• Energy Research

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.

Key Points A multinational survey of health care professionals on the kidney health impacts of climate change and the environmental burden of kidney care was conducted.Most participants reported knowledge gaps and high level of concern on these interconnected issues.Only a minority report personal or organizational initiatives in environmentally sustainable kidney care; this did not vary by country income level. Background Given the threat of climate change to kidney health and the significant environmental effect of kidney care, calls are increasing for health care professionals and organizations to champion climate advocacy and environmentally sustainable kidney care. Yet, little is known about their engagement, and existing literature is primarily emerging from high-income countries. Methods We conducted a cross-sectional survey to understand the knowledge, attitude, and practice of health care professionals on the interconnectedness of climate change and kidney health; to identify personal and organizational initiatives in sustainable kidney care and strategies to increase their engagement; and to compare responses by their country's income level as classified by the World Bank. Results Participants (n=972) represented 108 countries, with 64% from lower- or middle-income countries. Ninety-eight percent believed that climate change is happening, yet <50% possessed knowledge about the effect of climate change on kidney health or the environmental effect of kidney care. Only 14% were involved in climate change and kidney health initiatives (membership, knowledge/awareness, research, and advocacy), 22% in sustainable kidney care initiatives (education/advocacy, preventative nephrology, sustainable dialysis, promoting transplant/home therapies, and research), and 26% reported organizational initiatives in sustainable kidney care (sustainable general or dialysis practices, preventative/lean nephrology, and focused committees). Participants from lower-income countries generally reported higher knowledge and variable level of concern. Engagement in sustainable kidney care did not vary by income level. Guidance/toolkit (79%), continuing education (75%), and opportunities (74%) were the top choices to increase engagement. National initiatives (47%), preventative measures (35%), and research endeavors (31%) were the top avenues for organizational engagement. These varied by income level, suggesting that the vision and priorities vary by baseline resource setting. Conclusions We have identified knowledge and practice gaps among health care professionals on the bidirectional relationship between kidney disease and climate change in a multinational context and several avenues to increase their engagement.