Providing environmentally sustainable nephrology care: focus in low- and middle-income countries

Kidney Int. 2024 Feb;105(2):259-268. doi: 10.1016/j.kint.2023.09.034. Epub 2023 Nov 25.


Health care on a global scale significantly contributes to carbon emissions, with high-income countries being the primary culprits. Within health care, dialysis plays a significant role as a major source of emissions. Low- and middle-income countries have a high burden of kidney disease and are facing an increasing demand for dialysis. This reality presents multiple opportunities to plan for environmentally sustainable and quality kidney care. By placing a stronger emphasis on primary and secondary prevention of kidney disease and its progression, within the framework of universal health coverage, as well as empowering patients to enhance self-care, we can significantly reduce the need for costly and environmentally detrimental kidney replacement therapy. Mandating the adoption of lean and innovative low-carbon dialysis practices while also promoting the growth of kidney transplantation would enable low- and middle-income countries to take the lead in implementing environmentally friendly nephrology practices and reducing costs, thus optimizing sustainability and the well-being of individuals living with kidney disease.

Keywords: carbon footprint; climate change; dialysis; green nephrology; kidney health; sustainability.

MeSH terms

  • Carbon
  • Developing Countries
  • Humans
  • Kidney Diseases* / therapy
  • Nephrology*
  • Renal Dialysis


  • Carbon