The importance of sustainability emphasised at the Irish Nephrology Society Winter Meeting

The issue of climate change and conservation was discussed at the recent Irish Nephrology Society Winter Meeting, held at Tullamore Court Hotel, Co Offaly, on 20 January 2024.

A talk on sustainability and kidney care was delivered by guest speaker Dr Eleanor Murray. Dr Murray is Consultant Nephrologist at NHS Greater Glasgow and Clyde and former College/NHS Scotland Clinical Sustainability Fellow. She continues to be involved in various sustainability committees in relation to the specialty.

In her talk, Dr Murray referred to climate change as a danger to health and highlighted that healthcare systems are a significant emitter of greenhouse gases. She said that 3.7 tonnes of CO₂e [carbon dioxide equivalent] is produced per in-centre haemodialysis patient every year. The environmental impact of single-use plastic gloves and surgical equipment was also referenced, as were metered-dose inhalers. Dr Murray acknowledged that the journey to reaching net zero is a significant challenge; however, she added that there are many practical steps which units can take.

She said: “Our wards all had bottled water for the patients, a hangover from Covid-19. So even just returning to water jugs instantly reduced our carbon footprint. The bottled water had to be manufactured, transported, and refrigerated. And then the empty bottle had to be dealt with.”

Dr Murray said that NHS Scotland generated 18,000 tonnes of clinical waste last year, with one dialysis session generating 1.5kg to 8kg of waste. To help reduce this, she suggested that low-dose weekly injections could be changed to fortnightly or monthly injections. This would reduce nursing staff time required in renal dialysis unit administration, and lower the carbon footprint from a production, distribution, and waste management point of view. It would also lead to savings for the health service.

Changing dialysis machines could also help achieve this goal. “We have recently moved all our machines over to adaptive flow,” Dr Murray said. This sets the dialysate to 1.2x or 1.5x blood flow.

“Simply by doing that we have a 15 per cent reduction in dialysate use,” she added.

She also spoke about the use of central dialysate versus canisters.

“The carbon footprint of being on a cannister is essentially twice than from the central dialysate. To switch the unit over from cannisters to central dialysate is very expensive, but you get a rapid return on investment.”

One hospital which changed to a centralised delivery unit saw a reduction of 16 tonnes of CO₂ emissions, the meeting heard.

When asked what she would recommend as the single most important change that dialysis units could do, Dr Murray said engagement with other colleagues was key.

“Some of the examples I gave are really quick, easy fixes. Once you start applying them, you see changes you can make everywhere,” she said. “The more you engage with other colleagues, the more you can come up with ideas for the next projects, making environmental sustainability just part of the job.”

Following her talk, an audience member stated that one of the main challenges facing Irish nephrology is how rejected water is dealt with. The meeting heard that 90,000 litres of water are used per dialysis patient per year. It is estimated that about 500 litres of clean and potable water are used per dialysis session, with most of that rejected. It was also mentioned that in many countries water is a scarce resource.

Dr Murray, who spoke remotely from Glasgow, acknowledged this difficulty, saying that studies from Australia and elsewhere have already examined the issue.

“There are many efficiencies which could be implemented,” she said.

The carbon footprint created by an individual’s conference attendance over the course of a year and a career was also raised by the audience. When asked for her opinion, Dr Murray said a virtual attendance option for conferences would be very helpful for people who choose not to fly, while also allowing people with constrained resources to attend.

I think that there is a huge amount to be gained from in-person events that you lose if it’s just online, but there are definite benefits from having some of it virtually as well

“If they can join online that massively increases accessibility, participation, and equity,” she said, adding that she would like to see conferences offer hybrid models of attendance.

“I think that there is a huge amount to be gained from in-person events that you lose if it’s just online, but there are definite benefits from having some of it virtually as well.”

The importance of the patient voice in promoting sustainability was also pointed out by the audience and Dr Murray concluded by saying this was something she wished to work on in the UK over the next year.