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

There is limited data characterizing healthcare waste associated with peritoneal dialysis (PD). In Canada, Icodextrin for continuous cycling PD (CCPD) is only available as 2.5L bags for one-time use, and any remaining volume that is not used for a dwell is discarded. The environmental impact of this practice has not been well characterized. As such, we sought to estimate the costs associated with discarded Icodextrin and associated polyvinyl chloride (PVC) plastic waste production within our renal program. We conducted a cross-sectional audit of all patients utilizing CCPD in the Alberta Kidney Care South program in Canada in 2022. Icodextrin fill volume data were captured and the costs associated with Icodextrin use were calculated. Among patients on CCPD, the average fill volume for Icodextrin was 1273 mL, suggesting that an average of 1227 mL was discarded. In fact, 88% of patients used dwell volumes ≤1.5L. In 2021, our program spent $1.27 million CAD on Icodextrin for CCPD. Given that an average of 49% of each 2.5L bag was discarded, we estimate that the annual value of wasted Icodextrin among patients being treated with CCPD in our program was $622,300 CAD, or $3036 CAD per patient. Annual PVC waste was calculated to be 25.9 kg per patient, and we estimate that PVC waste could be reduced by 35% if there was access to 1.5L Icodextrin solutions. Our work suggests that the availability of Icodextrin bags that are better aligned with volumes used by patients could reduce healthcare costs and PVC waste.