Green home-based dialysis and sustainability: A Scoping Review

Andreas Vilhelmsson , Ida Knutsson

Background
Climate change is among the foremost threats to global health, and the healthcare
sector is itself a substantial source of greenhouse gas (GHG) emissions. Dialysis is
one of the most resource- and carbon-intensive treatments in medicine, and homebased
modalities have been proposed as a more sustainable alternative to in-centre
care. Despite growing interest, the empirical evidence on the environmental impact of
home dialysis, and on whether sustainability influences its uptake, has not been
systematically mapped. This scoping review aimed to summarise the available
evidence on (1) the environmental impacts of home-based dialysis, (2) resource use
across water, energy, waste, and transport, and (3) whether sustainability
considerations affect the uptake of home-based dialysis.
Methods
Following the PRISMA extension for Scoping Reviews (PRISMA-ScR), an information
specialist searched five databases — PubMed, Embase, Scopus, Web of Science, and
GreenFile — with the final search conducted on 5 August 2026. Two independent
reviewers screened records in Covidence; data were extracted in NVivo and
synthesised using a relational analytical framework.
Results
The search identified 3,929 records, reduced to 2,704 after removing duplicates; 14
studies, published between 2007 and 2026 and almost half appearing in 2024–2026,
met the inclusion criteria. The evidence base was methodologically heterogeneous but
anchored by six life cycle assessments; haemodialysis was the focus of eight studies,
peritoneal dialysis of four, and two examined both modalities. Home haemodialysis
consistently showed a lower carbon footprint than in-centre treatment, driven largely by
avoided patient travel. Resource use was the most-reported domain, where
consumables and packaging, rather than energy, typically formed the largest burden,
with transport a consistent secondary contributor, and PVC recycling identified as a
tangible mitigation lever. Only two studies addressed whether sustainability affects
uptake, and both did so speculatively; person-centred outcomes were reported in just
three studies.