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Ethier I, Sandal S, Tarakji AR, Finkle SN, Kahlon B, Pederson K, Samanta R, Stigant C. Climate Change and Environmentally Sustainable Kidney Care in Canada: A Knowledge, Attitudes, and Practices Survey of Kidney Care Providers. Can J Kidney Health Dis 2024; 11:20543581241287286. [PMID: 39386276 PMCID: PMC11462604 DOI: 10.1177/20543581241287286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/03/2024] [Indexed: 10/12/2024] Open
Abstract
Background Climate change impacts health and threatens the stability of care delivery systems, while healthcare is mobilizing to reduce its significant environmental impact. Objective This study aimed to assess knowledge, attitudes, and practices (KAP) about climate change among Canadian kidney care providers. Design setting participants measurements and methods An electronic KAP survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to kidney care providers across Canada, from March to April 2023. Results A total of 516 people responded to the survey. Most respondents (79%) identified as women; 83% were aged 30 to 59 years. Nurses and nephrologists made up 44% and 23% of respondents, respectively. About half of the participants felt informed about climate change to an average degree. Most respondents (71%; 349/495 and 62%; 300/489) were either extremely or very concerned about climate change and waste generated in their kidney care program, respectively. The vast majority of respondents (89%; 441/495) reported taking steps to lower their personal carbon footprint. People who felt more informed about climate change presented higher degrees of concern. Similarly, both those who felt more informed and those who reported higher degrees of concern about climate change were more likely to take steps to reduce their carbon footprint. Over 80% of respondents (314/386) were at least moderately interested in learning sessions about environmentally sustainable initiatives in care. Limitations This survey is at risk of social acceptability, representative, and subjective bias. Overrepresentation from Quebec and British Columbia, as well as the majority of respondents identifying as women and working in academic centers, may affect generalizability of the findings. Conclusions Most kidney care providers who responded to this survey are informed and concerned about climate change, and their knowledge is directly associated with attitude and practices. This indicates that educational initiatives to increase awareness and knowledge on climate change will likely lead to practice changes.
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Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, QC, Canada
- Health Innovation and Evaluation Hub, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, QC, Canada
| | - Shaifali Sandal
- Divisions of Nephrology and Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- MEDIC, The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | - Ratna Samanta
- Divisions of Nephrology and Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Caroline Stigant
- The University of British Columbia, Vancouver, Canada
- Royal Jubilee Hospital, Victoria, BC, Canada
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Iman Y, Bamforth R, Ewhrudjakpor R, Komenda P, Gorbe K, Whitlock R, Bohm C, Tangri N, Collister D. The impact of dialysate flow rate on haemodialysis adequacy: a systematic review and meta-analysis. Clin Kidney J 2024; 17:sfae163. [PMID: 38979109 PMCID: PMC11229034 DOI: 10.1093/ckj/sfae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Indexed: 07/10/2024] Open
Abstract
Background Patients with kidney failure treated with maintenance haemodialysis (HD) require appropriate small molecule clearance. Historically, a component of measuring 'dialysis adequacy' has been quantified using urea kinetic modelling that is dependent on the HD prescription. However, the impact of dialysate flow rate on urea clearance remains poorly described in vivo and its influence on other patient-important outcomes of adequacy is uncertain. Methods We searched Embase, MEDLINE and the Cochrane Library from inception until April 2022 for randomized controlled trials and observational trials comparing a higher dialysate flow rate (800 ml/min) and lower dialysate flow rate (300 ml/min) with a standard dialysis flow rate (500 ml/min) in adults (age ≥18 years) treated with maintenance HD (>90 consecutive days). We conducted a random effects meta-analysis to estimate the pooled mean difference in dialysis adequacy as measured by Kt/V or urea reduction ratio (URR). Results A total of 3118 studies were identified. Of those, nine met eligibility criteria and four were included in the meta-analysis. A higher dialysate flow rate (800 ml/min) increased single-pool Kt/V by 0.08 [95% confidence interval (CI) 0.05-0.10, P < .00001] and URR by 3.38 (95% CI 1.97-4.78, P < .00001) compared with a dialysate flow rate of 500 ml/min. Clinically relevant outcomes including symptoms, cognition, physical function and mortality were lacking and studies were generally at a moderate risk of bias due to issues with randomization sequence generation, allocation concealment and blinding. Conclusion A higher dialysate flow increased urea-based markers of dialysis adequacy. Additional high-quality research is needed to determine the clinical, economic and environmental impacts of higher dialysate flow rates.
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Affiliation(s)
- Yasmin Iman
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Ryan Bamforth
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Ruth Ewhrudjakpor
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Quanta Dialysis Technologies, Alcester, UK
- University of Manitoba, Rady Faculty of Health Sciences, Department of Internal Medicine, Winnipeg, Manitoba, Canada
| | | | - Reid Whitlock
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
| | - Clara Bohm
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- University of Manitoba, Rady Faculty of Health Sciences, Department of Internal Medicine, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- University of Manitoba, Rady Faculty of Health Sciences, Department of Internal Medicine, Winnipeg, Manitoba, Canada
| | - David Collister
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- University of Manitoba, Rady Faculty of Health Sciences, Department of Internal Medicine, Winnipeg, Manitoba, Canada
- University of Alberta, Faculty of Medicine & Dentistry, Department of Medicine, Edmonton, Alberta, Canada
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Phua E, Shen Y. The climate impact of dialysis. Curr Opin Nephrol Hypertens 2024; 33:97-101. [PMID: 37889560 DOI: 10.1097/mnh.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW A reciprocal relationship currently exists between climate change and healthcare, mutually influencing each other. There have been significant planetary shifts in recent decades, marked by escalating temperatures, frequent natural calamities, a disturbing surge in climate-linked fatalities, and a heightened incidence of kidney disease diagnoses. RECENT FINDINGS Dialysis, a life-preserving treatment for kidney failure, extends to 2-3 million patients globally, mainly through in-centre haemodialysis. This treatment exerts an environmental toll, contributing to the healthcare sector's carbon footprint through water usage, energy consumption, waste generation, and current procurement practices. Diligent scrutiny and data collection of these facets have spurred sustainability initiatives, beginning at the local level with water, energy, and waste management. Still, this represents just the tip of the iceberg, with a pressing need for more comprehensive and habitual sustainable dialysis practices. SUMMARY This review examines the carbon footprint from dialysis, probes its ecological ramifications, and underscores potential solutions to lessen its climate impact.
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Affiliation(s)
- Elaine Phua
- Renal Department, Royal North Shore Hospital
| | - Yvonne Shen
- Renal Department, Royal North Shore Hospital
- Sydney Dialysis Centre, Herbert Street, St Leonards
- University of Sydney, Camperdown, NSW, Australia
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Tarrass F, Benjelloun H, Benjelloun M. Nitrogen and phosphorus recovery from hemodialysis wastewater to use as an agricultural fertilizer. Nefrologia 2023; 43 Suppl 2:32-37. [PMID: 38245438 DOI: 10.1016/j.nefroe.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Hemodialysis wastewater contains high concentrations of ammonia nitrogen and phosphorus. Recovery of these nutrients as soil fertilizers represents an interesting opportunity to ensure a sustainable fertilizer supply. METHODS In this paper, a simple method for recovering phosphorous and nitrogen as crystalline struvite [MgNH4PO4·6H2O] is presented. An integrated cost model is also presented in order to create a positive business case. RESULTS Recovery rates in form of struvite of 95% of PO43--P and 23% of NH4+-N were achieved with a profit. CONCLUSION To the best of our knowledge, this paper is the first to study the recovery of these naturally occurring minerals from hemodialysis wastewater. This offers great potential for the valorization of this type of wastewater.
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Lattanzio S, Stefanizzi P, D’ambrosio M, Cuscianna E, Riformato G, Migliore G, Tafuri S, Bianchi FP. Waste Management and the Perspective of a Green Hospital-A Systematic Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315812. [PMID: 36497884 PMCID: PMC9738387 DOI: 10.3390/ijerph192315812] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 05/20/2023]
Abstract
The concept of a "green hospital" is used in reference to a hospital that includes the environment as part of its quality services and one that pays attention to the sustainable design of buildings. Waste disposal represents a potential risk for the environment; therefore, waste collection from healthcare centers is a key environmental issue. Our study aims to systematically review the experiences acquired in worldwide nosocomial settings related to the management of healthcare waste. Nineteen studies, selected between January 2020 and April 2022 on Scopus, MEDLINE/PubMed and Web of Science databases were included in our systematic narrative review. Operating room and hemodialysis activities seem to be the procedures most associated with waste production. To deal with waste production, the 5Rs rule (reduce, reuse, recycle, rethink and research) was a common suggested strategy to derive the maximum practical benefit while generating the minimum amount of waste. In this context, the COVID-19 pandemic slowed down the greening process of nosocomial environments. Waste management requires a multifactorial approach to deal with medical waste management, even considering the climate change that the world is experiencing. Education of health personnel and managers, regulation by governmental institutions, creation of an "environmental greening team", and awareness of stakeholders and policymakers are some of the measures needed for the greening of healthcare facilities.
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Affiliation(s)
- Sabrina Lattanzio
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marilena D’ambrosio
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Eustachio Cuscianna
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giacomo Riformato
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-80-5478473; Fax: +39-80-5478472
| | - Francesco Paolo Bianchi
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Bari Policlinico University Hospital, 70124 Bari, Italy
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Vanholder R, Agar J, Braks M, Gallego D, Gerritsen KGF, Harber M, Noruisiene E, Pancirova J, Piccoli GB, Stamatialis D, Wieringa F. OUP accepted manuscript. Nephrol Dial Transplant 2022; 38:1080-1088. [PMID: 35481547 DOI: 10.1093/ndt/gfac160] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
The world faces a dramatic man-made ecologic disaster and healthcare is a crucial part of this problem. Compared with other therapeutic areas, nephrology care, and especially dialysis, creates an excessive burden via water consumption, greenhouse gas emission and waste production. In this advocacy article from the European Kidney Health Alliance we describe the mutual impact of climate change on kidney health and kidney care on ecology. We propose an array of measures as potential solutions related to the prevention of kidney disease, kidney transplantation and green dialysis. For dialysis, several proactive suggestions are made, especially by lowering water consumption, implementing energy-neutral policies, waste triage and recycling of materials. These include original proposals such as dialysate regeneration, dialysate flow reduction, water distillation systems for dialysate production, heat pumps for unit climatization, heat exchangers for dialysate warming, biodegradable and bio-based polymers, alternative power sources, repurposing of plastic waste (e.g. incorporation in concrete), registration systems of ecologic burden and platforms to exchange ecologic best practices. We also discuss how the European Green Deal offers real potential for supporting and galvanizing these urgent environmental changes. Finally, we formulate recommendations to professionals, manufacturers, providers and policymakers on how this correction can be achieved.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Gent, Belgium
| | - John Agar
- Renal Services, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
| | - Daniel Gallego
- European Kidney Health Alliance, Brussels, Belgium
- European Kidney Patients Federation, Wien, Austria
| | - Karin G F Gerritsen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mark Harber
- University College London, Department of Renal Medicine, London, UK
| | - Edita Noruisiene
- European Kidney Health Alliance, Brussels, Belgium
- European Dialysis and Transplant Nurses Association-European Renal Care Association, Hergiswil, Switzerland
| | - Jitka Pancirova
- European Dialysis and Transplant Nurses Association-European Renal Care Association, Hergiswil, Switzerland
| | | | - Dimitrios Stamatialis
- Advanced Organ Bioengineering and Therapeutics-Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Fokko Wieringa
- European Kidney Health Alliance, Brussels, Belgium
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
- imec the Netherlands, Holst Centre, Eindhoven, The Netherlands
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