Greener care, smarter spending: economic opportunities in sustainable nephrology

Sustainable nephrology should be recognized not only as an environmental priority but also as an economic and clinical imperative. Kidney care, particularly dialysis, is among the most resource-intensive areas of healthcare, generating substantial costs and environmental impacts through high consumption of water, energy, plastics, and pharmaceuticals. Increasing evidence suggests that strategies such as chronic kidney disease prevention, risk-based follow-up, conservative kidney management, incremental dialysis, lean dialysis practices, circular resource management, and telenephrology can simultaneously reduce resource use, greenhouse gas emissions, and healthcare expenditure while maintaining or improving patient outcomes. Real-world experiences further demonstrate that sustainability initiatives can deliver substantial carbon reductions alongside significant financial savings. However, achieving these benefits requires systematic measurement of environmental performance, life-cycle assessment of technologies, and reimbursement models that reward value, prevention, and resource efficiency rather than healthcare volume. Sustainable nephrology therefore represents an opportunity to align environmental stewardship with economic sustainability and high-quality patient care. Integrating sustainability into kidney care is not simply an ecological responsibility but a practical strategy to improve the long-term resilience, efficiency, and value of health systems.