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.
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
Goldfarb DS, Hirsch J. Hypothesis: Urbanization and exposure to urban heat islands contribute to increasing prevalence of kidney stones. Med Hypotheses 2015; 85: 953–957. doi: 10.1016/j.mehy.2015.09.003
Brikowski TH, et al. Climate-related increase in the prevalence of urolithiasis in the United States. Proc Natl Acad Sci USA 2008; 105: 9841–9846. doi: 10.1073/pnas.0709652105
McTavish RK, et al. Association between high environmental heat and risk of acute kidney injury among older adults in a northern climate: A matched case-control study. Am J Kidney Dis 2018; 71: 200–208. doi: 10.1053/j.ajkd.2017.07.011
Payán-Rentería R, et al. Effect of chronic pesticide exposure in farm workers of a Mexico community. Arch Environ Occup Health 2012; 67: 22–30. doi: 10.1080/19338244.2011.564230
Gallo-Ruiz L, et al. Prevalence and risk factors for CKD among brickmaking workers in La Paz Centro, Nicaragua. Am J Kidney Dis 2019; 74: 239–247. doi: 10.1053/j.ajkd.2019.01.017
Xu X, et al. Long-term exposure to air pollution and increased risk of membranous nephropathy in China. J Am Soc Nephrol 2016; 27: 3739–3746. doi: 10.1681/ASN.2016010093
Costello A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693–1733. doi: 10.1016/S0140-6736(09)60935-1
Lim AEK, et al. The carbon footprint of an Australian satellite haemodialysis unit. Aust Health Rev 2013; 37: 369–374. doi: 10.1071/AH13022
Connor A, et al. The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom: The carbon footprint of hemodialysis. Hemodial Int 2011; 15: 39–51. doi: 10.1111/j.1542-4758.2010.00523.x
Chen M, et al. The carbon footprints of home and in-center peritoneal dialysis in China. Int Urol Nephrol 2017; 49: 337–343. doi: 10.1007/s11255-016-1418-5
Hansen AL, et al. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol 2008; 37: 1359–1365. doi: 10.1093/ije/dyn165
Green H, et al. Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research. Environ Res 2019; 171: 80–91. doi: 10.1016/j.envres.2019.01.010
American Society of Nephrology. Statement on climate change. April 22, 2022. https://www.asn-online.org/policy/webdocs/22.4.22StatementOnClimateChange.pdf
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