SAVING WATER, REDUCING WASTE: A COMPARATIVE STUDY OF INCREMENTAL VERSUS STANDARD DOSE PERITONEAL DIALYSIS ON WATER, DIALYSIS WASTE AND CARBON EMISSIONS
Ms Mary Ann Nicdao1,2,3,9, Katrina Chau1,4, Scott Hanson5, Kamal Sud1,6,7, Maria Daraoay1, Do Naw-Eh-Tha-Blay1, Surjit Tarafdar1,4,8, Allison Jaure2,3, Karine Manera2,3, Germaine Wong1,2,3, Martin Howell2,3
1Western Renal Service, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Australia, 3Sydney School of Public Health, University of Sydney, Australia, 4Blacktown Clinical School, School of Medicine, Western Sydney University, Australia, 5Western Sydney Local Health District, Australia, 6Department of Renal Medicine, Nepean Hospital, Australia, 7Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Australia, 8Department of Nephrology Kasturba Medical College, India, 9Royal North Shore Hospital, Sydney
Aim: To quantify the amount of water, plastic, carton, and potential carbon emissions saved through incremental peritoneal dialysis (PD), as compared to standard PD.
Background: Incremental PD may save water and reduce dialysis waste, but the extent of reduction in water and dialysis waste, compared with standard PD has not been quantified.
Methods: We compared the total water, plastic, and carton use, and potential carbon emissions associated with delivery of consumables, between incremental and standard dose PD within Western Renal Service, Sydney. These were calculated based on the number of PD exchanges/patient/day, adjusted to dose increments, versus standard PD.
Results: Of the 365 incident patients, followed for median time of 14 (IQR:19) months, 187 (51%) were prescribed incremental PD, 63% were male, 43% had diabetes as primary disease, and 34% had eGFR >10 mL/min (compared to 22% in the full dose group (N=178)). 41 (22%), 45 (24%), 18 (10%) and 83 (44%) patients treated with incremental PD were prescribed 1, 2, 3 manual exchanges, and three 1.8-litre cycles, respectively. This compared to 71 (40%) and 107 (60%) patients treated with four 2-litre manual exchanges and four 2-litre automated PD cycles, respectively. Compared with standard PD, the incremental group used 114, 924 less PD bags, equating to savings of >4 M litres water, 18,339 kg plastic and 13,424 kg cardboard cartons, potentially reducing deliveries to patients’ homes by 924, with associated carbon emissions by 9,171 kg CO2-e.
Conclusions: Incremental PD requires less water, plastic, cartons and fewer deliveries to patients’ homes compared to standard PD. In our cohort of incidental PD patients, this equated to a substantial reduction in waste and carbon emissions.
Presentation Slides PDF – Click here
Biography:
Mary Ann is a Nurse Practitioner for Home Dialysis in Western Renal Service in Sydney, NSW. In 2019, she led the protocol development and screening of incident patients for incremental PD suitability at WRS. She is also a PhD candidate at the Sydney School of Public Health, University of Sydney. For her research, she is comparing the clinical outcomes, costs and environmental implications of incremental versus full dose PD. Mary Ann is also investigating patients’ perceptions, experiences and quality of life on incremental PD, with focus on life participation associated with dialysis free time.