# Economic and environmental impacts of a resource-saving committee in a Japanese hemodialysis clinic: a case study

## TL;DR

A Japanese hemodialysis clinic reduced resource use and costs through a resource-saving committee, but rising expenses and waste disposal costs remain challenges.

## Contribution

The study evaluates the economic and environmental impact of a resource-saving committee in a hemodialysis clinic in Japan.

## Key findings

- The clinic's resource consumption per hemodialysis patient was comparable to an average Japanese household.
- Switching to a combination of city and well water reduced costs and environmental impact.
- Resource-saving efforts were partially offset by rising electricity and waste disposal costs due to inflation.

## Abstract

Dialysis therapy is a resource-intensive treatment for end-stage kidney disease that remains highly dependent on in-center hemodialysis in Japan. From both economic and environmental perspectives, it is necessary to reduce energy consumption and resource use, and minimize waste generation to achieve sustainable kidney healthcare. The clinic targeted in this study provides hemodialysis in a regional city and launched a resource-saving committee in 2008 to implement initiatives, appoint green champions, and monitor four environmental items (electricity, gas and water consumption, and waste generation) and financial effects. To retrospectively evaluate environmental impact, we calculated the carbon footprint. The median monthly consumption of electricity, gas, and water per hemodialysis patient was approximately 353 kWh, 17 m3, and 9 m3, respectively. These levels of resource consumption were nearly equivalent to those of an average Japanese household in 2022. Switching to a combination of city water and well water reduced both costs and environmental impact. However, the overall financial benefit and initial investment burden, such as for installation of light-emitting diode fixtures and developing the water supply system, were not fully investigated. The resource-saving committee appears to have mitigated both economic and environmental impacts to some extent; however, steady resource-saving efforts were accompanied by surging costs of electricity and medical waste disposal during the study period, indicative of recent general inflation in Japan. To achieve more sustainable dialysis therapy that balances environmental and health considerations, further proactive initiatives are needed to reduce resource use beyond the current scope, such as through individualized dialysate prescriptions.