Personal viewpoint: hemodialysis--water, power, and waste disposal: rethinking our environmental responsibilities.

While medical health professionals are trained to detect, treat, and comfort, they are not trained to consider the environmental impact of the services they provide. Dialysis practitioners seem particularly careless in the use of natural resources—especially water and power—and seem broadly ignorant of the profound medical waste issues created by single use dialysis equipment. If the data we have collected is an indication, then extrapolation of this data to a dialysis population currently estimated at ~2 million patients worldwide, a “world dialysis service” would use ~156 billion liters of water and discard ~2/3 of that during reverse osmosis. This waste occurs, despite the discarded water being high-grade “gray water” of potable standard. The same world dialysis service would consume 1.62 billion kWh of power—mostly generated from coal and other environmentally damaging sources. Our world dialysis service, based on ~2 kg of waste from each dialysis treatment, would generate ~625,000 tonnes of plastic waste—waste that would be potentially reusable if simple sterilizing techniques were applied to it at the point of generation. Dialysis services must begin to explore eco-dialysis potentials. The continued plundering of resources without considering reuse or recycling, exploration of renewable energy options, or the reduction of the carbon footprint of the dialysis process . . . is unsustainable. Sustainable dialysis practices should be a global goal in the coming decade.