The prevalence of chronic kidney disease is 7.05% in Italy . The replacement dialysis treatments determine greenhouse gas emissions  thus contributing to climate change, an important source of risk to global health . Furthermore, the percentage of the Italian Gross Domestic Product destined to public health expenditure has progressively contracted . The province of Belluno has an area of 3610 km2, with a population density of 56 people/km2, an old age index of 248.5 , and offers 4 dialysis centers; however, several patients take up to 8 hours/week to commute to the dialysis center, with a consequent significant environmental and economic impact.
We have investigated the Home Hemodialysis (H-HD) models, both as Assisted Home Hemodialysis (AH-HD), and as Not-assisted Home Hemodialysis (NH-HD), to evaluate their environmental and economic sustainability, and the actual impact due to their adoption by 5 patients.
Thanks to AH-HD it is possible a reduction up to 3767 kg of CO2 per year, and an economic saving of € 32 456 per year. Utilizing a NH-HD treatment, it is possible a reduction of 5330 kg of CO2 per year, and a reduction in annual healthcare costs up to € 30 156 per year. Furthermore, the adoption of H-HD treatment for 5 patients allowed an effective reduction of 14 537 kg of CO2 emitted and a net economic saving of 57 975 €.
Therefore, we consider H-HD methods a valid option for patients living in areas with low population density, where transports have a significant impact, allowing a net reduction of CO2 equivalent emissions and a considerable saving of the health resources.
Keywords: In-center Hemodialysis, Home Hemodialysis, economic sustainability, healthcare expense, environment sustainability, CO2 emission.