Green Dialysis Practices Across Referral Centers for Rare Diseases in Europe: an International Study

The healthcare sector significantly contributes to environmental degradation, with dialysis treatments being a major source of resource consumption in terms of water and power usage and waste production. Green dialysis practices aim to mitigate this impact by implementing environmentally sustainable strategies in dialysis facilities. This study assesses the current state of green dialysis initiatives across European referral centers for rare kidney diseases, analyzing awareness levels, implementation rates, and key challenges. A cross-sectional survey was conducted among dialysis centers within the European Rare Kidney Disease Reference Network (ERKnet). The survey comprised 27 questions addressing environmental sustainability strategies in dialysis, including water and energy consumption, waste management, and carbon footprint reduction. Centers’ green initiatives were evaluated using a "Green Score," while an "Awareness Score" assessed knowledge and perception of environmental impact. Additionally “Patients Survey” were conducted among home dialysis patients to gauge their awareness and willingness to adopt sustainable practices. Statistical analyses were performed using SPSS. Responses were obtained from 34 centers across Europe, response rate was 43%. 32 centers (94.1%) reported using a reverse osmosis system to produce water, 15 centers (44.1%) used a centralized dialysate preparation system and none reported reusing wastewater. Only 11.8% utilized renewable energy, and 29.4% had energy-saving programs. Waste recycling rates varied, with 91.2% of centers recycling paper, but only 64.7% recycling glass. 26 centers (78.8%) did not have any measurable indicator to confirm the strategy involved. The mean score of Green Score was 16,1 out of a maximum of 41 points, with an overall rate of green practices application of 39,4%. It was highlighted a statistically significant correlation between the presence of a formal Green Team in the facility and the Green Score (P-value <0.05) A notable discrepancy was observed between healthcare professionals’ perceptions of patient awareness and actual patient attitudes toward sustainability. While respondents believed that patients and their families lacked awareness of the environmental impact of dialysis, data from our center suggest otherwise. Among home dialysis patients, 75.6% (combined data for patients on home hemodialysis and patients on peritoneal dialysis) demonstrated a high level of awareness, and 95.6% expressed willingness to take further steps to reduce their environmental footprint. Additionally, nearly all home dialysis patients correctly separated waste. Our data show that a big effort is essential to reduce environmental footprint of dialysis. Resources at disposal are disease prevention, patient empowerment and preferential use of low carbon technologies. In addition, identification of best practices of resource within healthcare as inclusion of environmental criteria in procurement contracts and involvement of all figures operating in hospital field is important. Analysis of our sample shows a statistically significant correlation between presence of green team and implementation of environmental sustainability policies.