12.0 Environmentally Friendly Home Haemodialysis

Pedro Miguel Reinas André Pereira Baptista, RN, H. U. La Princesa, Madrid, Spain

Debbie Fortnum, Editor EDTNA/ERCA Brand Ambassador Australia/New Zealand, Clinical Nurse Manager Dialysis, SCGH Perth, Australia


Dialysis contributes to the carbon footprint worldwide but it is possible to reduce your carbon footprint. This is important because it is predicted that in 2020 there will be 3,500,000 patients worldwide needing dialysis1.

In this section you can learn about how home dialysis can become as green as possible.

12.1 Basics of Environmental Home Haemodialysis

12.1.1 Kyoto Protocol

The Kyoto Protocol on Climate Change is an international agreement that aims to reduce the emissions of six greenhouse gases that cause global warming:

  • Carbon dioxide (CO2).
  • Methane gas (CH4).
  • Nitrous oxide (N2O).
  • 3 fluorinated industrial gases.

This gas emission translates into the Carbon Footprint; “The measure of the impact our activities have on the environment, especially on climate change”. The purpose of this protocol is to contribute to a healthier environment, and support the ability of countries to control the carbon footprint.

12.1.2 Dialysis Carbon footprint

Haemodialysis can be done in hospital or at home using a standard dialysis machine with water treatment or by using the Nxstage system. The total carbon footprint for one patient each year, measured in the United Kingdom were:

  • For Haemodialysis in a hospital: 3818 kg of CO2 Eq per patient, per year.
  • For standard home haemodialysis: 4346 kg CO2 Eq per patient, per year2.
  • For Home Haemodialysis with NxStage system: 1844 kg of CO2 Eq per patient, per year.

Dialysis at home reduces the carbon footprint from travel, but the extra treatments increase the carbon footprint.

12.2 Water

12.2.1 Water purification process

Water used for dialysis has to be made pure. This uses both energy and wastes water. With standard haemodialysis about 360 liters of water are used for every treatment. To make each liter of pure water, up to 10 liters of water also goes down the drain. It is estimated standard haemodialysis uses around 82,000litres every year3.

The NxStage machine requires about 30 liters of pure water for each treatment, depending on how many hours of dialysis you do. All incoming water is converted into dialysis water on so that one liter of tap water makes one liter of dialysis water (dialysate). It is estimated frequent dialysis on this system uses around 7230l per year3.

12.2.2 Ways to reduce water usage

To reduce water usage in Haemodialysis;

  • Recycle waste water from the purification process (not relevant to the Nxstage machine).
  • Ask a technician to advise how you can use the waste water for other functions such as garden watering or washing.

12.3 Electricity

12.3.1 Electricity consumption

Dialysis units use high levels of power (approximately 1,000 kilowatt watt (kW) per hour). This is to run machines and purify the water. Electricity is also used for heating and air conditioning4.

Approximately 2.5-3.5 kW are used every hour to run a standard hemodialysis machine. In addition electricity is used for treatment of water.

Approximately 0.1kWh are used by the NxStage machine during dialysis5.

In addition electricity is used for heating and air conditioning. Transporting, extracting and consuming this energy also contribute to the carbon footprint.

12.3.2 Ways to reduce electricity consumption

To reduce electricity consumption use;

  • Low energy lighting (can save 50% of electricity).
  • Dialyse in a room that has low heating or air-conditioning needs. Blinds or curtains regulate temperature.
  • Only set up the machine when it is needed.
  • Turn off machines and any other equipment when not in use.
  • Ideally set an indoor temperature of 19 to 21° C in winter and 22 to 26° C in summer. Use a blanket for comfort.
  • If you are cold on dialysis ask your nurse about adjusting dialysate temperatures.

12.4 Waste

12.4.1 Waste production

Waste is any substance which is thrown away after primary use. Examples include solid waste (household trash/refuse), hazardous waste, waste water (including sewage and surface run-off) and radioactive waste. Each year;

  • NxStage dialysis at home produces waste of 179 kg CO2 Eq3.
  • Standard home dialysis produces waste of 208 kg CO2 Eq3.

12.4.2 Ways to reduce waste carbon footprint

  • Only put blood contaminated waste into bins going to incineration.
  • Put any non-contaminated waste into general waste.
  • Recycle plastics and cardboard.

Both hospitals and community offer recycling and it is important to take advantage of any local recycling opportunities. Recycling is becoming more important and there are many new plastic and crystal materials that can be recycled6.

Useful websites

This was just a brief overview and a website entitles Green dialysis provides more detail on this topic. https://www.greendialysis.org/resources/sources

Some countries also have organisations targeting green dialysis. Google your country to see if there are any groups available in your area.

More information on the Kyoto protocol can be found at https://en.wikipedia.org/wiki/Kyoto_Protocol


1. Stragier A, Boccato C. et al. Environmental Guidelines for Dialysis, A Practical Guide to Reduce the Environmental Burden of Dialysis. First Edition: May 2012. European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA)

2. NxStage® Basic Hemodialysis Treatment Manual

3. Benain JP. Micro-costing study made with 3 centers in UK using ICHD, incl. 1349 patients on traditional machines or System One at home. 2015. Pending publication

4. Agar J,W. (2010). Conserving water in ad applying solar power to Haemodialysis: green dialysis` through wiser resource utilization `Nephrology (Carlton), 15(4),448-53

5. NxStage System One User Guide. NC4794 Rev E 2018-01:p7-13

6. Garcia G. Carbon Footprint April Spanish Association for quality environmental committee. NxStage® Basic Hemodialysis Treatment Manual 2013