Sustainable Kidney Care Toolkit
Introduction
The Sustainable Kidney Care Toolkit supports kidney centres across the UK in implementing sustainable care whilst aligning with the NHS Renal Specialised Transformation Programme (RSTP). Chronic kidney disease (CKD) is a major public health issue, affecting over 10% of the population (Jager et al., 2019), with the burden on the NHS continuing to rise (NHS England, 2022).
This toolkit provides practical guidance for commissioners, service providers, and clinicians to ensure high-quality, patient-centred care, while reducing costs and environmental impact.
Principles
This toolkit is categorised into four domains aligned to sustainable healthcare practices. "How-to" guides will provide support with implementing the initiatives within your centres. Case studies provide further evidence to support you to embed sustainable initiatives.
Energy and Water Saving
Dialysis is a resource-intensive therapy, but targeted strategies can significantly reduce environmental impact. Initiatives such as reclaiming reject water from reverse osmosis (RO) systems, using dialysate autoflow features, and implementing online priming of haemodialysis lines reduce water and energy consumption. Additionally, encouraging patients to bring personal blankets further conserves water and energy used in laundry services.
1. Reverse Osmosis Water Reclaim
The re-use of reject water from reverse osmosis (RO).
- Case Study: Reuse of reject water in two dialysis units
- How-to Guide: 1. Reverse Osmosis (RO) Water Reclaim in Haemodialysis
2. Dialysate Autoflow Facility
Prescribing Haemodialysis Fluid Flow Rates.
- Case Study: Dialysate AutoFlow Facility
- How-to Guide: 2. Using Autoflow in Haemodialysis
3. Online Priming of Haemodialysis Lines
- Case Study: Online Priming Haemodialysis Lines in Acute Dialysis Unit
- How-to Guide: 3. Online Priming for Haemodialysis
4. Reducing Linen Use
- Case Study: Encouraging Patients to Bring Their Own Blankets
- How-to Guide: 4. Reducing unnecessary linen use in dialysis centres
Waste Reduction and Management
Reducing waste in dialysis care involves both minimising waste generation and improving waste handling. Switching to more concentrated acid solutions (1:44 instead of 1:34) and transitioning from individual canisters to central acid delivery systems reduce packaging and transport emissions. Digitising records cuts down paper use, while enhanced waste segregation and the use of reusable sharps bins help divert materials from landfill.
5. Switching from 1:34 to 1:44 Acid Concentrate
6. Central Acid Concentrate Delivery
Change from canisters to central acid concentrate delivery system of bulk delivered fluid or reconstituted fluid from dry powder.
- Case Study: Implementing Central Acid Delivery (Bradford)
- Case Study: Reducing the carbon footprint for a 30-bed haemodialysis unit by changing the delivery of acid concentrate supplied by individual 5 L containers to a central delivery system
- How-to Guide: 6. Central Acid Concentrate Delivery (CAD) for Haemodialysis
7. Paper Reduction in Dialysis Units
Digitalisation of patient notes, testing and reporting.
- Case Study: Reducing Paper Use
- How-to Guide: 7. Transition to paperless clinical documentation
8. Improved Waste Segregation
Recycling and waste stream management.
- Case Study: Improving Waste Management
- Case Study: Waste Management in Hemodialysis Unit Performance Improvement (Beirut, EDTNA/ERCA poster)
- How-to Guide: 8. Waste segregation in Kidney Centres
9. Reusable Sharps Bins
- Case Study: Impact Study on Reusable Sharps Containers
- How-to Guide: 9. Implementing Reusable Sharps Containers
Lean Processes and Pathways
Implementing lean practices ensures that dialysis services are both patient-centred and resource-efficient. Personalised dialysis prescriptions, such as incremental dialysis, tailor treatment intensity to individual needs. Expanding virtual clinics reduces travel-related emissions and increases accessibility, supporting patient wellbeing and environmental goals.
10. Personalised Dialysis Prescription
Incremental haemodialysis for patients with residual renal function.
- Case Study: Implementing Incremental Haemodialysis
- How-to Guide: 10. Implementing Incremental Haemodialysis
11. Travel and Transport: Remote Consultations
Introducing remote consultations and virtual clinics.
- Case Study: Remote CKD monitoring as part of a disease management program
- Carbon calculator: Remote consultations - calculating greenhouse gas emissions
- How-to Guide: 11. Enhancing Remote Consultations and Virtual Clinics
12. Travel and Transport: Sustainable Options
Providing electric vehicles as patient transport, reimbursed public transport costs and accessible cycling facilities.
- How-to Guide: 12. Sustainable Travel in UK Kidney Centres
Sustainable Food Options
Nutrition in dialysis is both health-promoting and environmentally sustainable. Offering plant-based meal choices, eliminating red and processed meats, and providing access to dietary education supports kidney health while lowering the carbon footprint of food services.
13. Sustainable Food Options
Plant based choices, not offering red or processed meats and patient access to plant-based diet factsheets.
- Patient information: Plant-Based Diet Factsheets for CKD and Dialysis
- How-to Guide: 13. Sustainable Food for Kidney Health
Resources
skc.ukkidney.org UKKA Sustainable Kidney Care Committee
ukkidney.org Sustainable Kidney Care – Implementing Best Practice project
sustainablehealthcare.org.uk CSH Networks Hub: Kidney Care Sustainability Network & Resource Library
networks.sustainablehealthcare.org.uk Case Studies for Sustainable Kidney Care
networks.sustainablehealthcare.org.uk NHS Sustainable Healthcare e-Learning
e-lfh.org.uk NHS England Greener NHS
england.nhs.uk NHS Scotland Centre for Sustainable Delivery
nhscfsd.co.uk NHS Renal Digital Playbook
transform.england.nhs.uk Remote Kidney Care Toolkit
kidneycareuk.org Medicines Optimisation Toolkit for AKI
thinkkidneys.nhs.uk