Greenhouse gas emissions from hemodialysis treatment in the United States have not been quantified. In addition, no previous studies have examined how much emissions vary across facilities, treatments, and emission contributors.

To estimate the magnitude and sources of variation in the carbon footprint of hemodialysis treatment, we estimated life-cycle greenhouse gas emissions in carbon dioxide equivalents (CO₂-eq) associated with 209,481 hemodialysis treatments in 2020 at 15 Ohio hemodialysis facilities belonging to the same organization. We considered emissions from electricity, natural gas, water, and supply use; patient and staff travel distance; and biohazard and landfill waste.

Annual emissions per facility averaged 769,374 kg CO₂-eq (95% CI, 709,388 to 848,180 kg CO₂-eq). The three largest contributors to total emissions were patient and staff transportation (28.3%), electricity (27.4%), and natural gas (15.2%). Emissions per treatment were 58.9 kg CO₂-eq, with a three-fold variation across facilities. The contributors with the largest variation in emissions per treatment were transportation, natural gas, and water (coefficients of variation, 62.5%, 42.4%, and 37.7%, respectively). The annual emissions per hemodialysis facility are equivalent to emissions from the annual energy use in 93 homes; emissions per treatment are equivalent to driving an average automobile for 238 km (149 miles).

Similar medical treatments provided in a single geographic region by facilities that are part of the same organization may be expected to have small variations in the determinants of greenhouse gas emissions. However, we found substantial variation in carbon footprints across facilities, treatments, and emission contributors. Understanding the magnitude and variation in greenhouse gas emissions may help identify measures to reduce the environmental effect of hemodialysis treatment.

美国血液透析治疗的温室气体排放量尚未量化。此外，之前没有研究考察过设施、处理方法和排放贡献者之间的排放量差异有多大。

为了估算血液透析治疗碳足迹变化的幅度和来源，我们估算了2020 年俄亥俄州 15 个血液透析设施中与 209,481 次血液透析治疗相关的生命周期温室气体排放量（以二氧化碳当量 (CO 2 -eq) 表示_）组织。我们考虑了电力、天然气、水和供应使用的排放；患者和工作人员的出行距离；以及生物危害和垃圾填埋场废物。

每个设施的年排放量平均为 769,374 kg CO ₂ -eq（95% CI，709,388 至 848,180 kg CO ₂ -eq）。总排放量的三大来源是患者和员工交通（28.3%）、电力（27.4%）和天然气（15.2%）。每次处理的排放量为 58.9 kg CO ₂ -eq，各个设施之间存在三倍的差异。每种处理排放量变化最大的因素是交通、天然气和水（变化系数分别为 62.5%、42.4% 和 37.7%）。每个血液透析设施的年排放量相当于 93 个家庭每年能源使用的排放量；每次治疗的排放量相当于驾驶一辆普通汽车 238 公里（149 英里）。

由同一组织的设施在单一地理区域提供的类似医疗预计在温室气体排放的决定因素方面会有微小差异。然而，我们发现不同设施、处理方法和排放源之间的碳足迹存在很大差异。了解温室气体排放量的大小和变化可能有助于确定减少血液透析治疗对环境影响的措施。