Advancing Green Dialysis: Environmental Benefits of Point-of-Care Peritoneal Dialysis Dialysate Generation

Authors

• Mandar Gori, Vivance Inc, Los Angeles, California, United States
• Akash Karopadi, Management Consulting Division, Alira Health Boston LLC, MA, US
• Priyanka Arya, Vivance Pte Ltd, Singapore
• Jason Tze Chern Lim, Vivance Pte Ltd, Singapore
• Suresha Belur Venkataraya, Vivance Pte Ltd, Singapore

Background

Conventional peritoneal dialysis (PD) systems generate significant plastic waste and CO₂ emissions due to reliance on prepackaged fluid and extensive logistics. Vivance’s Viva Komfort, introduces a point-of-care (POC) dialysate generation technology that produces PD fluid directly from tap water. This decentralized approach simplifies the supply chain and reduces the material footprint, offering a more sustainable and scalable alternative to current standard of care (SOC).

Methods

Estimates for cardboard box usage, plastic waste (kg), and treatment supply weight (kg) were based on industry benchmarks. Emissions were calculated using a freight truck emission rate of 170 g CO₂/ton-mile (EPA 2023). Comparisons between SOC and Viva Komfort were made using manufacturer specifications, and patient numbers from the 2024 USRDS report.

Results

Compared to SOC, Viva Komfort replaces 4 plastic bags with just one concentrate bag per therapy cutting storage requirements by up to 89%, offering a more sustainable and space-efficient approach to PD therapy.
Over 5 years, such a solution has the potential to save approximately 620,000 trees, eliminate 56,000 metric ton of plastic waste and prevent 415,000 metric ton of CO₂ emissions (Table 1). Its lighter freight load enables one truck to serve 10 patients versus one under SOC.

Conclusion

Given the projected environmental impact of the U.S. PD patient population over the next five years i.e. approximately 720,000 trees lost, 120,000 metric ton of plastic waste generated, and 470,000 metric ton of CO₂ emitted, there is a clear and urgent need for action. With its reduced material footprint and lower emissions, Viva Komfort presents a practical, scalable alternative for long-term dialysis care.

Presented at ASN Kidney Week 2025, Houston, TX, Nov 5 – Nov 9, 2025
Copyright © 2025 by the American Society of Nephrology

Published abstract available at: doi: 10.1681/ASN.20254gtp6yxm