Doctors, patients want options to reduce dialysis waste adding to climate change

Doctors, patients want options to reduce dialysis waste adding to climate change
The Canadian Society of Nephrology is calling for environmentally sustainable kidney care to reduce the large amounts of wastewater, energy and single-use plastics involved in dialysis. Francis Silva undergoes dialysis treatment at St. Paul's Hospital in Vancouver, B.C., Tuesday, May 7, 2024.

Francis Silva watches the blood flow through a¬†straw-like tube in his left arm¬†to¬†a¬†dialysis¬†machine where it’s cleaned of toxins and returned¬†to¬†his body through a second tube.

The 60-year-old chef endures the four-hour process every Tuesday, Thursday and Sunday¬†at St. Paul’s Hospital where a 42-bed unit is dedicated¬†to¬†lifesaving hemodialysis but is also the source of a significant amount of medical¬†waste¬†that a group of nephrologists wants¬†to¬†curb across the country.

“Last year when I had a heart operation, it just got worse,” Silva¬†said of his kidney problems, for which he tried¬†to¬†find a bright side. “I need the rest. I’ve been standing for eight hours.”

Down the hall, carts are loaded with blue plastic bins full of dialysis supplies that include plastic tubing in plastic and paper packaging. A supply room contains plastic jugs of solution that will be mixed with purified water and piped into the dialysis machines lined up against a wall.

A nearby room is stocked with boxes of more supplies including plastic saline bags ‚ÄĒ at least two per patient for each¬†dialysis¬†session.

Patient care manager Laila Aparicio points¬†to¬†a garbage bin filled with blood-contaminated tubing, which makes up a large volume of the clinic’s biohazardous¬†waste.

‚ÄúWe came here about 10 minutes ago and it was empty,‚ÄĚ Aparicio¬†said. “It would be awesome if we were able¬†to¬†decrease that as much as possible¬†to¬†reduce¬†the environmental impact,” she said of the¬†waste¬†that¬†patients¬†do not see.

In another room, hoses in the wall pump hundreds of litres of purified water into a¬†dialysis¬†machine where it is mixed with electrolyte solutions. Toxins from blood are removed, as is excess water from a patient’s body, and the wastewater is piped into the city’s sewer system.

“Downstairs, there are huge tanks, three of them, that provide highly purified water, lots of it,” said Aparicio.

The clinic does about 800 dialysis treatments a week, with two nurses assigned to each patient.

Dr. Caroline Stigant, a nephrologist at Royal Jubilee Hospital in Victoria and a leading advocate for sustainable kidney care, said each hemodialysis treatment uses up to 500 litres of water and large amounts of energy.

“A single hemodialysis treatment‚Äôs carbon emissions are comparable¬†to¬†that of an average vehicle driven 100 kilometres,” said Stigant.

She said more than 20,000 patients in Canada undergo the therapy. There are no established recycling programs for dialysis or medical waste in Canada, she added.

Biohazardous¬†waste, including tubing in some cases, as well as blood-soaked gauze, is sent¬†to¬†a facility¬†to¬†be autoclaved ‚ÄĒ ¬†sterilized with high temperature steam ‚ÄĒ and then¬†shredded and landfilled, Stigant said.

The Canadian Society of Nephrology has a planning committee to find ways to reduce waste. One goal is to develop a carbon footprint calculator to collect data on the environmental impact of kidney care.

Stigant, the committee’s inaugural chair, said kidney diseases are on the rise, producing more¬†waste¬†that contributes¬†to¬†climate¬†change. In turn,¬†climate¬†change¬†can increase the risk of kidney diseases, since dehydration during extreme heat is especially risky for vulnerable populations.

“There’s a global environmental evolution in nephrology and kidney care. And it’s huge work, not just for nephrologists. It’s for administrators, it’s for funders of the system, it’s for¬†patients¬†to¬†be involved in, it’s for industry as well,” she said.

“We believe that we need a redesign of the systems that we’re using in kidney care, in part because no patient wants¬†to¬†be on¬†dialysis. They’re tethered¬†to¬†a machine.”

She said it’s crucial¬†to¬†promote healthy living¬†to¬†prevent conditions including high blood pressure and diabetes, which are most commonly associated with kidney diseases. Early diagnosis is also important because by the time symptoms develop, a patient has likely lost 80 per cent of their kidney function, added Stigant, medical lead for planetary health at BC Renal, the agency responsible for kidney care in British Columbia.

Greater access¬†to¬†kidney transplants is also key, before¬†patients¬†end up needing¬†dialysis, Stigant said. “Their general well-being, their outcome, is also what’s best for the environment.”

Patients¬†who have¬†dialysis¬†at home with supplies that are typically shipped¬†to¬†them once a month must put their plastic and cardboard¬†waste¬†at the curbside, and that could include blood-soaked material, said Stigant. She said some¬†patients¬†pay municipalities for extra bags or take their garbage¬†to¬†a relative’s home.

“When people come in for their home¬†dialysis¬†training, they’ll say, ‘What about all this garbage? Does this all get thrown away?’ ” she said.

“They find the¬†waste¬†embarrassing, they find it very costly¬†to¬†deal with. And that’s something that the system hasn’t,¬†to¬†date, reimbursed.”

One of Stigant’s¬†patients¬†burns the¬†waste¬†produced by his peritoneal¬†dialysis¬†‚ÄĒ another form of therapy for kidney failure in which a catheter is inserted into the abdominal cavity, or peritoneum. It can be done daily and produces smaller but still challenging amounts of¬†waste.

“He lives in a rural area and there’s no garbage collection. He’s an elderly man and so it’s too burdensome for him¬†to¬†sort it into recyclable and non-recyclable.”

Home-based peritoneal dialysis generates 211,000 kilograms of recyclable polypropylene plastic, or PVC, annually in Canada, along with 55,600 kilograms of recyclable polypropylene, the thin peel-away plastic, according to a study Stigant co-authored and published last November in Kidney International Reports.

Stigant said that in Australia, recyclable plastic items are picked up each time peritoneal dialysis supplies are delivered.

“This is something we would love¬†to¬†implement locally.”

“We’re really in our infancy of managing the¬†waste¬†properly. But it has¬†to¬†involve reducing the burgeoning number of people with disease risk factors and even those living with impaired kidney function. The world is facing this very rapidly increasing condition.”

Nancy Verdin, a home¬†dialysis¬†patient in Red Deer, Alta., is a member of the nephrologists’ sustainability committee and said she struggles with the large amount of¬†waste¬†from hemodialysis she’s received for 26 years.

The 63-year-old who’s had three failed kidney transplants said some of the¬†waste¬†can’t be recycled in her city because it accepts only numbered plastics.

“I have¬†to¬†separately package and then decide, am I going¬†to¬†pay the shipping costs¬†to¬†send it¬†to¬†Edmonton?” she said of more recycling¬†options¬†there.

“I don’t drive any more. So that means I have¬†to¬†get someone¬†to¬†help me take it¬†to¬†a delivery site. And everything costs money.”

This report by The Canadian Press was first published May 18, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Camille Bains, The Canadian PressCamille Bains, The Canadian Press

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