Delivering healthcare is sometimes regarded as an issue that is entirely separate from the wider ecological and environmental challenges that Europe faces. However, the reality is that when it comes to water usage, the production of plastic waste, and generating carbon emissions, the healthcare sector presents a significant environmental challenge.
This means that, if the European Union is to meet its Green Deal targets, then healthcare providers and policymakers will need to carefully consider how to meet the changing healthcare needs of citizens whilst minimising negative environmental impacts.
One health issue that poses a unique set of environmental challenges is how we care for those who are living with advanced stages of Chronic Kidney Disease (CKD). Research demonstrates that current therapies for CKD, like dialysis, leave a substantial carbon footprint and cause wider damage to the environment through water and energy usage, and the production of plastics.
In Europe, around 100 million people suffer from CKD with 300,000 on dialysis, and experts predict that this is a problem likely to grow, adding up to a substantial environmental impact. Against this backdrop of rising numbers, what can policymakers, scientists, clinicians, and healthcare providers do to ensure that we make the transition to a sustainable model of kidney care?
A major gathering of politicians, researchers, and patient groups in Brussels this June will attempt to answer this critical question. The European Kidney Forum 2023, organised by the European Kidney Health Alliance (EKHA) taking place on 28th June, will focus on developing new approaches that can meet the health needs of people with CKD whilst minimising the negative impact on the environment.
Professor Raymond Vanholder, President of the EKHA, explained why the organisation has chosen to turn a spotlight on green nephrology.
“Chronic kidney disease impacts millions of people across Europe but the complex relationship between current treatments and environmental impact is not fully appreciated,” he tells us. “This important and timely event will focus on developing and supporting green nephrology practices that can make a major contribution to meeting European Green Deal targets.”
The data supports Professor Vanholder’s assessment of an area of healthcare with the potential to make a significant contribution to a more sustainable future. Dialysis, one of the most common forms of treatment, consumes a staggering 150 billion litres of water globally. Most of this water is ultimately discharged into the sewerage system. To put that in context, that is the equivalent of enough wasted water to fill around 40,000 Olympic swimming pools every year.
“Water usage is the most obvious area where we can do things better, but it is far from the only one,” Professor Vanholder tells us. “Dialysis as a treatment is also responsible for almost half of all healthcare carbon emissions. The CO2 emitted by just a single session of dialysis is equivalent to a 238 km car drive. As we all become more aware of the urgency of the climate crisis, healthcare has a vitally important role to play.”
One of the primary aims of the Forum is to build awareness of the sheer scale of the issue and the relationship between nephrology and Europe’s Green Deal targets. Whilst the Green Deal targets themselves are not health specific, the policies, regulations, and strategies that are likely to emerge in the coming months and years will challenge the healthcare sector to develop new ways of working that support the achievement of wider sustainability goals. This may include treatments with a lower carbon footprint or the development of drugs in a more sustainable way.
Nephrology has been highlighted as an area with scope for significant reductions, and the growing body of evidence on its environmental impact is providing a catalyst for a broader debate about new, sustainable models of care. But, if that change is to take place, a broader understanding of the scale of the issue is required.
“It is essential that there is a common understanding of the problem,” Professor Vanholder explains. “Building a greater awareness of the scale of the environmental impact of dialysis is the first step towards identifying opportunities for improvement.”
Central to these approaches is a renewed focus on preventative measures that avoid or delay the need for dialysis. Experts regard preventing kidney disease or slowing down its progression as a key strand in reducing the environmental impact of treatments. Focusing on lifestyle issues can reduce the prevalence of kidney disease whilst early identification of the condition can reduce the need for dialysis by 28%. That alone can deliver significant savings on water consumption, energy use, plastics, and carbon emissions. There is also a clear role for driving up levels of organ transplantation (although 25% of patients are medically unfit). Studies have estimated that the environmental impact of transplantation could be 90-95% less than dialysis.
However, increased prevention is only part of the solution. Developing alternatives to dialysis and increasing support to develop drugs that counter the progression of the disease will also deliver health and environmental benefits.
In addition, there is a general lack of awareness of the environmental and societal burden of CKD, which only worsens these issues. This is one of the reasons for the lack of investment in sustainable kidney care innovation in the last 60 years. MEP Ondřej Knotek told Parliament Magazine that he views kidney care as an area where innovation can lead to a drastic reduction in environmental impact.
“Offering less burdensome, accessible, affordable, sustainable and above all, patient-driven treatment options should be the way forward,” he tells us. “Europe should be a frontrunner in developing sustainable and innovative therapies for kidney patients.”
It is a view that is echoed by other European parliamentarians. MEP Hilde Vautmans shares Knotek’s view that there must now be a much greater focus on developing sustainable alternatives to dialysis for those living with CKD. She sees such innovation as critical if the EU wishes to remain at the leading edge of healthcare and ecology.
“I call on my fellow MEPs and on the European Commission to facilitate research on green innovations in nephrology to ultimately tackle existing challenges and improve the lives of kidney patients,” she tells Parliament Magazine. “The EU launched several initiatives to make the EU an ecologic forerunner, such as the European Green Deal, the LIFE Program 2021–2027, or the Horizon Europe programme. Building on these opportunities will prove essential in fostering green innovation in nephrology.”
Although the challenges are significant, innovation and new research is beginning to shape a roadmap that can lead to a more sustainable future. Scientists and clinicians across Europe are already developing new treatments that have the potential to reduce environmental impact, whilst delivering benefits for patients. That is why experts are calling on the EU to put innovation in nephrology high on the EU research agenda.
“Kidney care is an area that has an enormous negative ecological impact at the moment,” Professor Vanholder explains. “But with coordinated action and investment, there is scope to find new ways of working that benefit patients and the environment. If the EU is to meet its Green Deal targets and provide high-quality care, the environmental impact of the healthcare sector must be considered, and kidney care and dialysis are an essential factor in this endeavour.”
In partnership with
This article was produced in partnership with the European Kidney Health Alliance ahead of the 2023 European Kidney Forum. Register here now to join the forum, taking place on 28th June in the European Parliament.