TY - JOUR
T1 - Environmental footprint of peritoneal dialysis in Europe
T2 - a comparative life cycle assessment across four European centres
AU - Fehintola, Abass
AU - Jakubowska, Zuzanna
AU - Kepska-Dzilinska, Malgorzata
AU - Malyszko, Jolanta
AU - Crooijmans, Guus
AU - Thomas, Ootjers
AU - Larkin, James
AU - Ligabue, Giulia
AU - Alfano, Gaetano
AU - Donati, Gabriele
AU - MartínezCadenas, Rodrigo
AU - Yasar, Aycan
AU - Sanz, Belén
AU - de Rivera, Gonzalez M
AU - Cordero, Lucia
AU - Audije-Gil, Julia
AU - Arenas, María Dolores
AU - Steinbach, Ingeborg
AU - Arias, Marta
AU - Ortiz, Alberto
AU - Gerritsen, Karin
AU - Duane, Brett
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2026/6
Y1 - 2026/6
N2 - INTRODUCTION: Peritoneal dialysis (PD) is a home-based renal replacement therapy offering clinical and quality-of-life advantages, but it also poses environmental challenges due to resource use and waste generation. This study compares the environmental impacts of PD across four European centres to identify regional sustainability differences and evaluate the footprint of continuous ambulatory (CAPD), automated (APD), and incremental (iPD) PD.METHODS: A cradle-to-grave life cycle assessment (LCA) was conducted for one year of PD treatment per patient using OpenLCA software and the EcoInvent database across four clinical centres; Madrid, Warsaw, Utrecht, Modena. Data were collected on material use, energy and water consumption, transportation, and waste disposal. Key indicators included global warming potential (GWP), energy use, water footprint. The environmental performance of each centre and dialysis modality was assessed.RESULTS: Environmental impacts varied significantly between centres ranging from GWP 3381 kg CO₂-eq to 1736 kg, reflecting differences in energy mix and efficiency. Energy consumption ranged from 54,710 MJ to 28,894 MJ and water footprint from 6631 m³ to 854 m³. Across all centres, CAPD and APD had higher environmental burdens than iPD. iPD reduced emissions by up to 50% and had a lower-impact profile.CONCLUSIONS: PD displays substantial environmental impact variability across centres, driven by differences in material consumption, waste management, energy sourcing, and clinical protocols. Cleaner energy profiles, effective waste management, and reduced reliance on single-use consumables may lower environmental burdens. These findings underscore the importance of integrating environmental performance into clinical decision-making and health system planning.
AB - INTRODUCTION: Peritoneal dialysis (PD) is a home-based renal replacement therapy offering clinical and quality-of-life advantages, but it also poses environmental challenges due to resource use and waste generation. This study compares the environmental impacts of PD across four European centres to identify regional sustainability differences and evaluate the footprint of continuous ambulatory (CAPD), automated (APD), and incremental (iPD) PD.METHODS: A cradle-to-grave life cycle assessment (LCA) was conducted for one year of PD treatment per patient using OpenLCA software and the EcoInvent database across four clinical centres; Madrid, Warsaw, Utrecht, Modena. Data were collected on material use, energy and water consumption, transportation, and waste disposal. Key indicators included global warming potential (GWP), energy use, water footprint. The environmental performance of each centre and dialysis modality was assessed.RESULTS: Environmental impacts varied significantly between centres ranging from GWP 3381 kg CO₂-eq to 1736 kg, reflecting differences in energy mix and efficiency. Energy consumption ranged from 54,710 MJ to 28,894 MJ and water footprint from 6631 m³ to 854 m³. Across all centres, CAPD and APD had higher environmental burdens than iPD. iPD reduced emissions by up to 50% and had a lower-impact profile.CONCLUSIONS: PD displays substantial environmental impact variability across centres, driven by differences in material consumption, waste management, energy sourcing, and clinical protocols. Cleaner energy profiles, effective waste management, and reduced reliance on single-use consumables may lower environmental burdens. These findings underscore the importance of integrating environmental performance into clinical decision-making and health system planning.
U2 - 10.1093/ckj/sfag156
DO - 10.1093/ckj/sfag156
M3 - Review article
C2 - 42232595
SN - 2048-8505
VL - 19
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 6
M1 - fag156
ER -