There is increasing evidence that climate change is associated with kidney diseases, and in turn, kidney disease therapies, namely dialysis, put an additional strain on the environment (1). The narrative review by Bharati and colleagues (2) details the many associations and proposed mechanisms of climate change and kidney diseases (Figure 1). The increase in global temperature and extreme weather coupled with food and water scarcity is associated with acute kidney injury, kidney stones, and chronic kidney disease. Beyond the direct effect of heat injury and dehydration, population migration and industrialization lead to urban heat islands, which may contribute to the rise of kidney stones and kidney injury and related hospitalizations (3–5). Repeat episodes of dehydration, intense heat stress, and exposure to agricultural pesticides are thought to cause chronic kidney disease of uncertain etiology, and air pollution is linked to glomerulonephritis (6–9). The destruction of ecologic habitats and biodiversity may increase risk of zoonotic diseases and associated kidney injury events (3, 10). In addition, dialysis is a resource-intense therapy. Each hemodialysis session requires up to 500 L of water and 7 kW of energy, and the carbon footprint is high even with home modalities through disposable waste (11–14). Unfortunately, climate change-related kidney events may disproportionately affect individuals in developing countries or with lower socioeconomic backgrounds (5, 15, 16).
The review by Bharati and colleagues (2) is encouraging in that there is growing interest and awareness of the intersection between the environment and kidney health/diseases. However, as the authors mention, the time for action is now. ASN agrees with a recently published call to action for nephrologists to focus on climate change and advocate for policy changes (17) (Figure 2). Further research to understand the impact and mechanism of climate change on kidney diseases and the impact and development of innovative kidney therapies is needed. Such research can include the carbon footprint tradeoffs of telemedicine or new water purification systems. Myriad green initiatives have been tried in the past with recorded objectives, but real and lasting change will require governmental and regulatory policy (18).
The mantra, “Think globally, act locally,” is a call for organizations and institutions to identify a champion to help prioritize the relationship of the environment on kidney diseases and kidney therapies, such as eco-friendly dialysis units and health care innovations that can eventually be implemented globally. Nephrologists addressing issues in their own patient panels and dialysis units should be the first step for all of us.
References
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Bharati J, et al. The environment and kidney health: Challenges and opportunities. Salud Publica Mex 2022; 64: 46–55. https://dialnet.unirioja.es/servlet/articulo?codigo=8476738
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Yau A, et al. Addressing the environmental impact of kidney care. Am J Kidney Dis 2021; 77: 406–409. doi: 10.1053/j.ajkd.2020.09.011