Environmental Impacts of Kidney Replacement Therapies: A Comparative Lifecycle Assessment
Notice bibliographique
Résumé
RATIONALE & OBJECTIVE: Health care delivery is associated with considerable emissions of greenhouse gases and other pollutants. Although the relative health and economic impacts of kidney replacement therapies (KRTs) have been examined, their comparative environmental impacts have been poorly described. This study sought to characterize these impacts, comparing them across types of KRT. STUDY DESIGN: A comparative lifecycle assessment (LCA). SETTING & PARTICIPANTS: Data collection implemented at Vancouver General Hospital in Vancouver, British Columbia, Canada. EXPOSURE: Three KRTs: deceased-donor kidney transplant (KT), automated/cycler peritoneal dialysis (PD), or in-center hemodialysis (HD). OUTCOME: Environmental impacts of KRTs over 1 year were evaluated using the World ReCiPe (H) 2016 method. ANALYTICAL APPROACH: Lifecycle inventory results were transformed into 3 end-point and 18 midpoint environmental impact categories including climate change, air pollution, human toxicity, and water depletion. RESULTS: Across the majority of environmental impact categories, including climate change, air pollution, human toxicity, and water depletion, HD had the highest environmental impact and KT the lowest. The climate impact from a patient receiving HD was 74% and 46% more than from patients receiving KT and PD, respectively. Similarly, HD accounted for 65% of total air pollution impacts, 54% of human toxicity, and 44% of water depletion. The highest impact of PD was on water depletion (41%) and metal depletion (81%). KT demonstrated the lowest impact across all categories except terrestrial ecotoxicity. Within each therapy, patient and staff travel and consumables were the largest contributors to greenhouse gas emissions. LIMITATIONS: Pharmaceuticals were excluded from this study because of a lack of publicly available data. CONCLUSIONS: KT is the most environmentally preferred KRT. PD had fewer environmental impacts than HD. Understanding the relative environmental impacts of KRTs can help inform clinical decision-making in the management of kidney failure. PLAIN-LANGUAGE SUMMARY: The environmental impacts of health care are gaining attention, yet kidney care, and especially kidney replacement therapies (KRTs), have been underexamined. This study was inspired by growing concerns about the environmental consequences of KRTs like hemodialysis, peritoneal dialysis, and transplantation. We used environmental assessment tools to measure emissions and resource use across different KRTs in a clinical setting in Vancouver, Canada. We found that these therapies vary widely in their environmental impacts, with in-center hemodialysis having the greatest negative impact and kidney transplant the least impact. This study also explored the sources of these impacts and can inform health systems and health care policymakers regarding opportunities for more environmentally informed practices in kidney care.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».