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This is an abridged version of ASN's Statement on Climate Change, which can be viewed in its entirety online at www.asn-online.org.

The American Society of Nephrology (ASN) calls on kidney health professionals to take action to address the impact of climate change on the 850 million people—including more than 37 million Americans—living with kidney diseases across the world who are uniquely vulnerable to the effects of climate change.

Climate change—defined by the United Nations Framework Convention on Climate Change as “a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable periods of time”—poses an existential crisis that threatens the viability of life on this planet. Projections by the Intergovernmental Panel on Climate Change show global surface temperatures are likely to increase by 2.0° Celsius by mid-century if emissions remain at current levels and by as much as 3.5° Celsius by the end of the century. If emissions continue to increase, global surface temperatures are likely to increase by as much as 5.7° Celsius.

The effects of climate change (heat waves, precipitation events, droughts, and cyclone activity) are expected to become more extreme and occur with greater frequency. Specifically, extreme weather patterns may lead to climate events, such as floods and droughts; a reduction in agriculture and food security; or a decrease in water supply and quality due to increases in temperature and changes in precipitation. The diverse detrimental effects of climate change are compounded for people with kidney diseases, as this population is both more susceptible to the direct health impacts of climate change and vulnerable to breakdowns in the health care infrastructure during natural disasters.

Multiple cardinal features of climate change directly impact kidney health. First, heat exposure and dehydration have been implicated in epidemics of chronic kidney failure in Latin America and elsewhere (i.e., Mesoamerican nephropathy) and are also risk factors for kidney stones and acute kidney injury. Second, poor air quality has been linked to progressive chronic kidney failure. Vector-borne illnesses remain important causes of kidney diseases in developing countries and are becoming more prevalent across the world, including in developed countries and previously inhospitable climates, due to changes in temperature, precipitation modification of the landscape, and human behavior that increases vector-human contact. Finally, given that people with kidney diseases tend to have multiple other chronic conditions, such as heart and lung disease, and are prone to infection, the impact of climate change is likely to disproportionately impact this population.

More than 500,000 Americans with kidney failure require daily or thrice-weekly dialysis treatments to live, and the majority of these people receive thrice-weekly hemodialysis treatments in an outpatient dialysis center. Disruption of medical infrastructure and access to a medically pure water supply, necessary for dialysis during a natural disaster, can be immediately life threatening for this population.

More broadly, the population of people with kidney diseases is disproportionately composed of people at socioeconomic disadvantage who are also bearing the greatest burden of climate change. Kidney diseases are associated with social determinants of health and are even concentrated in geographic “hotspots,” such as industrial farming areas, which are especially impacted by climate change. Furthermore, kidney diseases may be associated with occupations that involve extended exposure to extreme temperatures and an increasingly hostile outdoor environment, such as agricultural labor, which are disproportionately held by people with lower socioeconomic status. The confluence of socioeconomic, geographic, and climate change risk factors may increase the incidence of kidney diseases and disrupt access to care.

Kidney health professionals must acknowledge that the health care industry is a significant contributor to greenhouse gas emissions and climate change. It is estimated that the delivery of health care accounts for up to 5% of annual global greenhouse gas emissions, and the management of kidney diseases contributes disproportionately to the overall environmental footprint of the health care industry due to the resource intensiveness of kidney replacement therapies. Hemodialysis, in particular, is an extremely water- and power-hungry therapy, consuming approximately 156 billion liters of water and 1.62 billion kW/hour of power in the treatment of about 2 million people per year. It also generates excessive amounts of plastic waste—approximately 625,000 tons per year—most of which is produced and discarded in an environmentally damaging manner.

Climate change threatens to increase the incidence and prevalence of kidney diseases, disrupt access to care, and widen inequity in kidney health. The more than 21,000 kidney health professionals who comprise the American Society of Nephrology are dedicated to creating a world without kidney diseases. ASN believes that climate health is kidney health and calls on kidney health professionals across the globe to:

  • Support people with kidney diseases to survive climate change by:

    • Researching the biological and population-level impacts of climate change on kidney health and developing interventions to mitigate these impacts

    • Fostering community resilience to the impacts of climate change, including disaster preparedness focused on kidney health care systems for extreme weather events

    • Broadening access to, and the supply chain for, existing therapies, such as home dialysis and transplantation, and developing new therapies, such as wearable or implantable artificial kidneys, which increase patient mobility and resiliency

  • 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 use, and devices that generate dialysate at the point of care

    • Reducing medical waste, including plastic waste, at every opportunity

    • Increasing the adoption of telehealth and other technologies that lower carbon emissions

    • Fostering the development of new therapies for kidney failure with a focus on environmental sustainability

  • Advocate for public policy to address climate change as a contributor to kidney health 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

    • Fostering the development of sustainable dialysis technology and new therapies for kidney failure with a focus on sustainability and allocating funding accordingly

    • Developing guidelines and best practices for incorporating sustainability into clinical practice, including collection and reporting of data on resource use

    • Promoting sustainable procurement practices

    • Reducing barriers to telehealth

The voices of kidney health professionals are critical to bring attention to the growing impact of climate change on kidney health and people with kidney diseases. Kidney health professionals must call for policy and interventions to address climate change.