Studies investigated the patient-care (in-hospital) and outside-the-hospital energy consumptions for delivering the hemodialysis (HD) service. A life cycle inventory methodology was used for this patient-based analysis for two hospitals located in Wichita, Kansas. It was found that, for both hospitals, the actual HD machines consumed approximately 3.5kilowatt-hours (kWh) of electrical energy per HD, only 8% to 16% of the total energy used for delivering the HD service (in hospital). This increases to 9.6 to 28.9kWh of hospital billable energy for the whole system of HD machine, auxiliaries, and dialysis water treatment. Converting these hospital direct electrical energy values to natural resource energy (nre) then adding the cradle-to-gate natural resource energy for the manufacturing and supply chain of all the HD consumables, the total is 78 to 149kWh nre/HD. The nre measures all the direct fuel burned to generate energy and is thus directly related to emissions to the air, water, and land and is a direct secondary impact on public health from HD. The ratio of outside-the-hospital energy to direct hospital HD electrical energy consumption is 4:1 to 7:1, so a broader base exists for improvement than just the hospital.