources, indirectly producing greenhouse emissions.
Water consumption represents, inevitably, the highest environmental impact. We nephrologists are generally ill informed on the topic, and few of us know the actual water requirement per single dialysis treatment. Particularly, little is known about the large volume of water wasted with reverse osmosis: despite the industry’s efforts to reutilize wasted water, currently some 30% of the water used by reverse osmosis is still lost. However, in some countries modified water systems already exist, recovering and reusing lost water lost for different purposes, such as cleaning, steam production and gardening.
The power requirement, waste production and even the design of dialysis centers are further issues in the dialysis-ecocompatibility relationship. Awareness of these issues is surely the first step. It is now vital that we keep ourselves informed and updated, and raise these issues in our dialysis centers. English and Australian experience will hopefully pave the way for certain small, already feasible, acts. In future, the immediate future, the design of dialysis centers and especially water treatment systems is bound to undergo huge changes if we are to reduce the negative impact on the environment.
Sustainability Series: Snapshot of Kidney Care. Examining the environmental impact of kidney care. https://sustainablehealthcare.org.uk/blog/sustainability-series-snapshot-kidney-care.
Connor A, Lillywhite R, Cooke MW. The Carbon Footprint of a Renal Service in the United Kingdom. QJM. 2010;103:965-975.
Lim AEK, Perkins A, Agar JWM. The carbon footprint of an Australian satellite hemodialysis unit. Aust Health Rev. 2013;37(3):369-74. doi: 10.1071/AH13022.
Barraclough KA, Gleeson A, Holt SG, Agar JWM. Green dialysis survey: establishing baseline for environmental sustainability across dialysis facilities in Victoria, Australia. Nephrology. 2019;24:88-93.
Sustainability the seventh dimension of quality. Working for Better Kidney Care. http://renaltsar.blogspot.com/2010/05/sustainability-seventh-dimension-of.html.
Piccoli GB, Nazha M, Ferraresi M, Vigotti FN, Pereno A, Barbero S. Eco-dialysis: the financial and economical cost of dialysis waste products: is a “cradle to cradle” model feasible for planet-friendly hemodialysis waste management? Nephrol Dial Transplant. 2015;30:1018-27. doi: 10.1093/ndt/gfv031.
Kawanishi H. The central dialysis fluid delivery system (CDDS): is it specialty in Japan? Ren Replace Ther. 2016;2:1. https://doi.org/10.1186/s41100-016-0016-4.
Bendine G, Autin F, Fabre B, et al. Hemodialysis therapy and sustainable growth: a corporate experience in France. Nephrol Dial Transplant. 2020;1-7. doi: 10.1093/ndt/gfz284.
Blankestijn PJ, Arici M, Bruchfeld A, et al. ERA-EDTA invests in transformation to greener health care. Nephrol Dial Transplant. 2018;33(6):901-3.
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