Environmental Impact of Haemodialysis and Haemodiafiltration: A Scoping Review

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🔬研究者:Provides a structured evidence map of environmental metrics for HD/HDF, identifying methodological gaps for future LCA studies.

🏢実務担当者:Offers insights into which dialysis components contribute most to environmental impact, guiding sustainable practice changes.

🏛政策担当者:Highlights the need for standardized environmental metrics in healthcare to inform policy on sustainable dialysis delivery.

Haemodialysis (HD) is a life-sustaining therapy but also one of the most resource-intensive activities in healthcare, consuming large volumes of water and energy and generating substantial quantities of single-use consumables and clinical waste. Haemodiafiltration (HDF), particularly online high-volume HDF, has been associated with improved patient outcomes compared with conventional high-flux HD, but requires additional ultrapure water, higher consumable use. As health systems move towards net-zero targets, there is increasing concern that decisions about dialysis modality should consider not only clinical effectiveness and cost, but also environmental sustainability. Over the past decade, a number of studies have quantified the carbon footprint and water footprint of dialysis, often at local or regional level. These studies report marked variations in water use, energy consumption, waste generation, and greenhouse gas emissions across HD and HDF, reflecting differences in technology, infrastructure, clinical practice, and system boundaries. Some reports suggest that certain HDF prescription strategies may even reduce water consumption compared with standard HD, while report greater resource use. There is no consolidated overview of how environmental impacts have been measured, which components of the dialysis pathway (e.g. water treatment, dialysate production, consumables, waste management, patient transport) contribute most to the overall footprint, or how HD and HDF compare when evaluated using consistent methodological approaches. With the growing prevalence of chronic kidney disease and increasing numbers of patients requiring renal replacement therapy, these gaps limit the ability of clinicians, providers, and policymakers to make informed, sustainable choices about dialysis delivery. This scoping review aims to systematically map and synthesise the existing evidence on the environmental impact of haemodialysis and haemodiafiltration. The primary objectives are: (1) to describe and compare the carbon footprint and water footprint associated with HD and HDF, and (2) to identify the specific processes and components within HD and HDF that contribute to these footprints (e.g. water purification and reject water, electricity use, dialysers and bloodlines, concentrates and cartridges, waste handling, and transport). Secondary objectives are to summarise the overall environmental impact of HD and HDF in terms of greenhouse gas emissions, water use, energy consumption, consumable use, and waste generation; and to characterise reported sustainability or efficiency strategies. The review will follow JBI guidance for scoping reviews and be reported in line with the PRISMA-ScR checklist. Using a PCC (Population–Concept–Context) framework, we will include adult and paediatric patients receiving HD or HDF (in-centre, satellite, or home settings) and identify studies that quantify or describe environmental sustainability aspects of these modalities. We will search major bibliographic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) and grey literature sources (e.g. ProQuest, trial registries, theses, sustainability case studies), using a comprehensive strategy that combines dialysis-related terms with environmental concepts such as carbon footprint, water footprint, life-cycle assessment, waste, and sustainability. Two independent reviewers will conduct title and abstract screening in Rayyan, followed by the lead reviewer performing full-text screening and data extraction using a piloted charting form. No formal risk of bias assessment is planned, consistent with scoping review methodology. Data will be extracted on environmental metrics (e.g. kg CO₂e per treatment or per patient-year, litres of water per treatment, kWh of electricity per treatment), methodology (e.g. life-cycle assessment, input–output or hybrid approaches, component analyses), dialysis modality and settings, and any sustainability interventions or strategies described. We will standardise units where possible (e.g. per session, per patient-year) and summarise findings using descriptive statistics and narrative synthesis, rather than meta-analysis. We will also map how studies define and operationalise system boundaries (e.g. inclusion of patient transport, building energy, equipment manufacture), and explore contextual factors such as country income level, recycling practices, and water reuse strategies. The expected outcomes of this project are: (1) a structured evidence map of environmental impact metrics for HD and HDF; (2) a descriptive comparison of the relative contributions of key components (water, energy, consumables, waste, transport) to overall carbon and water footprints; and (3) a synthesis of reported sustainability strategies and their estimated benefits. By identifying patterns, methodological gaps, and areas of uncertainty, this review will provide a foundation for future, more focused life-cycle assessments. This will help inform the design and interpretation of trials comparing HD and HDF (including their environmental outcomes), and support clinicians, service providers, and policymakers in developing greener dialysis pathways.

• openalex https://doi.org/10.17605/osf.io/fwkj8first seen 2026-08-02 17:09:42