Reducing the environmental impact of kidney care in B.C.

Health care systems are increasingly recognizing their environmental footprint, with the global sector accounting for an estimated four to five per cent of greenhouse gas emissions. Kidney replacement therapies — including dialysis and transplantation — are among the more resource-intensive forms of care, requiring significant infrastructure, medical supplies, water, energy and patient travel. 

A study led by Vancouver Coastal Health Research Institute researcher Dr. Christopher Nguan examined the environmental impacts of kidney replacement therapies in British Columbia, offering insight into how different treatment pathways contribute to emissions and where improvements may be possible. 

“One of the challenges in studying the environmental impact of kidney care is that kidney replacement therapy is not a single intervention — it’s a continuum of care that unfolds over many years,” says Nguan.

Patients may receive in-centre hemodialysis, peritoneal dialysis, home dialysis or kidney transplantation, often transitioning between therapies over time and across care settings. 

"Kidney care is challenging to study from an environmental perspective, as impacts occur across different locations, treatments and time periods."

Comparing environmental impacts across treatment pathways

Published in the American Journal of Kidney Diseases, the study used a life cycle assessment approach to evaluate environmental impacts across in-centre hemodialysis, peritoneal dialysis and kidney transplantation. This method examines impacts across the full life cycle of care, from material production to use and disposal.

The research team assessed multiple indicators, including greenhouse gas emissions, air pollution, human toxicity and water use. They found clear differences between treatment pathways, with in-centre hemodialysis having the highest environmental impact and kidney transplantation the lowest across most categories. 

Key drivers of environmental impact included medical consumables — such as dialysis tubing and other single-use supplies — as well as transportation associated with frequent dialysis visits. 

“Transportation can account for a substantial portion of dialysis-related emissions,” says Nguan. “In some settings, it represents a third or more of the total footprint.”

This is particularly relevant in B.C., where patients receiving in-centre dialysis typically travel three times per week, often over long distances and for extended periods. Transplant care also requires travel, with specialized services centralized in Vancouver. 

Steps to reducing the environmental footprint

Kidney replacement therapies are essential and lifesaving, and efforts to improve sustainability must not compromise patient safety or access, says Nguan. However, environmental and patient-centred priorities are often aligned.

“When sustainability is considered alongside clinical performance, there are opportunities to improve both,” he says. 

"Approaches such as home-based therapies and alternative care models may reduce travel and resource use while also improving quality of life for patients."

Looking ahead, Nguan suggests sustainability metrics could become an additional consideration alongside patient outcomes and health economics in health system planning.

The project also underscores the innovative and collaborative nature of sustainability research, involving expertise across multiple clinical subspecialties and academic units at UBC, including the Department of Environmental Engineering at UBC Okanagan. However, access to detailed clinical and operational data remains a key challenge in advancing this work. 

“The main takeaway is that health care has a meaningful environmental footprint — but it’s one we can measure and improve,” says Nguan. “It’s not about limiting care, but about strengthening health care systems so patients and communities can continue to receive high-quality care for generations to come.”