title: Eco-dialysis: the financial and ecological costs of dialysis waste products: is a 'cradle-to-cradle' model feasible for planet-friendly haemodialysis waste management?
abstract: BACKGROUND
  Approximately 2 million chronic haemodialysis patients produce over 2,000,000 tons of waste per year that includes about 600,000 tons of potentially hazardous waste. The aim of the present study was to analyse the characteristics of the waste that is produced through chronic haemodialysis in an effort to identify strategies to reduce its environmental and financial impact.
  
  
  METHODS
  The study included three dialysis machines and disposables for bicarbonate dialysis, haemodiafiltration (HFR) and lactate dialysis. Hazardous waste is defined as waste that comes into contact with bodily fluids. The weight and cost of waste management was evaluated by various policies of differentiation, ranging from a careful-optimal differentiation to a careless one. The amount of time needed for optimal management was recorded in 30 dialysis sessions. Non-hazardous materials were assessed for potential recycling.
  
  
  RESULTS
  The amount of plastic waste that is produced per dialysis session ranges from 1.5 to 8 kg (from 1.1 to 8 kg of potentially hazardous waste), depending upon the type of dialysis machine and supplies, differentiation and emptying policies. The financial cost of waste disposal is high, and is mainly related to hazardous waste disposal, with costs ranging from 2.2 to 16 Euro per session (2.7-21 USD) depending on the waste management policy. The average amount of time needed for careful, optimal differentiation disposal is approximately 1 minute for a haemodialysis session and 2 minutes for HFR. The ecological cost is likewise high: less than one-third of non-hazardous waste (23-28%) is potentially recyclable, while the use of different types of plastic, glues, inks and labels prevents the remaining materials from being recycled.
  
  
  CONCLUSIONS
  Acknowledging the problem of waste management in dialysis could lead to savings of hundreds of millions of Dollars and to the reuse and recycling of hundreds of tons of plastic waste per year on a world-wide scale with considerable financial and ecological savings.
authors: Nefrologia, Scienze Mediche e Biologiche, ASOU San Luigi Gonzaga, Orbassano, Torino, Italy gbpiccoli@yahoo.it.
authors: Giorgina Barbara
authors: GB
authors: Piccoli
authors: Scienze Mediche e Biologiche,ASOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors: Marta
authors: M
authors: Nazha
authors: Nefrologia, Scienze Mediche e Biologiche, ASOU San Luigi Gonzaga, Orbassano, Torino, Italy.
authors: Martina
authors: M
authors: Ferraresi
authors: Chair of Nephrology, University of Torino, Torino, Italy.
authors: Federica Neve
authors: FN
authors: Vigotti
authors: Architettura e Design, Politecnico di Torino, Torino, Italy.
authors: Amina
authors: A
authors: Pereno
authors: Architettura e Design, Politecnico di Torino, Torino, Italy.
authors: Silvia
authors: S
authors: Barbero
mesh_terms: D003247:Conservation of Natural Resources; D003365:Costs and Cost Analysis; D004463:Ecology; D005440:Fluid Therapy; D006801:Humans; D017744:Medical Waste Disposal / Q000379:methods*; D016083:Planets; D059027:Recycling; D006435:Renal Dialysis / Q000191:economics; D018505:Waste Management / Q000191:economics*; D014866:Waste Products
chemical_list: D017744:Medical Waste Disposal; D014866:Waste Products
keywords: costs; disposables; ecology; haemodialysis; waste