#NephMadness 2020: The Time for Nephrologists to Tackle Climate Change is Now

Megha Salani @m_salani

Megha Salani is an Assistant Professor in Nephrology at Vanderbilt University Medical Center in Nashville, Tennessee. She enjoys teaching and has a particular interest in home dialysis and in reducing the environmental impact of dialysis. 

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The 2015 Lancet Commission on Health and Climate Change noted that “tackling climate change could be the greatest global health opportunity of the 21st century.” If carbon emissions are not substantially reduced, the global average surface temperature is projected to increase by 4° C by 2100. As the temperature rises, we will have increasing frequency and severity of heat waves, flooding, and cyclones, which can lead to devastation in the communities that they hit, as well as worldwide food shortages. 

Climate change will specifically affect our patient population, as increasing temperatures can lead to an increase in episodes of acute kidney injury (AKI) and nephrolithiasis. We are also likely to see more mosquito-borne and rodent-borne illnesses that can cause more AKI events. In addition, extreme weather events often lead to missed dialysis treatments and supply shortages.  

The nephrology community also has an important role in advocating for change because dialysis accounts for the highest per capita water and power consumption and waste generation in the healthcare field. Our current resource utilization is not sustainable. As part of the healthcare community, we have a responsibility to practice and teach environmentalism and to develop and expand green dialysis initiatives.  

The good news is that much can be done to reduce our impact on the environment and mitigate climate change. Simple things like turning off and unplugging equipment that is not in use and using energy-efficient lighting and appliances can reduce carbon emissions. Utilizing renewable energy sources, such as solar and wind energy, can decrease the use of coal and natural gas.  

Eating less meat and dairy and fewer processed foods, as well as eating more locally grown food, are both healthy and ecological. Having an on-site garden at the dialysis unit can be a fun way to engage patients and staff in how to grow fruits and vegetables and herbs that they can then take home. Walking and biking are healthy modes of transportation; carpooling or taking public transportation are also good options. Increasing the use of telemedicine for home dialysis and chronic kidney disease or transplant clinic appointments would also reduce carbon emissions from transportation. Dialysis has a high carbon footprint; adding heat exchanger retro-fits into dialysis water systems that do not already have them can reduce carbon emissions and reduce costs for the dialysis unit. 

Water is a finite resource and use should be minimized to what is needed. Dialysis involves significant water utilization. Altering the plumbing at in-center units so that reverse osmosis reject water can be collected and reused can cut back on water waste. This water is already highly purified and sending it down the drain is illogical. It can be reused for many purposes, such as sanitation or laundering systems, steam sterilization, or watering crops. The use of NxStage and peritoneal dialysis can reduce water consumption for patients that dialyze at home.  

As healthcare professionals, we are role models in the community, so we need to be cognizant of our carbon and water footprints. We should also practice and teach responsible waste management. Patients and staff should have easy access for recycling. An on-site garden at the dialysis unit would provide an opportunity to teach about composting, which can reduce the production of greenhouse gases from organic products enclosed in landfills. This is also a good use of reverse-osmosis reject water! 

Dialysis generates a lot of waste and greener ways of disposing of it such as steam sterilization instead of incineration should be evaluated. Polyvinyl chloride is the most common polymer in medical products and is toxic in both its manufacture and disposal. We can use our voices to pressure companies to look for greener alternatives.  

Climate change may seem formidable, but it presents us with an opportunity to make changes that can benefit the global population for generations to come. We go into the healthcare field to serve those around us and now we have a chance to help people farther and wider than ever before. In order to do so, we need to implement changes in our personal and professional practice to reduce our ecological footprint. We can also reach out to politicians and corporations to send a message that this is of utmost importance to us, to our patients, and to our planet.  

– Guest Post written by Megha Salani @m_salani


As with all content on the AJKD Blog, the opinions expressed are those of the author of each post, and are not necessarily shared or endorsed by the AJKD Blog, AJKD, the National Kidney Foundation, Elsevier, or any other entity unless explicitly stated.


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