Green nephrology: a series of mini reviews on minimizing the environmental impact of kidney health care

Climate change, driven by rising atmospheric carbon dioxide and other greenhouse gasses released primarily from the use of fossil fuels,1 is occurring at such a rapid pace that the United Nations and its Intergovernmental Panel on Climate Change consider it as one of the major global challenges of our time.2 Along with a changing climate, overuse and pollution of natural resources, dwindling water supplies, and extensive contamination of the environment with plastics pose additional threats. The effects of this changing climate on ecosystems, biodiversity, and human communities are increasingly obvious, although debates surrounding the scope and nature of the actions required to combat climate change remain contested and complex owing to competing political and economic priorities. Sadly, the burden of climate change and environmental pollution disproportionately affects vulnerable populations, particularly in low- and middleincome countries,3 which are less equipped to deal with the consequences. The 2022 International Society of Nephrology Emerging Leaders1 Correspondence: Letizia De Chiara, Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, Florence, FI 50139, Italy. E-mail: letizia.dechiara@ unifi.it 1Members of The 2022 International Society of Nephrology Emerging Leaders are listed in the Appendix. Ironically, the health care sector, which is dedicated to improving peoples’ lives, is an important contributor to climate change and environmental decline. The business of health care generates more than 4% of global greenhouse emissions and as high as 8% in some high-income countries.1 Medical supply chains account for a large proportion of this carbon footprint. The problem was exacerbated by the COVID-19 pandemic, which created a tidal wave of medical waste in the face of single-use personal protective equipment and diagnostic tools. In addition, the treatment of advanced kidney disease (e.g., by dialysis) has among the highest carbon footprints in clinical care. As recognition of the environmental impact of health care has grown, many, mostly high-income, countries have made a formal commitment to providing health-related services in a more environmentally sustainable manner. This commitment includes reducing unnecessary consumption of resources, decarbonization of power generation, and investment in preventative care. However, creating sustainable health care is challenging, requiring parity between the mandate to deliver high-quality care and addressing the needs of the environment. Recognizing this pressing issue, Kidney International is launching series of minireviews dedicated to the topic of Green Nephrology. Our aim is to increase awareness of the climate and environmental impact of health care among the members of the nephrology community, conduct a deep dive into the relationship between kidney care and the environment, and promote environmentally friendly practices in nephrology. To this end, Kidney International partnered with the International Society of Nephrology’s Emerging Leaders 2022 Program (ISN-ELP 2022) to coordinate this initiative.