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. 2025 Jan;42(1):348-361.
doi: 10.1007/s12325-024-03039-w. Epub 2024 Nov 14.

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact

Juan Jose Garcia Sanchez  1 , Katherine A Barraclough  2   3 , Aleix Cases  4 , Roberto Pecoits-Filho  5   6 , Celine Germond-Duret  7 , Carmine Zoccali  8 , Nina Embleton  9 , Antony Wright  9 , Luke Hubbert  9 , Lindsay Nicholson  9 , Salvatore Barone  10 , Nigel Budgen  11 , Claudia Cabrera  12 , Viknesh Selvarajah  13 , Matthew J Eckelman  14
Affiliations

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact

Juan Jose Garcia Sanchez et al. Adv Ther. 2025 Jan.

Abstract

Introduction: While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example.

Methods: A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions.

Results: At CKD stage 5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9 kg carbon dioxide equivalents (CO2e) per session depending on dialysis modality, and 336-2022 kg CO2e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4-143.6 kg CO2e), followed by a 1-day hospital stay (28.8-63.9 kg CO2e) and an 8-h emergency room visit (14.4-27.5 kg CO2e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO2e emissions.

Conclusion: Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.

Keywords: Carbon emissions; Care pathways; Chronic kidney disease; Environmental impact; Greenhouse gas emissions; Healthcare.

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Conflict of interest statement

Declarations. Conflict of Interest: Katherine A. Barraclough, Aleix Cases, Roberto Pecoits-Filho, Celine Germond-Duret, Carmine Zoccali, and Matthew J. Eckelman received consulting fees for taking part in Scientific Steering Committee meetings regarding CKD environmental impact research. Aleix Cases has received research grants from CSL Vifor; consultancy fees from Astellas, Astra Zeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, Novo Nordisk, Otsuka, CSL Vifor, and lecture fees from Astellas, Astra Zeneca, Amgen, Bayer, Medscape, Novo Nordisk, Sanofi (Mexico), CSL Vifor. Roberto Pecoits-Filho has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Alexion, Akebia, AstraZeneca, Bayer, Boehringer, and Fresenius Medical Care. Juan Jose Garcia Sanchez, Salvatore Barone, Nigel Budgen, Claudia Cabrera, and Viknesh Selvarajah are employees and shareholders of AstraZeneca. Nina Embleton, Antony Wright, Luke Hubbert, and Lindsay Nicholson received consulting fees from AstraZeneca. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Study overview. CKD chronic kidney disease, KRT kidney replacement therapy, LCA life cycle assessment
Fig. 2
Fig. 2
Study boundary
Fig. 3
Fig. 3
Greenhouse gas emissions across healthcare visits of the CKD treatment pathway by country. CKD chronic kidney disease, ER emergency room, GP general practitioner, ICU intensive care unit, UK United Kingdom, US United States of America
Fig. 4
Fig. 4
Hotspot greenhouse gas emissions* across all life cycle stages of CKD in the US. *Data reported as kg CO2e. APD automated peritoneal dialysis, CAPD continuous ambulatory peritoneal dialysis, CKD chronic kidney disease, ER emergency room, GP general practitioner HD haemodialysis, ICU intensive care unit, US United States of America
Fig. 5
Fig. 5
Greenhouse gas emissions across specialist kidney replacement therapies of the CKD treatment pathway by country. APD automated peritoneal dialysis, CAPD continuous ambulatory peritoneal dialysis, CKD chronic kidney disease, HD haemodialysis, UK United Kingdom, US United States of America
See this image and copyright information in PMC

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