Estimating the costs and amount of recyclable polyvinyl chloride plastic waste associated with discarded Icodextrin

Welcome to AudioScholar. Today we're covering "Estimating the costs and amount of recyclable polyvinyl chloride plastic waste associated with discarded Icodextrin," by Ghimire and colleagues, published in *Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis*.

As clinicians, we’re increasingly aware of the environmental footprint of healthcare, and nephrology is a significant contributor. While much of the focus on "green dialysis" has been on the water and energy consumption of in-center hemodialysis, home-based peritoneal dialysis, or PD, also generates substantial waste, particularly plastics. This paper focuses on a very specific, and perhaps overlooked, source of waste in PD: the dialysate bags themselves. In Canada, the peritoneal dialysis solution Icodextrin, which is commonly used for the long overnight dwell in cycling patients to help with ultrafiltration, is only available in a single-use 2.5-liter bag. However, many patients are prescribed a fill volume much lower than 2.5 liters. This mismatch means that every day, a significant volume of expensive, sterile Icodextrin solution is discarded, along with an oversized plastic bag. This study aimed to quantify the financial and environmental cost of this practice within a single Canadian dialysis program.

To do this, the researchers conducted a cross-sectional audit of all patients receiving continuous cycling peritoneal dialysis, or CCPD, within the Alberta Kidney Care South program in Canada. On a single day in February 2022, they collected data on the prescribed Icodextrin fill volumes for all 205 patients in the program using the solution. They then used the program's total expenditure on Icodextrin from the previous year—1.27 million Canadian dollars—to calculate the cost of the discarded fluid. To estimate the plastic waste, they used a previously published figure that each 2.5-liter bag contains about 71 grams of recyclable polyvinyl chloride, or PVC. Finally, they modeled a hypothetical scenario: what if a smaller, 1.5-liter bag were available for patients who needed that volume or less?

The findings were striking. The average prescribed Icodextrin fill volume for the 205 patients was just 1273 milliliters. Since every patient used a 2500 milliliter bag, this means that on average, 1227 milliliters—or nearly half the solution in every bag—was discarded. In fact, the vast majority of patients, 88 percent, were prescribed a fill volume of 1.5 liters or less, making the 2.5-liter bag unnecessarily large for almost everyone.

When the researchers translated this into costs, the numbers were substantial. With 49 percent of the solution being discarded, they estimated that the program was wasting approximately 622,300 Canadian dollars annually on unused Icodextrin. This broke down to an average of over 3,000 dollars wasted per patient, per year.

The environmental impact was equally significant. Assuming each patient used one bag per day, the 205 patients generated over 5,300 kilograms of recyclable PVC waste annually from Icodextrin bags alone. That’s about 26 kilograms of plastic per patient each year. The researchers then calculated the potential benefit of a smaller bag. If a 1.5-liter bag were available for the 88 percent of patients who could use it, the total PVC waste could be reduced by 35 percent. This would prevent nearly two thousand kilograms of plastic from being produced and discarded each year in this one program alone.

This was a pragmatic, straightforward study, and its strength lies in its simplicity and the clarity of its message. It takes a routine clinical practice and exposes a significant source of both financial and environmental waste that is hiding in plain sight. However, the authors do note a few limitations. The data comes from a single program in Canada, though the issue of bag availability is a national one. The study is also a cross-sectional snapshot, so it doesn't capture changes in prescriptions or patient populations over time. Furthermore, the calculation for the potential PVC reduction relied on a hypothetical 1.5-liter bag, assuming its plastic weight would be proportional to the larger bag, which may not be perfectly accurate. Finally, by excluding patients on continuous ambulatory PD, the study may have actually underestimated the total waste.

So, what is the clinical bottom line? This paper isn't necessarily a call to change your Icodextrin prescription volumes. The problem isn't clinical practice, but product availability. The key takeaway is that a simple manufacturing and supply-chain change—providing Icodextrin in a smaller, more appropriately sized bag—could lead to massive savings for healthcare systems and a significant reduction in plastic waste. The authors point out that smaller bags are not a fantasy; 2-liter bags are available in Australia, and 1.5-liter bags are produced for other medical purposes like surgical irrigation. The issue is a commercial one. This study provides concrete data that clinicians, hospital administrators, and nephrology organizations can use to advocate for change. It’s a powerful example of how decisions made far upstream, in manufacturing and procurement, have profound downstream consequences for cost, sustainability, and patient care.

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