The treatment of end-stage renal disease (ESRD) makes extensive use of presterilized disposable items which, after use, are contaminated by blood. The preferred route of disposal of such items is by incineration. Disposal costs have risen and this increase in costs has not been matched by waste management programs in renal units. Many of the waste items generated also contain polyvinyl chloride (PVC) whose incineration is environmentally sensitive. Furthermore blood tubing sets contain plasticizers such as di(2-ethylhexyl) phthalate (DEHP), which is known to pose health risks to specific groups of patients. The generation of clinical waste in a dialysis unit is analyzed, issues associated with disposal are discussed, and approaches toward a cost-effective, environmentally sustainable clinical waste management program are reviewed.