As global surface temperatures continue to rise due to human activity, adverse impacts are compounded for people with kidney diseases. This population—850 million, including more than 37 million Americans—is more vulnerable to heat exposure and dehydration and increased risk for kidney stones and acute kidney injury. Poor air quality is also associated with progressive chronic kidney failure.

“ASN firmly believes that climate health impacts kidney health,” says ASN President Susan Quaggin, MD, FASN. “As ASN unites health care professionals, researchers, and innovators for kidney health, we must pay close attention to the quickly increasing impact climate change is having on people with kidney diseases.” 

Temperature changes, shifting precipitation patterns, and increasing vector-human contact have led to a wider prevalence of kidney diseases across the world. Moreover, the impact of climate change is likely to disproportionately impact people with kidney diseases who have other chronic conditions, such as heart and lung disease, and are prone to infection.

Over 500,000 Americans with kidney failure require multiple dialysis treatments each week to live. Given that most of these people receive hemodialysis treatments three times a week in an outpatient dialysis center, a disruption of medical infrastructure and access to a medically pure water supply necessary for dialysis during a natural disaster could have dire consequences. Disruption to supply chains or distribution of drugs could also result in a loss of donor kidneys: 230,000 Americans have had a kidney transplant and are dependent on regular immunosuppressant medications. 

As climate change threatens to increase the incidence and prevalence of kidney diseases, disrupt access to care, and widen inequity in kidney health, ASN is calling on kidney health professionals across the world to research the biological and population-level impacts and develop interventions, as well as  foster community resilience and advance disaster preparedness focused on kidney health care systems for extreme weather events.

The society also would like to see broader access to existing therapies, such as home dialysis and transplantation, and new therapies, such as wearable or implantable artificial kidneys. ASN is also urging kidney health professionals to diminish the contribution of kidney care to climate change by:

• Preventing kidney diseases by addressing upstream risk factors such as access to nutrition, access to care, chronic stress from discrimination and inequality, early detection and intervention of genetic kidney diseases, and co-morbid conditions such as hypertension and diabetes.
• Researching the environmental footprint of kidney replacement therapies to better understand and mitigate the impact of necessary therapies in clinical practice.
• Utilizing more efficient technologies including state of the art reverse osmosis modules which decrease water usage and devices which generate dialysate at the point of care.
• Reducing medical waste, including plastic waste, at every opportunity.
• Increasing the adoption of telehealth and other technologies which lower carbon emissions.
• Fostering the development of new therapies for kidney failure with a focus on environmental sustainability.

By joining a growing number of medical societies and journals in sounding the alarm and calling on governments to strengthen efforts to meet emissions targets, kidney health professionals can advocate for public policy to address climate change in the kidney space. Fostering the development of sustainable dialysis technology and new therapies for kidney failure with a focus on sustainability and allocating funding accordingly will also be important.

Other steps include, developing guidelines and best practices for incorporating sustainability into clinical practice (including collection and reporting of data on resource usage), promoting sustainable procurement practices, and reducing barriers to telehealth. 

“It is increasingly important for kidney health professionals to put a voice to this important issue and foster resiliency, research, and innovation on behalf of all people living with kidney diseases,” adds Dr. Quaggin.