Division of Nephrology, The MetroHealth System, Cleveland, Ohio.
Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, Ohio.
J Am Soc Nephrol. 2022 Sep;33(9):1790-1795. doi: 10.1681/ASN.2022010086. Epub 2022 Jun 2.
Greenhouse gas emissions from hemodialysis treatment in the United States have not been quantified. In addition, no previous studies have examined how much emissions vary across facilities, treatments, and emission contributors.
To estimate the magnitude and sources of variation in the carbon footprint of hemodialysis treatment, we estimated life-cycle greenhouse gas emissions in carbon dioxide equivalents (CO-eq) associated with 209,481 hemodialysis treatments in 2020 at 15 Ohio hemodialysis facilities belonging to the same organization. We considered emissions from electricity, natural gas, water, and supply use; patient and staff travel distance; and biohazard and landfill waste.
Annual emissions per facility averaged 769,374 kg CO-eq (95% CI, 709,388 to 848,180 kg CO-eq). The three largest contributors to total emissions were patient and staff transportation (28.3%), electricity (27.4%), and natural gas (15.2%). Emissions per treatment were 58.9 kg CO-eq, with a three-fold variation across facilities. The contributors with the largest variation in emissions per treatment were transportation, natural gas, and water (coefficients of variation, 62.5%, 42.4%, and 37.7%, respectively). The annual emissions per hemodialysis facility are equivalent to emissions from the annual energy use in 93 homes; emissions per treatment are equivalent to driving an average automobile for 238 km (149 miles).
Similar medical treatments provided in a single geographic region by facilities that are part of the same organization may be expected to have small variations in the determinants of greenhouse gas emissions. However, we found substantial variation in carbon footprints across facilities, treatments, and emission contributors. Understanding the magnitude and variation in greenhouse gas emissions may help identify measures to reduce the environmental effect of hemodialysis treatment.
美国血液透析治疗产生的温室气体排放尚未量化。此外，以前的研究尚未检查设施、治疗方法和排放源之间的排放量差异有多大。
为了估计血液透析治疗碳足迹的变化幅度和来源，我们估计了 2020 年在俄亥俄州的 15 家隶属于同一组织的血液透析机构中，209481 例血液透析治疗的生命周期温室气体排放，以二氧化碳当量（CO-eq）表示。我们考虑了电力、天然气、水和供应使用、患者和员工旅行距离以及生物危害和垃圾填埋废物产生的排放。
每个设施的年排放量平均为 769374 千克 CO-eq（95%置信区间，709388 至 848180 千克 CO-eq）。总排放量的三个最大贡献者是患者和员工的交通（28.3%）、电力（27.4%）和天然气（15.2%）。每例治疗的排放量为 58.9 千克 CO-eq，各设施之间的排放量差异高达三倍。每例治疗的排放量变化最大的三个贡献者是交通、天然气和水（变异系数分别为 62.5%、42.4%和 37.7%）。每个血液透析设施的年排放量相当于 93 户家庭每年能源使用量的排放量；每次治疗的排放量相当于驾驶一辆普通汽车行驶 238 公里（149 英里）。
在同一地理区域内，属于同一组织的设施提供的类似医疗治疗可能在温室气体排放的决定因素方面变化很小。然而，我们发现各设施、治疗方法和排放源之间的碳足迹存在很大差异。了解温室气体排放的规模和变化可能有助于确定减少血液透析治疗对环境影响的措施。
