Sustainable and accessible hemodialysis: life cycle assessment on central acid delivery system

Introduction: The healthcare sector contributes over 4% of global greenhouse gas emissions. As healthcare systems pursue carbon reduction targets, sustainable innovations in clinical operations are essential. Hemodialysis (HD) relies heavily on dialysate concentrates as one of its major consumables. This study evaluates the environmental impact of implementing a central acid concentrate delivery system (CCDS) using dry concentrate powder at the University Medical Center Utrecht (UMC Utrecht) and examines its broader global applicability. Methods: A comparative life cycle assessment (LCA) was conducted to assess the environmental impacts of acid concentrate delivery via single-use liquid canisters versus CCDS using dry powder in reusable barrels at UMC Utrecht. The analysis includes additional scenarios involving long-distance distribution to Italy in Europe, Kenya in Africa, and the Philippines in Asia. Results: Implementation of CCDS at UMC Utrecht reduced carbon emissions by 58%. Endpoint impacts on human health, ecosystem quality, and resource scarcity were reduced by more than half. Despite longer transport distances in global scenarios, CCDS consistently outperformed the canister system across most impact categories, driven by reuse of packaging and reduced transport volume and weight. Conclusions: CCDS offers a more sustainable alternative, with substantial environmental benefits even in long-distance applications. Operational advantages include reduced manual handling and simplified logistics. By enabling local dialysate production and decreasing reliance on imported disposables, CCDS may also improve accessibility in low-resource settings. Widespread adoption could thereby advance environmental sustainability globally.