Critical care nephrology: opportunities for implementing green practices

The intersection between climate change, healthcare, and nephrology is becoming increasingly evident. Globally, healthcare systems contribute approximately 4.4% of greenhouse gas emissions, with intensive care units (ICUs) representing some of the most resource-intensive hospital areas. Within this environment, critical care nephrology plays a central role, particularly in managing acute kidney injury (AKI) and delivering renal replacement therapies (RRT) such as hemodialysis, continuous renal replacement therapy (CRRT), and peritoneal dialysis. Nephrology interventions in the ICU, while life-saving, are associated with high environmental costs, including significant water consumption, energy use, and the production of large volumes of medical waste For instance, a single hemodialysis session can consume over 500 liters of water, while CRRT in critically ill patients may require 10 to 15 large plastic bags daily, most of which are incinerated as hazardous waste Nephrology has pioneered "Green Nephrology" initiatives focused on reducing the ecological footprint of chronic dialysis through water reuse, optimized dialysis fluid flows, and material recycling (8, 11), however, similar structured strategies for sustainability within critical care nephrology remain underdeveloped. This article explores the environmental challenges of nephrology practice in ICUs, highlights existing gaps, and proposes opportunities, including artificial intelligence (AI) to promote sustainable, high-quality kidney care for critically ill patients.