A recent study published in the American Journal of Kidney Diseases shows that, among the top three most common forms of kidney replacement therapy, hemodialysis (HD) has the highest environmental impacts, whereas kidney transplant has the lowest. For example, HD was associated with four times more greenhouse gas (GHG) emissions than transplantation, and two times more emissions than cycler peritoneal dialysis (PD).
Kidney failure is a serious condition affecting an estimated 3.9 million people worldwide. Kidney replacement therapies are life-saving options for these patients, but these therapies can also have negative impacts on the environment. Some studies have explored the environmental footprint of a single modality at a single site, but no studies to date have measured and compared multiple types of kidney replacement therapies at a single site. Importantly, such data could help support better, greener decision-making and policy.
“This study comes from a growing recognition that healthcare doesn't operate in a vacuum," explains Dr. Christopher Nguan, Director of Surgical Services, Vancouver General Hospital (VGH) Kidney Transplant Program. “We've extended and improved lives through kidney replacement therapies, but now we need to measure—and take responsibility for—the environmental consequences of that progress."
In their study, Nguan and his colleagues conducted an environmental impact assessment of HD, PD, and transplantation using kidneys from deceased donors. Using real data from VGH, they assessed each of these modalities for 18 different types of environmental impacts, including climate change, air pollution, human toxicity, and water depletion.
With few exceptions, across the environmental impact categories, HD had the highest impact, followed by PD, and then kidney transplantation. In terms of greenhouse gas emissions, delivering HD to a single patient was associated with the equivalent of 2.7 tonnes of carbon dioxide emissions annually, compared with 1.4 tonnes for PD and 0.7 tonnes for kidney transplantation.
The researchers caution that this assessment only captures environmental impacts over the course of one year, and the kidney transplant lasts for a median of 12 years or longer. While the one-time procedure involves many follow-up appointments – and thus carbon emissions – in the first year, the actual environmental impact of kidney transplant for longer periods would be progressively lower than what is estimated in this study.
Across all categories, kidney transplantation was found to be the most environmentally-friendly therapy, with impacts at less than 35% of those of HD. PD also demonstrated lower environmental impacts than HD, between 9–41% less across all 18 assessed categories. PD's largest environmental impact was associated with water depletion.
The researchers note that the benefits of transplantation extend far beyond the environment to encompass substantial benefits for patients, including lower mortality rates, improved patient experience and quality of life, and also benefits for health care systems in terms of cost-effectiveness.
“This research helps clarify the environmental impacts of kidney care and points us toward next steps," says Helen Chiu, who supports BC Renal's planetary health strategy within her role as Quality Lead, Patient-Centred Performance Improvement. “It's important to integrate the evidence thoughtfully at the system level and in care conversations to support transparent, informed decision‑making that upholds high-quality care and respects what matters most to each person's unique circumstances. The goal is to care for people and the planet together."
Study: Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment
