We do not support or recommend any particular home dialysis products, but provide this information to aid your awareness of the equipment available. Note that because each state or hospital selects the equipment it uses, not all machines are available in all states.

There are a number of companies that provide dialysis equipment for both peritoneal dialysis (PD) and home haemodialysis (Home HD). The companies can be contacted directly for detailed information about their products.

Baxter Healthcare
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Baxter Healthcare offers a PD cycler called the Homechoice and also a Home HD machine.

Continuous ambulatory peritoneal dialysis (CAPD) bags are available in a range of glucose strengths and volumes. Also available are the peritoneal dialysis solutions icodextrin and nutrineal.

You can see more information on their website here 

Fresenius Medical Care
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Fresenius Medical Care offers a PD machine known as the sleep-safe cycler.

They also have the 4008 and 5008 models of a Home HD machine.

Peritoneal dialysis fluids are available in a range of glucose strengths and volumes and include the Biocompatible Balance range.

You can see more information on their website here

NxStage®
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NxStage® offers the System One cycler, which is smaller in size than traditional dialysis machines and weighs about 32 kilograms.

This is a concentrate-based option that uses the PureFlow™ SL dialysate preparation system to make up to 60-litre batches of ultrapure dialysate using ordinary tap water.

They also have a prepackaged option of dialysate fluids consisting of sterile dialysis fluids packaged in 5-litre bags and which do not require water.

You can see more information on their website here

New technology
As new machines and technologies become available we will add further information to this page. 

Environmental factors
Taking a ‘green’ approach to dialysis may not increase program uptake but it is a positive for the environment. Recycling of waste and water, and buildings that minimise power costs or use reusable energy sources, are all areas for consideration.

Professor John Agar and Rosie Simmonds of the Geelong Home Dialysis Unit in Victoria have contributed much of the Australian knowledge on ‘Green Dialysis’ and have also provided the information for this section of our website.

You can see more about their globally respected environmental work here.

Environmental concerns for dialysis
Dialysis is one the most energy and resource greedy of treatments in today’s healthcare system. The large volume of finite resources and subsequent amount of carbon that is produced from the care of people with kidney disease is adversely affecting our environment and is not sustainable. As a community we must begin to engage in and employ methods that not only save our precious resources but also save our planet.

Much work has been done across the world in recent years to begin to educate the renal community of the importance of ‘greening’ dialysis. In particular, one concerned group in the United Kingdom has been very proactive, and in early 2009 they held the first Green Nephrology Summit.

Hosted by the Campaign for Greener Healthcare, it is here that ideas were first shared about the simple and practical measures that can be undertaken in renal units to improve sustainability. From this meeting the first Green Nephrology Fellow, Dr Andrew Connor, was appointed and who over the following year explored the environmental impacts of renal care and began working with NHS staff and patients to improve practice in Dialysis units across the UK.

Simple measures including re-use of waste water, recycling of plastics and improving energy efficiency have been introduced and encouraged. In the United Kingdom today, The Green Nephrology Network, under the auspices of the Centre for Sustainable Healthcare, brings together patients, clinicians, renal technicians and industry partners to share ideas for sustainable kidney care. This Network continues to promote, encourage and alert the renal community about the importance of constantly improving the sustainability of renal care.

Here in Australia, improving our practice to incorporate green principles and reduce our carbon footprint is gradually being embraced by many renal units. Awareness is slowing growing of how easy it is to incorporate responsible practices into our daily routines to make for a more sustainable future.

Water conservation
Haemodialysis consumes large volumes of water. Water from the mains supply is commonly purified of residual salts using a reverse osmosis system prior to being presented to the dialysis machine. The reverse osmosis machine typically rejects around two thirds of the water presented to it and consequently, for one four-hour dialysis session around 500 litres of mains water is required.

This ‘reject water’ is high-grade grey water that generally meets all biochemical criteria for potable water and poses no infection risk as it does not come in contact with the patient. However, it remains classed as grey water and as such is legally unacceptable for further human consumption. A medium sized dialysis unit rejects > 100,000 litres of water to the drain each week.

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Some simple plumbing enables this reject water to be collected and then used in other areas of the hospital and in the home. It can be reused for steam sterilisation units, for flushing of toilets, garden maintenance and it can be easily transported in tankers to sporting grounds and gardens within the local community.

In the home, again simple plumbing can divert the reject water into storage tanks for future use on gardens or for use again by the dialysis machine. A dialysis technician can advise on this process. 

Waste reduction
Dialysis produces a large volume of waste. According to the Green Nephrology group, a single haemodialysis session produces about 2.5 kg of solid clinical waste, of which approximately 38 per cent is plastic.

This amounts to an estimated 390 kg per year for each person receiving haemodialysis in-centre; 617kg of waste per year for people on peritoneal dialysis and up to 650kg of waste per year for people undergoing home haemodialysis.

None of these estimates include the significant amounts of packaging waste. (Connor 2010). These figures alone alert us to the fact that we must be vigilant when it comes to waste reduction.

Recycling of packaging waste at home and in healthcare settings is something we can all easily do, and ensuring we segregate our waste for easy recycling can make a big difference.

A great deal of the waste produced by dialysis services is incinerated because it is deemed to be ‘infectious’ waste. This practice not only costs a significant amount but leaves a heavy carbon footprint. An innovative and greener option to dispose of waste is via autoclave steam sterilisation devices such as the Sterishred® 250.

The Sterishred® is able to sterilise and shred virtually all dialysis waste including lines, syringes, glass and other infectious materials in preparation for disposal. This shredded material can be then sent to land fill, which although not ideal, does leave a softer carbon footprint than incineration. More sophisticated ways of using this recycled shredded plastic are also being trialed around the world, for example it has been used in road surfacing projects in India.

Energy supply
The electricity requirements for dialysis are large. Each year while providing haemodialysis for a single patient, a dialysis machine and reverse osmosis machine can consume anywhere between 1310kW to 3744kW, depending on the hours and frequency of dialysis.

If this level of energy consumption is then translated into operating large in-centre dialysis units it is very clear to see that dialysis is an energy-hungry and resource-greedy therapy. Alternative energy sources, preferably from renewable resources, are now readily available and accessible.

One of those is solar power. With as little as six hours per day of solar exposure, the potential to apply solar-powering to haemodialysis is unquestionable. One renal unit in Victoria (Agar, 2011, 2012) has reported the installation of a solar array that has produced enough solar energy to power over 80 per cent of the requirements for four haemodialysis machines and four portable reverse osmosis units.

Though the short-term costs of setting up a solar array may be expensive (approx $16,200 for a 24m² array), the longer-term savings and carbon footprint reductions are undeniable. A solar array has an operational life of approximately 30 years. Income generation with the national electricity grid via a grid-share and reimbursement arrangement can predict a potential revenue stream back to the dialysis service in the 3rd decade of the solar array’s lifespan. (Energy Matters 2011)

The installation of suitable solar arrays for people on home dialysis would also make a significant reduction on our overall carbon impact and help alleviate overall costs for people dialysing at home. Solar power seems a logical choice as an alternative power source for dialysis services.

Carbon footprint
Home haemodialysis using standard energy sources creates a carbon footprint with emissions (37 per cent), energy use (27 per cent) and travel (20 per cent).

In the UK it was determined that one in-centre haemodialysis patient has a carbon footprint of 3.8tonCO2Eq per year. At home on standard dialysis equipment, the carbon footprint increased, determined by the hours on dialysis, up to 7.2ton for a six-nightly nocturnal regime.

The lack of need for travel saves approximately one ton. The new technology of NxStage® reduces the carbon footprint. The electricity consumption is 0.1kWh compared to 1.29 kWh for a standard machine and water treatment equipment. For six-nightly nocturnal it was estimated to require 2.1ton. This may be a future consideration when choosing dialysis equipment. (Connor 2011)

Water recycling
Water recycling is an important consideration and with minor modifications can be achieved. A typical dialysis patient uses 80 000 litres of water per year. Recycling of reject reverse osmosis water alone can reduce water consumption by approximately 60 per cent.

Alternative use of grey water for gardens is also a consideration, although this may be inhibited by council regulations that assume dialysis water is contaminated. For individuals reliant on the use of tank water, recycling is essential.

Plastic and paper recycling
Plastic and paper waste should be recycled when possible. Local councils will advise on local regulations. Fresenius Medical Care use biofine, a plastic free from DEHP in their peritoneal dialysis consumables.

Renewable energy
The use of solar or wind power to provide electricity is also the future. This is positive for the environment and the energy bills. Some councils and energy schemes provide rebates for use of solar power. This is a consideration for future home training dialysis units. 

The Geelong Home Dialysis Unit in Victoria is using solar power and claiming government subsidies.

Simple measures to make a difference
Other simple sustainable practices can also be easily incorporated into renal units and the home and can reduce the carbon emissions quite significantly.

In the UK in 2010 the Campaign for Greener Healthcare promoted the 10:10 Renal Checklist. The idea was simple: they aimed to achieve a 10 per cent cut in the UK’s carbon emissions in 2010 by introducing a number of simple measures.

Those measures remain as relevant today as they were five years ago and are a great starting point for many Australian renal units. (10:10 Renal Checklist, Campaign for Greener Healthcare)

The measures include:

Lighting – Use low-energy lighting wherever possible. Turn lights off in rooms when not in use.

Heating and cooling – Make sure temperatures are comfortable. Only turn on when needed. Turn off the ‘auto on’.

Staff and patient travel – Think about home dialysis and the reduction in travel.

Virtual clinics – Consider teleconferencing and phone follow-up for those who are stable on dialysis / transplant.

Low carbon ordering and delivery – Try purchasing fluids in the smallest possible volumes (highest concentrations) to save on transportation and ask suppliers to take back packaging. Look for recyclable materials, encourage suppliers.

Reduce, re-use, recycle – Always look for ways to use fewer resources. Position bins conveniently for recycling paper and plastics, domestic and clinical wastes. Conduct waste audits. 

References
Perkins A, Simmonds R (2011). Editorial: Making change in haemodialysis units for a sustainable future.

Ren Soc Aust J, 7(3), 105-106. Agar, JWM (2010) Conserving Water in and applying solar power to haemodialysis: “Green Dialysis” through wiser resource utilisation. Nephrology (Carlton) 15(4):448-453

Agar JWM, Simmonds RE, Knight R, (2009) Using Water wisely: New, essential and affordable water conservation practices for both facility and home hemodialysis.

Hemodialysis International 13(1):32-37 Agar, J. Simmonds, R., Magoffin, J, Knight, R.(2008) Simple but essential new water-conservation practices for home=based dialysis services.

Hemodialysis International; 12:p121 Centre for Sustainable Healthcare – Green Nephrology. Retrieved from www.greenerhealthcare.org/green-nephrology. Accessed 5 May 2012.

Connor, A, Mortimer, F, Tomson, C (2010) Clinical Transformation: The Key to Green Nephrology. Nephron Clin Pract; 116:c200-c206 STERISHRED 250® (2012). Product Information. Retrieved from www.sterishred.com Access 6 May 2012.

Agar, JWM (2011) Solar-powered dialysis. Hemodialysis International.15(1):142-143

Agar, JWM (2012) Solar-assisted haemodialysis. CJASN. 7(2): 310-314

Connor, A, Lillywhite, R, Cooke, M.W. The Carbon footprints of Home and In-center Maintenance hemodialysis in the United Kingdom Haemodialysis International. 2011 pp1-13 DOI:10.1111/j.1542-4758.2010.00523 10:10 Renal Checklist. Centre for Sustainable Healthcare. Retrieved from www.greenerhealthcare.org/1010-renal-checklist  Access 5 May 2012.

Further enquiries
If you have any enquiries please phone freecall 1800 454 363 or email homedialysis@kidney.org.au.

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