Analysis of the carbon footprint of pharmacological treatments in advanced chronic kidney disease and peritoneal dialysis: Oral vs. subcutaneous administration

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BACKGROUND: Carbon footprint quantification currently stands as the most accepted model for assessing the ecological impact of human activities. Selecting the most environmentally friendly treatment for pathologies arising from advanced chronic kidney disease can reduce the carbon footprint. METHODS: We aimed to analyse the carbon footprint from using subcutaneous administration treatments versus oral medication in patients with the same medical condition: advanced chronic kidney disease (ACKD) (CKD stage 4 or 5 not in dialysis) or peritoneal dialysis (PD). This is an observational, cross-sectional study with 41 patients, 19 receiving oral medication (cinacalcet), and 22 subcutaneously administered erythropoiesis-stimulating agent (darbepoetin alfa). Both treatments were dispensed at the Hospital Clínico Universitario de Valencia internal pharmacy. The carbon footprint was calculated using analytical techniques from hybrid life cycle models of the studied medications. For this analysis, three groups were considered: patient and supplies transportation, energy, and waste disposal. RESULTS: A total of 41 patients were included, with a median age of 72 years (IQR: 63–80). No significant between-group differences were detected in analytical parameters. The overall carbon footprint derived from the subcutaneous treatment process with erythropoiesis-stimulating agents (ESA) was 95,512.93 kg of CO2/year, compared to 12,199.85 kg of CO2/year resulting from cinacalcet treatment (p<0.001). Group-wise analysis did not detect significant differences in travel-related consumption. However, in waste generation and transportation, ESA use showed a significantly higher carbon footprint than oral medication use (p<0.001), partly attributable to the refrigeration energy consumption of darbepoetin (inexistent for cinacalcet). CONCLUSIONS: The use of drugs not requiring subcutaneous administration with syringes could significantly reduce healthcare-related carbon footprint.

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