Sustainable kidney Care

The problem with renal replacement therapy

End-stage kidney disease (ESKD) requires a disproportionate share of healthcare system resources for its treatment, with correspondingly large cost, resource use and environmental impacts.

The 18.61 million tonnes CO2e emissions attributed to NHS England in 2004 result from the provision of care to 51.4 million people, equating to 0.4 tonnes per patient per year.

A 2010 study for Dorset Renal Service estimated that the provision of haemodialysis and peritoneal dialysis to just 277 patients, from a population of 865,000, results in 1,965 tonnes CO2eq, equating to 7.1 tonnes of CO2eq per dialysis patient per year. This means that renal care is 18 times more resource intensive than the general healthcare emissions burden of a typical patient. Just as kidney care is considered to be a ‘high cost, low volume’ specialty in financial terms, it seems that it is also a carbon intensive specialty.

Resource and greenhouse gas intensity of RRT

Globally, it is estimated that the roughly 2 million renal replacement therapy (RRT) patients require 2 to 3% of healthcare budgets and their care and that might be responsible for 14 million tonnes CO2e per year. That is bigger than the annual emission of Ghana, a country of 32 million people. Add to this the rising trends in the incidence of ESKD and the fact that not all the people in need of RRT are currently able to access it, the actual CO2 and financial cost burdens are likely to rise sharply.

Recognising this, the renal community has long been at the forefront of efforts to improve the sustainability of healthcare and reduce avoidable harm to people and planet alike. There is now a need for urgent action if renal care is going to help meet international goals for a 1.5°C world and national efforts, such as the NHS England ambition to become Net Zero.