Every week, hundreds of thousands of people across Europe arrive at dialysis units for life-sustaining treatment. Each session — typically three times a week, lasting up to five hours — demands vast quantities of water, energy, and single-use materials. Kidney disease is one of healthcare’s most resource-intensive conditions to manage. Yet for decades, the clinical imperative to keep patients alive and well has left little room to ask: could we do this more sustainably?

KitNewCare, a European Union–funded project, is asking exactly that question — and four pioneering clinical pilot sites are already delivering answers. From Madrid to Utrecht, from Modena to Warsaw, kidney care teams are not waiting for large-scale systemic change. Instead, armed with evidence, structured methodology, and a willingness to challenge habits formed over years of routine practice, they are redesigning care from the inside out.

A Structured Approach to Meaningful Change

What makes KitNewCare distinctive is not just what the clinical teams are changing, but how. Each optimisation follows the Plan-Do-Study-Act (PDSA) cycle, a quality improvement methodology trusted in healthcare contexts worldwide. Rather than mandating changes from above, the PDSA approach empowers local teams to identify the right change for their context, test it in practice, study its effects carefully, and refine it before embedding it into routine care.

The process begins with three deceptively simple questions: What are we trying to accomplish? How will we know that a change is an improvement? And what changes can we make that will actually result in improvement? These questions draw on the SusQI (Sustainable Quality Improvement) framework, which integrates environmental sustainability directly into the logic of healthcare quality improvement — a marriage that is still surprisingly rare in clinical settings.

“Once a change has been proven effective at one site, it becomes a tested, replicable model — ready to travel across the partnership and ultimately to kidney care units far beyond the project.”

The result is a living library of change projects: rigorously planned, carefully monitored, and refined through real-world learning. Once a change has been proven effective at one site, it becomes a tested, replicable model — ready to travel across the partnership and, ultimately, to kidney care units far beyond the project.

From Blood Tests to Bicarbonate: The Breadth of the Optimisations

The range of changes being implemented is striking in its breadth. Some address the everyday rituals of clinical practice; others target the heavy infrastructure that keeps dialysis machines running. Together, they point to a systemic reimagining of what sustainable kidney care can look like.

Eliminating Redundant Tests and Supplies

At Fundación Jiménez Díaz (FJD) in Madrid, clinicians identified a deceptively simple opportunity: patients wearing continuous glucose monitoring (CGM) devices — which measure blood sugar automatically through a small sensor under the skin — were still being tested with single-use glucose test strips at the start of every dialysis session. The rationale for the strips had long since been overtaken by technology. Removing this routine for CGM users reduces consumable waste, cuts supply costs, and eliminates a small but entirely unnecessary procedural burden — all while maintaining accurate, real-time glucose monitoring.

A related change at FJD targets the broader landscape of blood tests. Some analytical tests are carried out routinely — by force of habit as much as clinical necessity. By reviewing testing profiles and reducing the frequency of non-essential tests, the team expects to cut material waste, lower costs, and free up staff time for work that genuinely matters to patient outcomes.

Rethinking Energy Consumption

At FJD, an audit of the Nephrology and Dialysis departments found that the vast majority of computers were simply left on overnight and through weekends — not out of necessity, but out of inertia. In collaboration with the hospital’s IT department, an automated shutdown has been introduced for 90% of department computers at the end of every working day. The change is simple, costs virtually nothing to implement, and directly reduces electricity consumption.

A parallel change addresses the warming plates used in peritoneal dialysis. These devices heat the fluid bags that patients use for treatment, improving comfort. But in several units, they were left switched on continuously — even during periods when no treatment was being prepared. Switching them on only when needed introduces no clinical risk and meaningfully reduces unnecessary power draw.

Transforming Waste Management

Perhaps the most transformative cluster of optimisations concerns the handling and disposal of medical waste — an area where the gap between current practice and best practice is often significant, and where the environmental and financial stakes are high.

At the University Medical Centre Utrecht (UMCU) in the Netherlands, used blood circuits — including bloodlines, artificial kidneys, and effluent bags — are being drained before disposal. This single step reduces the total weight of waste sent to central incineration or decontamination, lowering both transport emissions and disposal costs. A companion initiative goes further: plastic bags containing biological fluids are being emptied and decontaminated, transforming them from hazardous waste into recyclable material. The environmental logic is compelling: less incineration means less energy use and lower emissions.

UMCU is also pioneering the introduction of recycling bins at each dialysis station, supported by staff training, to enable proper waste separation at source. The goal is to prevent recyclable materials from being discarded as hazardous waste — a common and costly mis-classification in busy clinical environments.

In Modena, the University of Modena and Reggio Emilia (UNIMORE) team is tackling the same problem through a complementary lens, redesigning processes and providing practical infrastructure and staff guidance to ensure general and recyclable materials are correctly separated. They are also implementing a sustainable disposal process for bicarbonate cartridges — either rinsing them for recycling or using dedicated collection bins — diverting significant volumes of material from incineration or landfill.

At the Medical University of Warsaw (WUM) in Poland, a programme of waste segregation improvement — combining better infrastructure with staff training — mirrors these efforts within the Polish healthcare context.

Optimising the Machines at the Heart of Dialysis

Modern dialysis machines are sophisticated devices, with built-in features designed to improve both efficiency and sustainability. Yet in busy clinical environments, these features are often inconsistently used — or not used at all.

At UMCU, the AutoFlow function on dialysis machines is being systematically activated. AutoFlow dynamically adjusts the rate of dialysate flow to match actual clinical need, reducing water, acid, and bicarbonate concentrate consumption without any compromise to treatment quality. Similarly, standby mode and online reinfusion features are being embedded into standard operating practice.

UNIMORE is taking a particularly rigorous approach. An audit of machine use revealed significant variation across nurses, shifts, and rooms in how built-in sustainability features were being applied. A unified protocol is now being implemented to standardise practice across the unit — ensuring that the machines’ environmental potential is consistently realised, regardless of who is operating them or when.

Both UMCU and WUM are also incorporating sustainability criteria into the procurement of new dialysis machines — a forward-looking change that will shape environmental performance for the decade ahead. Energy efficiency, water use, and broader environmental impact are now formal considerations in purchasing decisions, rather than afterthoughts.

Smarter Systems and Leaner Processes

Alongside clinical and operational changes, the pilot sites are investing in smarter infrastructure. UMCU is installing GPS (GreenTec Performance System) software for real-time monitoring of Reverse Osmosis processes, as well as heat and water consumption across its dialysis installations. The software transforms previously invisible resource flows into actionable data — enabling early detection of inefficiencies and providing the evidence base for further sustainability improvements.

UMCU is also replacing sterile connection sets used for venous access puncture during haemodialysis with safe, clinically validated non-sterile alternatives. The change reduces both material waste and storage space requirements, without any impact on patient safety — a reminder that clinical convention and clinical necessity are not always the same thing.

At WUM, a redesign of the online medical ordering and pharmacy system is reducing drug returns: a form of waste that carries both financial and environmental costs, from unnecessary manufacturing and transport through to the energy-intensive disposal of unused medications. In parallel, the introduction of electronic signatures is eliminating paper-based documentation — a change whose benefits compound across thousands of dialysis sessions every year.

The Sum Is Greater Than the Parts

Viewed individually, each of these optimisations might seem modest. A computer switched off at the end of the day. A blood test avoided. A waste bag drained before disposal. But the KitNewCare model is built on a different arithmetic. Multiplied across hundreds of dialysis sessions per week, per site, per year — and replicated across the growing community of hospitals that will adopt these changes — the cumulative impact is substantial.

More importantly, every optimisation validated in practice becomes a template. The PDSA methodology ensures that what works in Utrecht can be understood, adapted, and implemented in Warsaw or Madrid — with the evidence and the learning already in hand. This is not just change management; it is knowledge transfer at scale.

The KitNewCare project is demonstrating something that can sometimes be lost in the complexity of healthcare sustainability debates: that the gap between current practice and best practice is often surprisingly small, and that the people best placed to close it are the clinicians and care teams who live and breathe these environments every day.

“The gap between current practice and best practice is often surprisingly small — and the people best placed to close it are the clinicians who live and breathe these environments every day.”

Europe’s kidney care community is watching. And in four hospitals, the future of sustainable dialysis is already being written — one small, evidence-based change at a time.