On April 25, 2025, Karin Gerritsen presented our ongoing work at the KDIGO Controversies Conference on Green Dialysis in Berlin. The conference focused on “Environmentally Sustainable Care, Growth, and Innovation,” highlighting the urgent need for more sustainable approaches to dialysis. More information about the conference is available here.
Karin’s plenary lecture was part of the session “Moving Toward Sustainable and Greener Dialysis Delivery: Examples from Real-World Experience.” She discussed the main contributors to the environmental footprint of dialysis: water use, energy consumption, waste production, and transportation.
As part of the KITNEWCARE project, we measured the water and energy use at the dialysis ward. The data showed that each treatment uses around 346 liters of water, with the reverse osmosis (RO) system operating at only 53% efficiency. Energy measurements showed that 61% of the energy consumption was due to the RO system, and 39% was used by the dialysis machine itself.
To address these issues, Karin presented our ongoing efforts to:
- Maximize water recovery and minimize energy use by our RO system, e.g. by increasing the concentration factor for release of RO reject water and optimizing the duration and frequency of the heat disinfection cycles
- Investigate reuse of reject water from the RO process.
- Explore possibilities for spent dialysate reuse in future systems.
Another way to save resources is to reuse dialysate during treatment within a closed loop. The company NextKidney has developed an energy-efficient portable artificial kidney that uses sorbents and immobilized enzymes to regenerate dialysate. ART Kidney Lab is supporting this development within the NXTGEN Hightech program, helping to upscale production capabilities and testing improved sorbent materials.
We are also exploring the reuse of dialyzers in collaboration with the industrial partner Novaflux. Reusing dialyzers could further reduce waste and the environmental impact of dialysis.
Portable and wearable dialysis solutions are also important to enable home dialysis and therewith reduce transport emissions. Projects like CORDIAL and collaborations with NextKidney are key steps toward achieving this.
Fokko Wieringa also took part in a plenary panel discussion on “Challenges to Implementing Environmentally Sustainable Dialysis,” sharing experiences and barriers from research and practice, including examples of highly sustainable medical quality plastics that are already on the market.
Later in the conference, during the session “Identifying and Developing Green Initiatives in Hemodialysis,” Karin and Fokko presented ART Kidney Lab’s collaboration with Aquaporin, developing forward osmosis membranes that can produce dialysate directly from concentrate and tap water—without relying on the energy-intensive RO systems.
Finally, both Karin and Fokko presented the progress made within the KIDNEW project. This project aims to develop an implantable dialysis filter. When combined with dialysate regeneration, it offers a path to hemodialysis treatment that is more patient-friendly and much less resource-intensive.
