Early intervention key to driving sustainability in cardiorenal care

The impact of cardiorenal diseases on people, society and our planet are immense and growing,¹ yet cardiorenal diseases remain underdiagnosed,^2,3 undertreated² and, their interconnections,² under-recognised. By better understanding these interconnections, driving earlier screening and intervention and improving access to healthcare, we can slow disease progression. Keeping people healthier reduces the burden on healthcare systems while also minimising the impacts on our planet often caused by hospitalisations and carbon-intensive treatments. At AstraZeneca, we are focused on sustainable science, decarbonising patient care pathways and playing our part to improve equitable access to healthcare with a lower environmental footprint. 

The environmental impacts of chronic kidney disease

More than 840 million people worldwide – equivalent to more than 1 in 10 people – are living with chronic kidney disease (CKD)⁴, a progressive and potentially fatal condition.⁵ When CKD progresses to advanced stages, haemodialysis or kidney transplantation is required.⁶ Haemodialysis remains one of the most carbon-intensive fields in medicine, consuming enormous amounts of water and producing high amounts of medical waste – in a year, globally, haemodialysis uses more than 169 billion litres of water⁷ and creates more than one billion kilograms of medical waste.⁸

As the burden of CKD continues to grow, so too will the environmental impacts. Recent real-world evidence (RWE) from the UK, from IMPACT CKD analysis, predicted that, by 2032, the environmental impact for patients receiving in-centre haemodialysis will be equivalent to over 1.35 million tonnes of CO2 emissions (CO2e).⁹

Therefore, there is a critical need to diagnose and treat CKD early. Slowing disease progression, avoiding hospitalisations and preventing cardiorenal complications will reduce the carbon emissions and fresh water needed for haemodialysis and other intensive treatment. This will minimise the impact on our planet and promote better health outcomes in line with the GREEN-K initiative.¹⁰

Calculating the carbon intensity of haemodialysis 

We are working to address the environmental impacts of CKD and support physicians to screen and diagnose cardiorenal diseases early. We’re raising awareness of the interconnections between CKD and other cardiorenal conditions like heart failure (HF), and collaborating on initiatives to assess the environmental impact of treatment. In partnership with Newcastle upon Tyne Hospitals NHS Foundation Trust and the Sustainable Healthcare Coalition (SHC), we have developed an open access in-centre Haemodialysis Carbon Calculator (ICHD) to enable hospitals to assess their haemodialysis units’ carbon footprint.

This tool allows hospitals to make their haemodialysis service more sustainable and to understand the savings that could be achieved by early detection and secondary prevention of CKD. 

Decarbonising chronic kidney disease treatment in the United Arab Emirates (UAE)

At the United Nations Climate Change Conference, COP28, we presented initial findings from research on the health, health system and environmental burdens of CKD in the UAE.

The discussion paper, developed in partnership with the Sustainable Healthcare Coalition (SHC), Pure Health and Maverex, underlines the importance of early detection and prevention on reducing life-time healthcare emissions. One study using the SHC Care Pathway Guidance¹¹ found that as CKD progresses, per patient carbon emissions increase, with haemodialysis being the largest individual contributor to greenhouse gas (GHG) emissions. The study also found emissions for CKD treatment at each of CKD stage (1-5) represent an additional 6.8-58.7% of CO2e on top of the average UAE persons’ annual greenhouse gas footprint.¹²

Our collaboration with the Abu Dhabi Public Health Centre (ADPHC) of the Department of Health – Abu Dhabi (DoH) – also announced at COP28 – on decarbonising the Emirates’ healthcare ecosystem, includes a focus on CKD, and underlines the interconnection between climate action and illness prevention policies.

Digital patient pathways in heart failure

Heart Failure (HF) – a complex syndrome occurring when the heart cannot pump enough blood around the body – and CKD are interconnected.^13,14 Nearly 64 million people worldwide live with HF, ¹ approximately one third of which also live with CKD.¹⁵ Early detection of HF plays a crucial role in preventing poor clinical and patient outcomes.¹

In the UK, we worked with NHS Greater Glasgow and Clyde, the West of Scotland Innovation Hub, the University of Glasgow and other partners to deliver PROJECT OPERA, an initiative to optimise a digital diagnostic pathway for HF in the community, reducing echocardiogram waiting times down from 12 months to 6 weeks.¹⁶ Early diagnosis means patients can start appropriate HF treatment and reduce the risk of hospitalisation and death all the while reducing 8kg of CO2 emissions per patient per year. ¹⁷ This is now expanding to other parts of the UK, Spain, France, Germany, Mexico and China.

Strengthening our commitment in cardiovascular disease with Healthy Heart Africa 

Cardiovascular disease (CV) accounts for nearly 50% of mortality in CKD stages 3-5.¹⁸ Our Healthy Heart Africa (HHA) programme addresses hypertension and the increasing impacts of cardiovascular (CV) disease in Africa, with the ambition to reach 10 million people with elevated blood pressure across Africa by 2025. We have established programmes to work with clinicians, governments and policymakers to improve access to healthcare, remove barriers to diagnosis and change the way millions of patients receive CV care. HHA supports local health systems by increasing awareness of the symptoms and risks of hypertension, training providers to drive care to the lower levels of the healthcare system and offering health education, screening, plus reduced-cost treatment and control.

Reducing the environmental costs of cardiorenal diseases

The need for immediate action is now more urgent than ever. By better understanding interconnections between cardiorenal diseases, by driving earlier screening and intervention and improving equitable access to healthcare we can improve patient outcomes, reduce environmental impacts and ultimately save lives.^19,20

We are committed to playing our part to deliver better healthcare outcomes with a lower environmental footprint, and creating positive societal impact helping more people live healthier, better lives.

Veeva ID: Z4-60464
Date of preparation: January 2024