Green haemodialysis: comparison of dialysis bags versus fresenius granumix at the AOU Policlinico di Modena, Italy

Background: Haemodialysis (HD) has a significant environmental footprint due to its high resource consumption and waste generation. A key component is dialysate production, which typically involves mixing water, bicarbonate, and a single-use acid concentrate bag for each session. An alternative method is the central delivery of acid concentrate, prepared on-site using dry powder formulations. This study compares the environmental impact of these two delivery systems, focusing on waste reduction, elimination of single-use plastic, and decreased transport-related emissions. Methods: A detailed life cycle assessment (LCA) was carried out using OpenLCA and the Ecoinvent v3.1 database to compare the traditional acid concentrate bag system with the central delivery system (Granumix, Fresenius, Germany). Data on material inputs, energy use, waste generation, and transportation were collected. Flow diagrams captured the full life cycle of each method, and various environmental indicators were analysed, including climate change, acidification, and ecotoxicity. Results: The Granumix system demonstrated considerably lower environmental impact than traditional bag use. It reduced climate change potential by 30% (CO₂-equivalent) and freshwater ecotoxicity by 15%. Additional benefits were observed in acidification, resource use, and overall emissions, indicating the system’s broader environmental advantages. Conclusions: The central delivery of acid concentrate using the Granumix system is a more sustainable option for HD, significantly reducing environmental burdens across several categories. These findings underscore the value of adopting innovative delivery models to make essential healthcare treatments more environmentally sustainable.