Background Approximately 2 million chronic haemodialysis patients produce over 2 000 000 tons of waste per year that includes about 600 000 tons of potentially hazardous waste. The aim of the present study was to analyse the characteristics of the waste that is produced through chronic haemodialysis in an effort to identify strategies to reduce its environmental and financial impact. Methods The study included three dialysis machines and disposables for bicarbonate dialysis, haemodiafiltration (HFR) and lactate dialysis. Hazardous waste is defined as waste that comes into contact with bodily fluids. The weight and cost of waste management was evaluated by various policies of differentiation, ranging from a careful-optimal differentiation to a careless one. The amount of time needed for optimal management was recorded in 30 dialysis sessions. Non-hazardous materials were assessed for potential recycling. Results The amount of plastic waste that is produced per dialysis session ranges from 1.5 to 8 kg (from 1.1 to 8 kg of potentially hazardous waste), depending upon the type of dialysis machine and supplies, differentiation and emptying policies. The financial cost of waste disposal is high, and is mainly related to hazardous waste disposal, with costs ranging from 2.2 to 16 Euro per session (2.7–21 USD) depending on the waste management policy. The average amount of time needed for careful, optimal differentiation disposal is approximately 1 minute for a haemodialysis session and 2 minutes for HFR. The ecological cost is likewise high: less than one-third of non-hazardous waste (23–28%) is potentially recyclable, while the use of different types of plastic, glues, inks and labels prevents the remaining materials from being recycled. Conclusion Acknowledging the problem of waste management in dialysis could lead to savings of hundreds of millions of Dollars and to the reuse and recycling of hundreds of tons of plastic waste per year on a world-wide scale with considerable financial and ecological savings.

The vast transformation the circular economy that will occur in the upcoming years inevitably will change the EU panorama, designing new scenarios from an economical-social-environmental perspective. To best build a circular economy, it is necessary innovative policy-planning with a holistic and systemic perspective that fosters a cohesive and smooth transition to circular business models. This paper explores the impacts of circular economy policy design processes driven by a systemic design and how this expertise could ease innovative and effective paths for policy-planning on a circular transition in EU regions. This examination of systemic design features recent approaches to design as a discipline addressing complex problems, and the literature review on systems and design thinking for sustainable development, and policy design, focusing on existing barriers to circular economy. The discussion is narrowed to the specific case study in which the systemic design methodology is applied to provide a path for five European regions towards the CE: the Interreg Europe RETRACE (A Systemic Approach for Regions Transitioning towards a Circular Economy) project. Including an in-depth examination of how systemic design can address current barriers for a circular transition within an effect in the short, medium, and long-term policy horizon in the transition of the European regions towards the circular economy.