Connor Andrew, Lillywhite Robert, Cooke Matthew W
The Campaign for Greener Healthcare, Oxford, UKDepartment of Renal and General Medicine, Dorset County Hospital, Dorchester, UKResearch Scientist, Warwick HRI, University of Warwick, Coventry, UKProfessor of Emergency Medicine, Warwick Medical School, University of Warwick, Coventry, UK.
Hemodial Int. 2011 Jan;15(1):39-51. doi: 10.1111/j.1542-4758.2010.00523.x. Epub 2011 Jan 14.
Climate change presents a global health threat. However, the provision of healthcare, including dialysis, is associated with greenhouse gas emissions. The aim of this study was to determine the carbon footprints of the differing modalities and treatment regimes used to deliver maintenance hemodialysis (HD), in order to inform carbon reduction strategies at the level of both individual treatments and HD programs. This was a component analysis study adhering to PAS2050. Emissions factors were applied to data that were collected for building energy use, travel and procurement. Thrice weekly in-center HD has a carbon footprint of 3.8 ton CO2 Eq per patient per year. The majority of emissions arise within the medical equipment (37%), energy use (21%), and patient travel (20%) sectors. The carbon footprint of providing home HD varies with the regime. For standard machines: 4 times weekly (4 days, 4.5 hours), 4.3 ton CO2 Eq; 5 times weekly (5 days, 4 hours), 5.1 ton CO2 Eq ; short daily (6 days, 2 hours), 5.2 ton CO2 Eq; nocturnal (3 nightly, 7 hours), 3.9 ton CO2 Eq; and nocturnal (6 nightly, 7 hours), 7.2 ton CO2 Eq. For NxStage equipment: short daily (5.5 days, 3 hours), 1.8 ton CO2 Eq; 6 nightly nocturnal (2.1 ton CO2 Eq). The carbon footprint of HD is influenced more by the frequency of treatments than by their duration. The anticipated rise in the prevalence of home HD patients, dialyzing more frequently and for longer than in-center patients, will increase the emissions associated with HD programs (despite reductions in patient travel emissions). Emerging technologies, such as NxStage, might offer a solution to this problem.
气候变化对全球健康构成威胁。然而，包括透析在内的医疗保健服务与温室气体排放相关。本研究的目的是确定用于提供维持性血液透析（HD）的不同方式和治疗方案的碳足迹，以便为个体治疗和HD项目层面的碳减排策略提供信息。这是一项遵循PAS2050的成分分析研究。将排放因子应用于收集的建筑能源使用、出行和采购数据。每周三次的中心HD治疗，每位患者每年的碳足迹为3.8吨二氧化碳当量。大部分排放来自医疗设备（37%）、能源使用（21%）和患者出行（20%）领域。提供家庭HD的碳足迹因方案而异。对于标准机器：每周4次（4天，4.5小时），4.3吨二氧化碳当量；每周5次（5天，4小时），5.1吨二氧化碳当量；每日短程（6天，2小时），5.2吨二氧化碳当量；夜间（3晚，7小时），3.9吨二氧化碳当量；夜间（6晚，7小时），7.2吨二氧化碳当量。对于NxStage设备：每日短程（5.5天，3小时），1.8吨二氧化碳当量；6晚夜间（2.1吨二氧化碳当量）。HD的碳足迹受治疗频率的影响大于治疗时长。预计家庭HD患者的患病率将会上升，与中心HD患者相比，他们透析更频繁且时间更长，这将增加与HD项目相关的排放（尽管患者出行排放有所减少）。诸如NxStage等新兴技术可能为解决这一问题提供方案。
