Theoretically redesigning peritoneal dialysis products for sustainability: A life cycle inventory approach

: Peritoneal dialysis (PD) is a life-sustaining treatment for end-stage kidney disease but contributes significantly to environmental degradation due to its reliance on single-use plastics, energy-intensive manufacturing and high-volume transport. Redesigning PD products for sustainability is increasingly important as healthcare systems seek to reduce their carbon footprint. In this study, ten high-use peritoneal dialysis (PD) products were redesigned using life cycle thinking. Interventions included low-carbon transport (electric vans), renewable energy and improved waste treatment (pyrolysis). Life cycle inventories (LCIs) were modelled in Open Life Cycle Assessment (OpenLCA)and modelled using cradle-to-gate carbon footprints (kg CO₂-eq) to compare redesigned and conventional versions. All redesigned products achieved carbon footprint reductions, with eight showing decreases greater than 40%. The automated PD set and 2 L dialysate bag saw reductions of 63% and 54%, respectively (saving 1.15 and 0.86 kg CO2-eq per item). The APD machine achieved the largest percentage reduction at 87%, primarily driven by the elimination of printed packaging and the use of renewable electricity. Key contributors to emissions savings across products included lower-impact transport, sustainable packaging materials and circular waste strategies. Redesigning PD products using sustainable materials and processes can deliver substantial environmental benefits without compromising functionality. These findings support evidence-based pathways for reducing emissions in kidney care through product innovation and procurement reform.