Vol 17, No 1 (2024)
Review paper
Published online: 2024-04-02

open access

Page views 81
Article views/downloads 55
Get Citation

Connect on Social Media

Connect on Social Media

Renal replacement therapy and environmental risks

Rajmund Michalski1
DOI: 10.5603/rdatf.99851
Renal Disease and Transplantation Forum 2024;17(1):19-24.


It is estimated that at the end of the 19th century the number of chemical substances present in the environment was about 300,000. Today, according to the Chemical Abstract Service database (CAS, https://www.cas.org/cas-data/cas-registry), the number of known substances (most of which are man-made) is already more than 125,000,000. Although at the level of concentrations that can directly threaten us it is "only" about a million substances, but keeping in mind the synergistic effect, their impact on our health is enormous. One of the most common diseases of civilization is kidney disease, which is mostly asymptomatic, but contributes to the death of millions of people. In cases of end-stage renal failure, renal replacement therapy is necessary. Hemodialysis and peritoneal dialysis, on the one hand, save patients' lives, and on the other hand, have a major impact on environmental pollution and carbon footprint. This paper addresses these interrelationships.

Article available in PDF format

View PDF Download PDF file


  1. Michalski R. Application of IC-MS and IC-ICP-MS in Environmental Research. John Wiley & Sons, Hoboken, New Jersey 2016: 1–269.
  2. Michalski R. Chapter 16: Applications of ion chromatography in environmental analysis. In: Nesterenko PN, Poole CF, Sun Y. ed. The Handbook of Separation Science: Ion-Exchange Chromatography and Related Techniques. Elsevier 2024: 333–349.
  3. Michalski R. Application of ion chromatography in clinical studies and pharmaceutical industry. Mini Rev Med Chem. 2014; 14(10): 862–872.
  4. Michalski R, Lyko A. Research onto the contents of selected inorganic ions in the dialysis fluids and dialysates by using ion chromatography. Journal of Liquid Chromatography & Related Technologies. 2016; 39(2): 96–103.
  5. Ripple W, Wolf C, Newsome T, et al. World Scientists’ Warning of a Climate Emergency. BioScience. 2019.
  6. Reports and statements Biosciences 17.08.2022, Health in the Climate Emergency: A global perspective. https://easac.eu/publications/details/health-in-the-climate-emergency-a-global-perspective.
  7. Reports and statements Environment 05.04.2022, Regenerative agriculture in Europe. https://easac.eu/publications/details/regenerative-agriculture-in-europe.
  8. Reports and statements Environment 28.02.2022, Forest bioenergy update: BECCS and its role in integrated assessment models, https://easac.eu/publications/details/forest-bioenergy-update-beccs-and-its-role-in-integrated-assessment-models.
  9. Reports and statements Environment 11.03.2020, Packaging plastics in the circular economy. https://easac.eu/publications/details/packaging-plastics-in-the-circular-economy.
  10. Reports and statements Environment 29.10.2020, Towards a sustainable future: transformative change and post-COVID-19 priorities, Perspective by EASAC’s Environment Programme. https://easac.eu/publications/details/towards-a-sustainable-future-transformative-change-and-post-covid-19-priorities.
  11. Wu MY, Lo WC, Chao CT, et al. Association between air pollutants and development of chronic kidney disease: A systematic review and meta-analysis. Sci Total Environ. 2020; 706: 135522.
  12. Johnson RJ, Sánchez-Lozada LG, Newman LS, et al. Climate Change and the Kidney. Ann Nutr Metab. 2019; 74 Suppl 3: 38–44.
  13. Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018; 392(10159): 2052–2090.
  14. Vanholder R, Annemans L, Brown E, et al. European Kidney Health Alliance. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat Rev Nephrol. 2017; 13(7): 393–409.
  15. Dębska-Ślizień A, Rutkowski B, Jagodziński P, et al. etc. Aktualny stan leczenia nerkozastępczego w Polsce – 2022, Nefrol Dializ Pol. 2022; 26: 21–38.
  16. Legallais C, Kim D, Mihaila SM, et al. Bioengineering Organs for Blood Detoxification. Adv Healthc Mater. 2018; 7(21): e1800430.
  17. Burnier M, Fouque D. Global warming applied to dialysis: facts and figures. Nephrol Dial Transplant. 2021; 36(12): 2167–2169.
  18. Agar JWM, Barraclough KA. Water use in dialysis: environmental considerations. Nat Rev Nephrol. 2020; 16(10): 556–557.
  19. Agar JWM. Reusing and recycling dialysis reverse osmosis system reject water. Kidney Int. 2015; 88(4): 653–657.
  20. Tarrass F, Benjelloun H, Benjelloun M. Nitrogen and phosphorus recovery from hemodialysis wastewater to use as an agricultural fertilizer. Nefrologia (Engl Ed). 2023; 43 Suppl 2: 32–37.
  21. Herrmann M, Olsson O, Fiehn R, et al. The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater. Environ Int. 2015; 85: 61–76.
  22. Nawrocki J, Biłozor S. Uzdatnianie wody. PWN, Warszawa 2000.
  23. Himmelfarb J, Ratner B. Wearable artificial kidney: problems, progress and prospects. Nat Rev Nephrol. 2020; 16(10): 558–559.
  24. Zawierucha J, Marcinkowski W, Prystacki T, et al. Green Dialysis: Let Us Talk about Dialysis Fluid. Kidney Blood Press Res. 2023; 48(1): 385–391.
  25. Sehgal AR, Slutzman JE, Huml AM. Sources of Variation in the Carbon Footprint of Hemodialysis Treatment. J Am Soc Nephrol. 2022; 33(9): 1790–1795.
  26. Wieliczko M, Zawierucha J, Covic A, et al. Eco-dialysis: fashion or necessity. Int Urol Nephrol. 2020; 52(3): 519–523.
  27. Piccoli GB, Nazha M, Ferraresi M, et al. Eco-dialysis: the financial and ecological costs of dialysis waste products: is a 'cradle-to-cradle' model feasible for planet-friendly haemodialysis waste management? Nephrol Dial Transplant. 2015; 30(6): 1018–1027.
  28. Grafals M, Sanchez R. The environmental impact of dialysis vs transplantation. Am J Transplant. 2016; 16: C74.
  29. Bubieńczyk A, Suchowierska E, Naumnik B. The use of remote patient management in early diagnosis of ultrafiltration failure in peritoneal dialysis. . Renal Disease and Transplant. Forum. 2022; 15(2): 87–94.
  30. Michalski R. Mikroplastiki i metody ich oznaczania. Źródło. 2023; 62(1): 4–9.
  31. Barraclough KA, Agar JWM. Green nephrology. Nat Rev Nephrol. 2020; 16(5): 257–268.
  32. Namieśnik J. Green analytical chemistry - Some remarks. Journal of Separation Science. 2001; 24(2): 151–153, doi: 10.1002/1615-9314(20010201)24:2<151::aid-jssc151>3.0.co;2-4.
  33. Silvestri C, Silvestri L, Forcina A, et al. Green chemistry contribution towards more equitable global sustainability and greater circular economy: A systematic literature review. Journal of Cleaner Production. 2021; 294: 126137.
  34. Anastas PT, Warner JC. Green Chemistry: Theory and Practice. Oxford University Press, Oxford, United Kingdom 1998.
  35. Armenta S, Garrigues S, Guardia Md. Green Analytical Chemistry. TrAC Trends in Analytical Chemistry. 2008; 27(6): 497–511.
  36. Michalski R. Chromatografia jonowa. PWN, Warszawa 2020.
  37. Michalski R, Pecyna-Utylska P. Green Aspects of Ion Chromatography versus Other Methods in the Analysis of Common Inorganic Ions. Separations. 2021; 8(12): 235.
  38. Ion chromatography as a part of green analytical chemistry. Archives of Environmental Protection. 2023.

Renal Disease and Transplantation Forum