Our Approach to Water Conservation for More Sustainable Dialysis

Providing our patients with life-sustaining care requires large quantities of water, both in our production sites and in dialysis treatments. Water stress — which, for example, refers to decreasing availability of water in a region — is expected to impact how we provide patient care while operating in an environmentally responsible manner. Our resource management prioritizes patient safety, monitoring our resource usage, and supporting our commitment to minimizing our environmental impact. In 2023, our reported water withdrawal decreased by 4 percent compared to 2022.

Although water seems abundant, less than 1 percent of Earth’s water is available for human use. To safeguard our responsible water use, we continue to analyze which of our sites are in water-stressed areas with the help of the Aqueduct Water Risk Atlas of the World Resources Institute.

In 2023, our water stress assessments revealed that 12 percent of our dialysis centers and 10 percent of our production sites are at extremely high risk of water stress. We expanded our water assessment coverage to include almost all our dialysis centers and all our production sites. This information then informs our optimization and improvement plans. We have set ourselves the target to roll out sustainable water plans for production sites and dialysis centers by 2026 in all areas threatened by water scarcity.

We continue to focus on water stress scenario analysis and identifying where water stress levels will increase over the next 10 to 15 years. Most of the identified dialysis centers and sites are located in the U.S., although sites in Europe, the Middle East, Africa, Latin America, and the Asia-Pacific region are also likely to be affected by an increase in water stress.

Much of our water management plan focuses on the U.S., where the majority of our dialysis centers are located. This region is also home to a wide range of environments with varying resource availability. In the United States, we rely on municipal water sources to supply dialysis patients with clean, quality water that meets EPA standards. Globally, dialysis water supply varies in each country, but there’s a universal need for advanced water filtration that meets our patients’ unique requirements.

Another component of our water management strategy includes improving technology and equipment in our dialysis centers. Upgrading to newer central dialysis water systems can conserve the precious natural resource while meeting international water quality standards for medical use. Full-heat disinfection eliminates the need for chemical disinfections, making dialysis wastewater safe for local sewer systems. Newer reverse osmosis systems also have more efficient water intake, with a water recovery rate up to 85 percent. These measurements are individually monitored for performance and optimized for resource efficiency.

In addition, automated water meters were installed in U.S. dialysis centers in water-stressed areas and should be rolled out to all U.S. centers in 2024. The new meters will provide greater transparency on water use during treatment and help identify drivers of water withdrawal, which will help us develop measures to reduce our water withdrawal going forward.

In addition to water resource monitoring and risk mitigation, we are emphasizing education and engagement in all our sustainable processes. Our sustainability education initiatives range from monitoring resource use activity to keeping dialysis center staff informed about the importance of water conservation in general.

To increase awareness of water stress, we implemented knowledge-sharing sessions and educational videos on water stress. We are committed to prioritizing sustainability and water resource management for the safety of both our patients and our planet. Dedicated planning and careful monitoring are crucial to conserving water while delivering high-quality hemodialysis treatments around the world.