The healthcare sector is hindered by several barriers that hamper the application of circular economy principles (e.g. the safety restrictions of the domain limit the use of recycled materials due to the need of materials biocompatibility, and safety in products to be used in the human body). Led by a multidisciplinary consortium of 39 partners (plus 13 industry affiliates) from 15 EU countries plus UK and USA, ENKORE aim to tackle challenges and develop an ecoDesign framework that supports the development of safe and environmental compliant devices eco-responsible packaging, which minimize the environmental impact, reduce the carbon footprint, and maximize the use and preservation of resources. The main goal is to connect the design of the medical devices packages with the end-of-life stage, thus the technologies that support circularity are taken into account at the medical device conception stage. ENKORE framework will be validated in 5 Reference Use Cases (RUCs), led by 5 different health regions that bring HPCs and policy maker, 3 large EU hospitals and the reference network for European Regional and Local Health Authorities (EUREGHA). The project developments and RUCs are supported by several associations and NGOs, a packaging manufacturer and a group of SMEs and researchers, specialists in circularity, LCA, social sciences, environment, circularity, and materials. The validation of the framework shall provide evidence to work with policymakers, creating new or revised standards and create tangible/quantitative evidence. Policy making and regulatory engagement will be strongly performed. The methods and tools comprise Environmental and Social Life Cycle Assessment (ELCA/SLCA), Circularity Calculator (CC) and Digital Product Passport (DPP) approaches, which could be adapted during the second stage of the proposal.

End stage kidney disease ranks among the most severe chronic non-communicable diseases with an unmet medical need, given the high (between 10 and 15%) and stable annual mortality rates. Kidney replacement therapy is necessary when kidney function is below 10% of the normal value. Much effort is put into developing strategies to prevent chronic kidney disease progression. Regenerative medicine still is in the experimental phase and kidney transplantation is only available for a small number of patients. Indeed, the everyday reality is the growing number of dialysis patients. Haemodialysis treatment is the current standard of care for the vast majority of patients with end stage kidney disease. It is a substantial burden to the patient and for society. Haemodialysis treatment is associated with high risks for fatal and non-fatal cardiovascular disease, for infections, hospitalisation and low quality of life. Improvement in the currently available standard is urgently needed. Over the past decade an alternative for haemodialysis became available, i.e. haemodiafiltration. Both are accepted by regulatory authorities. Haemodiafiltration removes waste products that are accumulated due to kidney failure, more effecticvely than standard hemodialysis. Present evidence supports the idea of superiority of haemodialfiltration compared to standard haemodialysis. However, definite proof is lacking and as a consequence haemodiafiltration is not yet widely applied. This consortium aims to determine the best possible dialysis treatment by comparing the conventional guideline based haemodialysis treatment versus high-dose haemodiafiltration by carrying out a prospective randomized controlled clinical trial addressing clinical endpoints, quality of life and a cost-utility analysis. The study will deliver an answer on the question which intervention gives the best value for money. Therefore, it will be considered a “land mark” study, allowing to publish an “end of discussion” paper