Green nephrology: environmentally sustainable kidney care in pediatrics

Climate change represents a major threat to the health and wellbeing of children and families worldwide. Changes to the environment are already having and increasingly will have an impact on kidney health, particularly in pediatrics, where children are more vulnerable to heat injuries, environmental toxins, and issues related to access to care. At the same time, the environmental cost of healthcare is high, contributing substantially to greenhouse gas emissions, waste generation, and resource depletion. Within healthcare, the environmental impact of kidney care-particularly dialysis therapies-is disproportionately high, and children, who are initiated on dialysis therapies younger and will require treatments for longer periods, have an amplified contribution. Integrating sustainability into pediatric kidney care is not only a health imperative but it also reflects the values of the next generation. In this review, we discuss the effects of climate change on pediatric kidney health, the impact of dialysis therapies on the deteriorating environment, and strategies for incorporating sustainable health practices in the pediatric setting.