International Environmental Impact of CKD Care

Barraclough, K.A. and Cases, A. and Eckelman, M.J. and Germond-Duret, C. and Zoccali, C. and Embleton, N. and Wright, A. and Hubbert, L. and Nicholson, L. and Barone, S. and Cabrera, C. and Garcia Sanchez, J.J.G. and Selvarajah, V. and Pecoits-Filho, R. (2025) International Environmental Impact of CKD Care. Kidney International Reports. (In Press)

Abstract

Introduction Data reporting the environmental impact of the overall chronic kidney disease (CKD) care pathway are limited. Methods 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. Results 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). Conclusion This research provides insights into the overall environmental burden of CKD and impact hotspots, enabling the development of targeted interventions that reduce emissions.