Comparison of carbon emissions, water use, and dialysis waste between incremental and full-dose peritoneal dialysis: a cohort study

Introduction: Incremental peritoneal dialysis (PD) may confer environmental benefits compared to full-dose PD due to reduced resource use. We aimed to quantify and compare carbon emissions, water consumption, and waste generation between incremental and full-dose PD in a cohort of incident PD patients. Methods: We compared environmental metrics, including carbon emissions, water consumption, and waste generation between incremental and full-dose PD, using prospectively collected data between June 2019 and May 2024 at the Western Renal Service, Sydney, Australia. Carbon emissions were quantified using standardized coefficients from a published life-cycle analysis, while water and waste volumes were estimated using literature-based assumptions. Group comparisons were conducted using the Mann–Whitney U test, with a two-sided p-value <0.05 considered statistically significant. Results: Among 365 incident patients (187 incremental, 178 full-dose), followed for a median of 20 months (interquartile range 13–37), incremental PD had lower median annual per-patient carbon dioxide equivalent emissions (1016 vs. 1360 kg), blue water consumption (24,090 vs. 25,548 L), landfill waste (212 vs. 271 kg), gray water generation (8213 vs. 10,549 L), and recycling volume (73 vs. 131 kg), compared to full-dose PD (all p < 0.001). Incremental PD yielded estimated savings of 201,087 kg carbon dioxide equivalent emissions, over 5 million liters of blue water, 1.8 million liters of gray water, 27,223 kg of landfill waste, and 16,219 kg of recyclable materials. Conclusion: Incremental PD was associated with a lower environmental impact than full-dose PD, highlighting its potential contribution to environmentally sustainable dialysis care.