Talbot B1,2, Barraclough K3,4, Sypek M3,4, Gois P5,6, Arnold L7, McDonald S8, Knight J1,2,9,10

1The George Institute For Global Health, UNSW, Sydney, Australia, 2Ellen Medical Devices, Sydney, Australia, 3School of Medicine, University of Melbourne, Melbourne, Australia, 4Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia, 5Department of Nephrology, Fraser Coast Hospital and Health Service, Hervey Bay, Australia, 6University of Queensland, School of Medicine, Brisbane, Australia, 7Renal Service, Wellington Regional Hospital, Wellington, New Zealand, 8Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 9Faculty of Medicine, UNSW , Sydney, Australia, 10University of Sydney School of Medicine, Sydney, Australia

Aim: To document environmental sustainability practices in dialysis units in Australia and New Zealand.

Background: Dialysis consumes large amounts of water and energy and produces substantial waste.  The ‘green nephrology’ movement encourages dialysis clinics to minimise their environmental impact. The extent of the uptake of this advice is unknown.

Methods: An online survey was used to identify environmental sustainability practices in dialysis units in Australia and New Zealand between January and December 2020.

Results: 132 units completed the survey, representing 122/350 (35%) of treatment centres listed in the ANZDATA registry; 35/132 (27%) were home training units (peritoneal dialysis or haemodialysis), 89/132 (67%) in-centre or public satellite units and 7/132 (5%) private satellite units. Fewer than half of responding units reported having an environmental sustainability strategy in place (44/132, 33%) or having ever undertaken an environmental audit (27/132, 20%). Most units reported recycling bins in clinical areas for hard plastics (89/132, 67%) but not soft plastics (41/132, 31%) or polyvinyl chloride (PVC) (50/132, 38%). Used pallets were re-collected by dialysis suppliers at 89/132 (67%) of units, but of the remaining units, only 7/17 (41%) recycled pallets themselves. Only 16/126 (13%) of haemodialysis units reported reclaiming reverse osmosis (RO) reject water. For home training units, less than half reported that their patients recycled cardboard (14/35, 40%) or PVC (14/35,40%). Whilst 52% (15/29) of home haemodialysis units reported that at least one of their patients reclaimed RO reject water, only 7/29 (24%) of home haemodialysis units offered assistance in establishing water reuse systems.

Conclusions: This study describes environmental practices in dialysis units across Australia and New Zealand and has identified numerous areas that can be targeted for improvement.


Ben is renal registrar who has worked in both the UK and Australia. He is currently completing a PhD at the George Institute for Global Health with a focus on the outcomes and economics of treating chronic kidney disease in low-and-middle-income countries. Ben is also clinical advisor for Ellen Medical Devices (The Affordable Dialysis Project) developing a system to provide low cost dialysis to those who currently cannot afford it.

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