Abstract:Rationale and Objective: Dialysis is a life-sustaining treatment for end-stage renal disease. In Thailand, Peritoneal Dialysis (PD) is prioritized under Universal Health Coverage (UHC) due to its accessibility and cost-effectiveness. However, the environmental impacts of PD and Hemodialysis (HD) have not been comprehensively evaluated in the Thai context. This study aimed to assess and compare the environmental burdens of both modalities using a Life Cycle Assessment (LCA), contributing evidence for climate-resilient and sustainable health systems. Methods: An LCA was conducted using SimaPro software version 10.2.0.0 to estimate environmental impacts across four stages: manufacturing, supply chain, service delivery, and waste management. The ReCiPe 2016 midpoint and endpoint methods were applied to quantify effects on disability-adjusted life years (DALYs), species loss, and natural resource depletion. Emission data were collected from PD and HD manufacturers (Baxter and Fresenius), Thailand Post (logistics), five dialysis centers (energy and travel), and the national medical waste agency. Carbon emissions per treatment session were calculated, and key emission hotspots identified. Results: Preliminary analysis identified significant environmental hotspots in both dialysis modalities. Per-session carbon footprint estimates showed PD produces lower emissions than HD, mainly due to reduced energy use and simpler logistics. These findings will inform a forthcoming Green Health Technology Assessment (Green HTA) that integrates environmental criteria into cost-effectiveness evaluations. Conclusion: PD was found to have a lower environmental footprint per session than HD. These results emphasize the importance of incorporating environmental performance into clinical and policy decisions under UHC. The study contributes to the global movement toward sustainable healthcare by providing evidence to support greener procurement, treatment choices, and health policy planning in low- and middle-income countries.
Keywords: Climate Change and Planetary Health, Life Cycle Assessment, Dialysis, Environmental Impact, Green HTA, Planetary Health
