Some may be unaware … and a few (I hope) may be interested to learn … of the progress we are (slowly) making in developing our unit theme of ‘eco-dialysis’ or ‘green dialysis’.
My intention is to alert you, the users, to the disproportionate footprint that dialysis leaves on our landscapes with its’ rapacious use of natural resources - water and power in particular - and to the paltry efforts we have traditionally made to understand, control, minimizse or re-use the wastes we generate by the processes of dialysis.
You need to demand of your dialysis service that it takes more cognizance of the environmental mark it leaves. If we were to assume that there were ~2,000,000 dialysis patients world-wide, and all used the same amount of water and power that our service used to use - clearly a ‘broad’ assumption - then our ‘world dialysis service’ would consume about 156 billion litres of water and 1.62 billion kWh or power per year of dialysis.
That’s a lot of water and power!
We have sought to address some of these issues in some of our publications in recent years.
The most recent of these publications deals with our effort to trial solar-assisted systems to augment the power requirements of dialysis. This blindingly simple concept has proved to be remarkably easy and cost efficient and we are left wondering why none of us had tried it before.
To fill you in on where we have gone with all this …
On January 5th, the Clinical Journal of the American Society of Nephrology (CJASN) forward-published the abstract (by eoi release) of a paper entitled “Solar-assisted Hemodialysis”.
If you Google the 3 words <solar assisted hemodialysis> this will lead you to some of the associated press releases. The full paper will be released (also as an eoi) on 19th January and will formally appear in print format in an upcoming edition of CJASN. This is the first report - anywhere - of solar power assisted haemodialysis program.
In addition - and perhaps giving a better overview of our progress towards eco-dialysis - a paper will appear in the next edition of Hemodialysis International, in an easy, lay-readable format, entitled …
“Personal viewpoint: Hemodialysis—Water, power, and waste disposal: Rethinking our environmental responsibilities”
… the abstract for this paper is at http://onlinelibrary.wiley.com/doi/10.1111/j.1542-4758.2011.00639.x/abstract
This second paper documents our journey, here in Geelong, from our first introduction of nocturnal haemodialysis into Australia in 2000, to our realisation of the utility impact this home program was exerting on our home patients, then through to the steps we took to lessen that impact. It should be remembered that here, in Australia, our home patients do not have access to the more water-efficient NxStage system … but even in the US, this system is used by a tiny fraction of the whole dialysis population (a little > 4000 out of 400,000 … so, perhaps only 1%). The remainder, like we do here, use water-guzzling, power-bleeding, single-pass equipment.
We resolved to lobby (successfully) for a government subsidy to defray the utility costs of home dialysis for home dialysis patients (both HD and PD). Concurrently, we introduced a range of both home and facility-based water conservation practices - simple, effective, water re-use and re-cycling programs - which have made a huge impact on water use for both our home and our facility-based programs.
To understand more specifically our program for water conservation, see another of our papers, also in HDI …
Agar JWM, Simmonds RE, Knight R. “Using water wisely: New, essential and affordable water conservation practices for both facility and home hemodialysis”. Hemodialysis International 13(1):32-37, January 2009.
This was the second reported program water conservation program in HD. Tarrass et al (from Morocco) published the 1st reported program in the same year in AKJD … a paper for which I was invited to write the AJKD editorial in the same edition …
Agar JWM. Recycling Dialysis Wastewater: ‘The Elephant in the Room’. Editorial: Am J Kid Dis. 2008. 52(1):10-12.
The success of these initial water-conservation programs led us on to consider options in power reduction. This led to the introduction of our solar-assisted power program (as above) and, more recently still, to plans (still to be fully realised, but in progress) to revise of our waste management systems. While these latter steps are yet to be developed to a reportable level, our waste management concepts are described ‘in overview’ in the up-coming HDI ‘Personal Viewpoint’ publication.
What all this means is that we, as a profession, and as the users of dialysis systems, may be very adept at diagnosis, treatment and support (though I know some may even question that statement) and utilisation of these systems … but we have paid scant (if any) attention to the environmental impact those systems exert.
The purpose of our more recent work has been to seek ways to lessen that impact, protect (where we can) our environment and to make dialysis a more sustainable and resource-thoughtful process into the future.
I hope some of you take the time to read these papers … and we have others - though mainly in our Asia-Pacific nephrology literature … none of which require an extensive medical knowledge.
The purpose of alerting the dialysis community to the need for resource and material management in dialysis is to try to arouse a ground-swell demand from you (the users) of your providers (us) to get our act together and do our bit to make the planet we live in just a little safer and more habitable into the future.
Ask your service what they are doing to conserve the resources - power and water - and manage the disposal and/or degradation pathways associated with their spent equipment and consumables.
It’s just a little favour you can do for your planet … and one worth doing.