Time to integrate climate science into kidney care planning: a 'PASIGE' to a climate change mitigation and adaptation...

Kidney diseases affect around 850 million people globally and are a growing public health burden, with high rates of associated cardiovascular mortality and no major decline in age-standardized mortality compared to other noncommunicable diseases. Climate change is an inequitable driver of kidney diseases, and climate-related disasters can disrupt access to life-sustaining kidney replacement therapies. Conversely, the care of patients with kidney diseases contributes to greenhouse gas emissions, pollution, and generates large amounts of waste.

Environmentally sustainable kidney care planning is pursuing kidney care practices and innovations that minimize environmental harm while remaining patient-centered and cost-effective. An adaptation and mitigation framework (a structured approach to developing adaptation strategies, policies, and measures) to guide this is lacking.

We propose the 'PASIGE' framework to guide climate science integration in kidney care planning -> Prevent: approaches to prevent kidney disease, its progression to kidney failure, and complications; Adopt: sustainable lifestyle, practices and therapies; Screen: targeted population screening for early detection and identification of kidney disease; Innovate: technology, manufacturing, procurement, energy sources and transportation; Generate: sustainably powered and produced low-impact net zero waste kidney replacement therapies resilient to climate threats; and Enhance: patient engagement, care quality, and system resiliency.