Green Kidney Care in Australia: Looking Backward and Forward

Broader action

It took over 10 years for the broader Australian kidney care community to spur to action. In 2017, with a new generation of nephrologists pressuring leadership, mentored by Agar, the Australian and New Zealand Society of Nephrology (ANZSN) established an Environmental Sustainability Committee (ESC). The group's aim was to foster, promote, and support environmentally sustainable kidney care in Australia and New Zealand. The range of initiatives it has undertaken over the years since is outlined in Table 1.

Table 1

Environmental Sustainability Committee initiatives

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Collectively, this work has led to significant increases in awareness of both the need for and ways to achieve “green kidney care.” Yet, despite these efforts, a 2020 survey of Australian and New Zealand dialysis services found that environmental sustainability remained a low priority in clinical practice, building design and infrastructure, and management systems (6).

Accordingly, the ESC has since turned its attention to initiatives aimed at stimulating “on-ground” change. In 2022, it published best practice guidelines for the design, construction, and operation of dialysis facilities (7). These outline objectives and minimum requirements across the areas of energy, water, waste, and resource recovery (Figure 1). They have been incorporated into the Australasian Health Facility Guidelines for Dialysis Units, which should aid broad implementation. The ESC has also developed guides for optimizing RO plant settings, hemodialysis machine disinfection schedules, and acid concentrate use. Work is now underway to identify “green champions” in each kidney care service to apply the guidance.

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Examples of objectives for opportunity areas identified in dialysis units

Citation: Kidney News 16, 4

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Where to go from here?

The global situation is markedly different today compared with Agar's day. Rather than being a future threat, climate change is currently exerting an escalating toll on nature and people. Simultaneously, there is now widespread acceptance of the need for deep, rapid, and sustained action, including from within the kidney care community.

Green kidney care committees and initiatives now exist in multiple world regions, including the United Kingdom, Europe, and Canada. UK efforts are particularly notable and provide a model for us all to follow (8). We believe the establishment of similar committees in other world regions, including in the United States, is critical for driving change. These might begin by looking at strategies and guides developed in other world regions and adapting them to suit local circumstances.

More recently, the International Society of Nephrology established GREEN-K (Global Environmental Evolution in Nephrology and Kidney Care) (9), an initiative designed to be “inclusive and global, focusing on collaborative action to develop a coordinated plan to achieve low carbon kidney services across our spectrum of care” (10). Regional societies worldwide have also been invited to participate, providing a ready opportunity for them to learn from and work with others.

Is this enough? Not nearly, given what is at stake. Yet it is progress, and from its humble beginnings in Australia, it is fair to say that an increasingly global green kidney care movement is now underway.

In Australia, the ESC's plans for the coming year include:

• broad kidney community engagement through establishment of a green champions network;

• increased industry engagement, given that the supply chain is where the bulk of kidney care carbon emissions reside; and

• concerted international collaboration because we are stronger together, and so we may learn from each other.

We aim to dig deep and give it our all. Because in the words of Agar, we can, and simply must, do better. In this, we sincerely hope others will join us.