Environmental footprint of peritoneal dialysis in Europe: a comparative life cycle assessment across four European centres

ABSTRACT Introduction. Peritoneal dialysis ( PD) is a home-based renal replacement therapy offering clinical and quality-of-life advantages, but it also poses environmental challenges due to resource use and waste generation. This study compares the environmental impacts of PD across four European centres to identify regional sustainability differences and evaluate the footprint of continuous ambulatory ( CAPD) , automated ( APD) , and incremental ( iPD) PD. Methods. A cradle-to-grave life cycle assessment ( LCA) was conducted for one year of PD treatment per patient using OpenLCA software and the EcoInvent database across four clinical centres; Madrid, Warsaw, Utrecht, Modena. Data were collected on material use, energy and water consumption, transportation, and waste disposal. Key indicators included global warming potential ( GWP) , energy use, water footprint. The environmental performance of each centre and dialysis modality was assessed. Results. Environmental impacts varied significantly between centres ranging from GWP 3381 kg CO2 -eq to 1736 kg, reflecting differences in energy mix and efficiency. Energy consumption ranged from 54,710 MJ to 28,894 MJ and water footprint from 6631 m3 to 854 m3 . Across all centres, CAPD and APD had higher environmental burdens than iPD. iPD reduced emissions by up to 50% and had a lower-impact profile. Conclusions. PD displays substantial environmental impact variability across centres, driven by differences in material consumption, waste management, energy sourcing, and clinical protocols. Cleaner energy profiles, effective waste management, and reduced reliance on single-use consumables may lower environmental burdens. These findings underscore the importance of integrating environmental performance into clinical decision-making and health system planning.