International Environmental Impact of CKD Care

Data reporting the environmental impact of the overall chronic kidney disease (CKD) care pathway are limited.

We performed a life cycle assessment (LCA) of CKD stages 1 to 5, with a primary focus on greenhouse gas (GHG) emissions and a secondary aim of quantifying broader environmental effects. The main scope estimated annual environmental impacts in the USA and UK, both per patient and for the total CKD population, with 8 additional countries included in exploratory analyses. Model inputs (annual health care resource use; travel distance; energy mix; and heating, cooling, and lighting requirements) were country-specific, where available. Environmental impacts by stage were calculated using the ReCiPe impact assessment method.

In the USA and UK, annual per-patient GHG emissions increased with CKD stage, from 1.9 to 7.8 tonnes and 0.4 to 5.1 tonnes of carbon dioxide equivalents (CO₂e), respectively, with similar trends for other environmental impacts. Total annual GHG emissions were 30.6 and 1.8 megatonnes CO₂e in the USA and UK, respectively, with stage 3 contributing the greatest proportion. Hospitalization drove emissions for stages 1 to 4, for stage 5 on supportive care, and for the prevalent transplant population. For patients receiving kidney replacement therapy (KRT), choice of modality drove GHG emissions. Although only 6.7% of the US CKD population and 2.6% of the UK population received KRT, this accounted for 15.2% and 11.1% of national CKD emissions, respectively, largely from thrice-weekly in-center hemodialysis (HD).

This research provides insights into the overall environmental burden of CKD and impact hotspots, enabling the development of targeted interventions that reduce emissions.