Driving Sustainable Change in Dialysis: Northern General Hospital's (Sheffield) actions for Greener Dialysis

As a Sustainable Kidney Education Fellow at the Centre for Sustainable Healthcare, I had the invaluable opportunity to participate in a meeting at the Renal Department in Northern General Hospital, Sheffield. This experience allowed me to gain firsthand insight into the sustainable interventions being implemented, as well as the challenges and barriers that may arise during their adoption. The meeting was led by Leeanne Lockley, Kidney Quality Improvement Partnership’s Quality Improvement Programme Manager, and Dr. Stephanie Choo, nephrology registrar at Leeds Hospital. 

They are both leading on their Trying to Reduce Unnecessary Carbon in Haemodialysis (TRUNC-HD), which is a Yorkshire and Humber regional sustainability project. The multidisciplinary team in the Sheffield Kidney Institute has collaborated with the TRUNC-HD project and has been actively working on sustainable initiatives. It was inspiring to witness their proactive approach to greener dialysis care and to engage in discussions on how to further advance sustainability in nephrology.

Their commitment to reducing waste, conserving resources, and engaging patients in sustainable practices serves as an excellent model for other dialysis units looking to implement similar interventions. Here are some of the key initiatives that have contributed to their progress:

1. Encouraging Patients to Bring Their Own Blankets
   One of the simplest yet effective changes has been encouraging patients to bring their own blankets, reducing the reliance on hospital-provided ones which have to be laundered after every single use. A great way to measure success is by checking with the unit's laundry service—if the number of blanket orders has decreased, it's a positive sign! However, the key to success lies in how this initiative is communicated. By explaining the environmental benefits and engaging patients in conversations about sustainability, Sheffield’s team aim to foster a sense of shared responsibility and enthusiasm for this change.
2. Considering Reducing the Frequency of Dialysis Machine Disinfections
   Another potential intervention under evaluation is assessing the number of heat citric acid disinfections performed on the internal circuit of dialysis machines per day. By optimising the frequency of heat disinfections based on clinical necessity and evidence-based practices rather than rigid protocols, Sheffield aims to reduce the environmental footprint of heat disinfectant use while maintaining patient safety.
3. Implementation of Reusable Tourniquets
   The department has switched to reusable tourniquets as a sustainable alternative to single-use options. This shift has reduced medical waste and generated cost savings over time. Standardising the use of these items across dialysis units could contribute significantly to sustainability efforts.
4. Incremental Haemodialysis (HD) Program
   Incremental HD programs, which gradually increase dialysis frequency and duration based on individual patient needs, are under consideration. This approach ensures that patients receive the right amount of dialysis while optimising resource use. This year, the Sheffield Kidney Institute is working with other kidney units in the Yorkshire and Humber region, looking at standardising this approach and making personalised incremental dialysis an option for all suitable patients.
5. Reducing Dialysate Flow Rate from 800 to 500ml/min
   Perhaps one of the most impressive achievements so far has been successfully reducing the dialysate flow rate from 800 to 500ml/min in a satellite dialysis unit. At 2 months post implementation review, they have maintained a similar dialysis dose without significant clinical changes while achieving substantial reductions in water, electricity consumption, and costs. This change has also allowed them to switch to smaller bicarbonate cartridges, further minimising waste. The team is currently reviewing the 4-month data prior to considering department-wide adoption of the change to the other dialysis units.

The Renal Department in Northern General Hospital (Sheffield) is a testament to what can be achieved with thoughtful, practical changes that prioritize both patient care and environmental responsibility. Their efforts demonstrate that sustainability in kidney care is not just an ideal but a tangible, achievable goal. By sharing these successes, we hope to inspire other dialysis units to explore and implement their own sustainable practices, contributing to a greener future for kidney care.