Carbon Emission Calculation in Hemodialysis Patients Using a Carbon Footprint Calculator: A Multicenter Observational Study

Abstract

Background: Haemodialysis is a resource-intensive treatment associated with greenhouse-gas emissions from repeated treatment delivery, transportation, household energy use, diet and waste. Patient-level carbon-emission data from India remain limited. This study assessed carbon emissions associated with maintenance haemodialysis across centres in Telangana, India. Methods: This multicentre observational assessment included 489 patients receiving maintenance haemodialysis at 18 dialysis centres during 2025, representing 156,264 haemodialysis sessions. Carbon emissions were estimated using the CarbonClick carbon-footprint calculator and included reported transportation, air travel, dietary habits, household energy use and household waste generation. Emissions were expressed as tonnes of carbon dioxide equivalents (t CO₂e). Results: The total reported carbon footprint was 1121.7 t CO₂e, with a mean of 2.29 ± 0.18 t CO₂e per participant, a median of 2.30 and a range of 2.00–2.60. Transportation contributed 39.1% of total emissions, housing energy 30.4%, dietary sources 26.0% and other sources 4.5%. Small petrol-powered vehicles predominated. Electricity accounted for 83% of the housing-energy contribution, while LPG and diesel-generator use contributed 12% and 5%, respectively. Among 475 participants with dietary data, the largest categories were vegetarian or very-low-meat and vegetarian diets. Conclusions: Transportation, housing energy and dietary factors were the main reported contributors. Patient- and centre-level carbon accounting may help identify locally relevant opportunities for more environmentally sustainable dialysis care.