Kidney dialysis is a life-saving treatment, but it creates a lot of pollution. Researchers in Germany created a website tool to measure how much carbon pollution different dialysis centers produce. They studied five dialysis centers over eight years and found that each patient’s yearly dialysis treatment creates about 3.7 tons of carbon pollution—similar to what a car produces in a year. The good news? By making smart changes like using solar power and adjusting treatment settings, these centers reduced their pollution by 9%. However, reaching bigger pollution-reduction goals will require more dramatic changes, like switching some patients to different types of dialysis treatments.

The Quick Take

  • What they studied: How much pollution kidney dialysis centers create and what changes can reduce that pollution
  • Who participated: Five kidney dialysis centers in Germany that treated patients between 2015 and 2023, representing about 40 dialysis facilities’ worth of data
  • Key finding: Each dialysis patient creates about 3.7 tons of carbon pollution per year. Centers reduced this by 9% through practical changes like solar panels and adjusting how much dialysate (cleaning fluid) they use. Even with all possible improvements using current technology, they could only reduce pollution by 39%—not enough to meet climate goals.
  • What it means for you: If you receive dialysis, your treatment center may be working to reduce its environmental impact. These changes don’t affect your care quality. However, reaching major pollution-reduction goals will require bigger changes in how dialysis is delivered, which may eventually affect treatment options available to patients.

The Research Details

Researchers created a website calculator tool that dialysis centers could use to measure their carbon pollution. Five German dialysis centers used this tool from 2015 to 2023, entering information about their energy use, transportation, equipment manufacturing, and waste. The researchers then analyzed this data to see where pollution came from and what changes reduced it most effectively.

The study looked at four main sources of pollution: energy used to run machines, manufacturing and disposing of equipment, patient transportation to the center, and other operational activities. Researchers tracked changes over time as centers made improvements like installing solar panels, adjusting treatment settings, and changing dietary recommendations for patients.

This approach allowed researchers to see real-world results from actual dialysis centers rather than just theoretical calculations. They could identify which changes worked best and estimate how much additional pollution reduction might be possible with other available technologies.

Understanding where pollution comes from in dialysis treatment is crucial because dialysis is essential for millions of people with kidney disease. By measuring and tracking pollution, dialysis centers can make targeted improvements without compromising patient care. This research provides a practical tool that any dialysis center worldwide can use to benchmark their environmental impact and identify the most effective ways to reduce it.

This study has several strengths: it tracked real dialysis centers over eight years (not just a short period), it measured actual changes rather than just predictions, and it involved multiple centers so results weren’t based on just one location. However, the study included only five centers in Germany, so results may not apply equally to all countries or healthcare systems. The study is recent (data through 2023) and published in a respected kidney disease journal, which adds credibility. The researchers were transparent about limitations and didn’t overstate what current technology can achieve.

What the Results Show

The average dialysis patient’s yearly treatment created 3.72 tons of carbon pollution. To put this in perspective, this is roughly equivalent to the annual carbon emissions from driving a gasoline car about 9,000 miles. The largest sources of pollution were manufacturing and disposing of dialysis equipment (about 40% of total), energy consumption to run the machines (about 35%), and patient transportation to the center (about 15%).

Over the eight-year study period, the five dialysis centers achieved a 9.1% reduction in total pollution per patient per year. This reduction came from three main changes: reducing the amount of dialysate (cleaning fluid) used per treatment, installing solar power systems, and recommending a more environmentally-friendly diet to patients. These changes saved about 0.47 tons of carbon pollution per patient annually.

When researchers modeled what would happen if centers implemented all available improvements using current technology—including switching 40% of patients to a different dialysis method called peritoneal dialysis and 10% to a gentler form of traditional dialysis—they projected a maximum possible reduction of 38.7%. This would save about 1.5 tons of carbon per patient per year, bringing the total down from 3.72 to about 2.2 tons.

The study identified specific, practical changes that dialysis centers can implement immediately. Reducing dialysate flow (the amount of cleaning fluid used) was one of the most cost-effective changes. Installing renewable energy like solar panels provided significant long-term benefits. Interestingly, recommending dietary changes to patients—specifically a diet that’s better for the planet—contributed to pollution reduction while potentially offering health benefits. The research also showed that different dialysis centers had different pollution profiles, suggesting that customized approaches work better than one-size-fits-all solutions.

This is one of the first studies to systematically measure and track carbon pollution from dialysis centers over an extended period. Previous research estimated dialysis pollution theoretically, but this study provides real-world data from actual centers making actual changes. The findings align with global concerns about healthcare’s environmental impact—dialysis is known to be resource-intensive, and this research quantifies exactly how much. The study’s approach of creating a benchmarking tool is novel and allows for ongoing comparison between centers.

The study included only five dialysis centers in Germany, so results may differ in other countries with different energy sources, transportation systems, or healthcare structures. The study didn’t include all possible dialysis centers or patient populations, so the findings may not apply universally. While the researchers modeled what could happen with maximum improvements, they didn’t actually implement all changes, so real-world results might differ. The study focused on carbon pollution but didn’t measure other environmental impacts like water usage or chemical waste. Additionally, the study didn’t examine whether reducing pollution might affect treatment quality or patient outcomes, though the researchers suggest it shouldn’t.

The Bottom Line

If you receive dialysis: Ask your treatment center if they’re tracking their carbon footprint and what steps they’re taking to reduce pollution. Support center initiatives to reduce environmental impact, as these changes typically don’t affect your care quality. If you’re involved in dialysis center management: Use the benchmarking tool described in this research to measure your center’s carbon footprint and identify improvement opportunities. Prioritize changes like optimizing dialysate flow, exploring renewable energy, and adjusting operational practices. Consider whether alternative dialysis methods might be appropriate for some patients. Work with other centers to share best practices and accelerate progress. For policymakers: Recognize that meeting climate goals will require more than operational improvements—it will need structural changes in how dialysis is delivered, including increased use of peritoneal dialysis and kidney transplantation.

Dialysis patients should care because their treatment centers’ environmental practices may eventually affect their care options. Healthcare administrators and dialysis center managers should prioritize this because they can implement changes now. Environmental advocates should care because healthcare’s carbon footprint is significant. Policymakers should care because reaching climate goals will require systemic changes to kidney disease treatment. People at risk for kidney disease should care because prevention and transplantation will become increasingly important. However, this research shouldn’t cause dialysis patients to worry about their current treatment—dialysis is essential and life-saving, and the focus should be on making it more sustainable, not on avoiding it.

Dialysis centers can implement some changes immediately (like adjusting dialysate flow settings), with results visible within months. Solar panel installation and other infrastructure changes take longer—typically 1-3 years—but provide benefits for decades. Switching patients to alternative dialysis methods requires individual medical assessment and training, typically taking several months per patient. Reaching the 50% pollution reduction goal by 2030 (as mentioned in the research) would require rapid implementation of multiple changes starting now. Reaching net-zero emissions by 2045 will require technological innovations that don’t yet exist, so this is a longer-term goal requiring ongoing research and development.

Want to Apply This Research?

  • If you receive dialysis at a center using the carbon footprint calculator, track your center’s reported emissions reduction over time (if this information is made available to patients). Measure your personal contribution by noting your travel method to dialysis appointments and tracking changes if your center implements transportation alternatives like shuttle services.
  • Work with your dialysis center to optimize your treatment schedule and method if medically appropriate. If your center recommends dietary changes for environmental reasons, track your adherence to these recommendations in a nutrition app. If alternative dialysis methods become available, discuss with your care team whether switching might be appropriate for you. Reduce transportation-related emissions by carpooling, using public transit, or exploring telehealth options for non-dialysis appointments.
  • Ask your dialysis center quarterly about their progress on carbon reduction initiatives. Track any changes to your treatment protocol or dialysis method. Monitor your own environmental impact through transportation choices and dietary adherence. If your center provides environmental impact reports, review them annually to see progress toward reduction goals. Participate in patient feedback surveys about sustainability initiatives to help your center prioritize improvements.

This research describes environmental impacts of dialysis treatment and potential ways to reduce them. It does not suggest that dialysis patients should avoid or delay necessary treatment. Dialysis is a life-saving therapy for people with kidney failure, and the environmental benefits of treatment modifications should never compromise patient safety or health outcomes. All treatment decisions should be made in consultation with your nephrologist (kidney specialist) based on your individual medical needs. This article is for informational purposes and should not be considered medical advice. If you have questions about your dialysis treatment or environmental sustainability at your treatment center, speak with your healthcare team.