Kidney care is under growing pressure to move beyond late-stage disease management and in-centre haemodialysis as costs, environmental burden, poor outcomes and reduced quality of life expose the limits of the current model. In a recent editorial published in Kidney International, that shift is linked to the World Health Organization Resolution on Kidney Health, approved at the 78th World Health Assembly, which places prevention, early detection and sustainable access to dialysis, transplantation and conservative care within a broader public health mandate. Chronic kidney disease is one of the world’s most common noncommunicable diseases and remains underrecognised despite its links to cardiovascular disease, premature mortality, societal costs and a considerable environmental footprint.
Prevention and Early Detection
The proposed model places prevention at the centre of kidney care. Diabetes and hypertension, the leading causes of chronic kidney disease, remain widely underdiagnosed and undertreated. Kidney function is also affected by smoking, unhealthy nutrition, alcohol use, obesity, nephrotoxins, physical inactivity, heat exposure, environmental pollution and agrochemicals. Prevention also extends to poverty, remoteness, unsafe housing and insufficient cooling. Public health measures include healthier diets, taxation and education campaigns. World Kidney Day summarises prevention through Eight Golden Rules covering lifestyle, hydration, blood pressure, glucose control, medication use and regular kidney testing. Public understanding remains poor, making tailored communication essential for high-risk groups.
Early detection is equally important because chronic kidney disease symptoms usually appear late, when treatment can often only delay kidney failure. Serum creatinine remains the most common routine marker but lacks sensitivity for early detection. Albuminuria is a simple, low-cost and reliable early indicator of kidney microvascular damage and chronic kidney disease. Yet urinary screening remains rare even in well-developed health systems. Population-wide timely albuminuria screening and treatment could lower the lifetime incidence of dialysis or transplantation by 21.8% and cardiovascular disease by 12%. Screening from age 45 years or even 35 years has been suggested to improve cost-effectiveness and resilience. Screening is linked to education of the public and frontline providers and to access to effective follow-up therapy.
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Environmental Risks and Greener Treatment
Environmental change is a direct kidney health threat. Global warming increases heat stress and dehydration, major contributors to acute kidney injury and kidney stones and eventually to chronic kidney disease progression. Outdoor workers in poorly adapted conditions are exposed. Climate change also intensifies floods, hurricanes and typhoons, while higher temperatures favour malaria, dengue, leptospirosis and infectious diarrhoea, all of which can cause acute kidney injury. Flood waters may become nephrotoxic when contaminated, and fine particulate matter from industry, transport and forest fires has been linked to chronic kidney disease prevalence. Vulnerable populations face the greatest risk because they often lack cooling and protection.
That approach extends to kidney failure care itself. Transplantation offers the best outcomes, lower societal costs, better quality of life and less environmental impact than dialysis. Home dialysis is also given a more prominent role because it can reduce transport needs, room temperature control, reverse osmosis electricity use and, with compact systems and peritoneal dialysis, water consumption. Dialysis remains a major environmental concern because of energy use, greenhouse gas emissions and plastic waste. Around 70% of healthcare-related greenhouse gas emissions linked to dialysis stem from the supply chain, especially manufacturing, transport and waste handling. The proposed response includes transparency on these burdens, recycling, waste triage, reduced water wastage and simpler systems, without compromising quality of care or patient safety.
Treatment Choices, Empowerment and Crisis Planning
The sustainable model does not rely on one replacement therapy alone. Conservative care stands alongside transplantation and dialysis as a legitimate option, especially for frail and elderly people, with a focus on quality of life and full medical support without starting kidney replacement therapy. It remains underused even though some people with stage 3 to 5 chronic kidney disease prefer it when dialysis would mean more hospital visits or restricted travel. Many people also receive average or poor information before starting kidney replacement therapy. Paternalistic decision-making remains common, while shared decision-making is linked to better satisfaction, quality of life, outcomes, transplantation rates and home dialysis rates and to lower reliance on in-centre haemodialysis. Smaller outpatient units, stronger nurse involvement, discussion groups and patient organisations are presented as ways to make care more patient friendly.
Crisis preparedness is another part of the model because people with kidney disease depend on medication and resource-intensive treatments that require staff, clean water, electricity, transport and reliable infrastructure. Those conditions are often disrupted during natural disasters, pandemics and armed conflicts. Missed dialysis can rapidly cause life-threatening complications, and interruption of drug therapy can accelerate disease progression or cause graft rejection, yet kidney care is rarely included in official disaster plans. The proposed response is to integrate kidney health into emergency protocols, raise awareness among authorities and develop less resource-dependent treatment strategies.
Earlier detection, prevention, equitable access and lower-impact care are central to a more sustainable approach to kidney health. Greater use of transplantation, home dialysis, conservative care, patient involvement and crisis preparedness can reduce reliance on late-stage, dialysis-dominated pathways while addressing both environmental conditions and the environmental burden of care. Recognition of kidney disease as a global priority at the 78th World Health Assembly creates a basis for coordinated action across health, labour, environment and policy. Kidney care becomes more sustainable only when it protects people and the planet at the same time.
Source: Kidney International
Image Credit: iStock
References:
Vanholder R, Abdellatif D, Soares Dos Santos A et al. (2026) Kidney health for all: caring for people, protecting the planet. Kidney International, 109: 408-417.
