Table 1 Opportunities that individual dialysis units can implement to promote sustainable kidney care

Water usage

Remarks

Recycle reverse osmosis (RO) reject water.

Easy to implement infrastructure project with huge potential savings.

Upgrade to water treatment plants that are more efficient and allow RO reject water recirculation.

Decreases water wastage from RO reject water; significant capital investments involved.

Incremental dialysis or reduction of dialysate flow rate, where appropriate, to reduce water demand.

Dependent on patients’ clinical condition, and therefore not suitable for all patients.

Renewable energy generation eg. use of rooftop solar panels.

Requires capital investment through installation or retro-fitting equipment.

Equip dialysis machines with heat exchangers.

Central dialysis delivery system to reduce reliance on individually packed dialysis consumables.

Results in fixed dialysate composition with no opportunity to provide individualized care to cater to patients’ unique needs.

Risks of system dysfunction which may in turn affect all patients.

Risks of microbial contamination with the use of long dialysis piping.

Waste segregation for appropriate disposal & recycling.

Appropriate segregation of waste minimizes the need for incineration and/or disinfection prior to waste disposal.

Baler machines for recycling cardboard and plastic waste from dialysis consumables.

Recycling reduces the burden on landfill sites.

Paperless clinical documentation & laboratory reporting.

Tele-health for clinicians’ review.

Promotion of active modes of transport to staff and patients.

Use of greener alternatives in dialysis facilities eg. motion-sensor energy-saving lights, dual-flush system in toilets, biodegradable linen etc.

Process and care model innovations, coupled with general green measures, are usually cost-free (or low cost) and can be implemented easily across different settings.

These green initiatives can reduce carbon emission, save water and electricity, reduce waste, but more importantly, create awareness for healthcare professionals and patients.