Advancing Green Nephrology: A Scoping Review of Sustainability Interventions in Kidney Care

Objective: To map and synthesise existing interventions aimed at improving environmental sustainability in kidney care, and to identify challenges and opportunities for implementation across treatment modalities. Design: Scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology. The study merged two existing frameworks to form appropriate review questions. Data sources: Embase, MEDLINE, Scopus, and CINAHL alongside relevant grey literature, searched in September 2024. Eligibility criteria for selecting studies: The review included studies from 1 January 2005 to 30 September 2024 that reported on environmental sustainability interventions in kidney care, including chronic kidney disease, haemodialysis, peritoneal dialysis, kidney transplantation, and conservative management and that provided measurable or descriptive information about the intervention. Conference abstracts and opinion pieces without intervention data were excluded. Results: Out of 2,512 records screened, 95 studies were included. Environmental interventions were most commonly implemented in haemodialysis (n=58), followed by chronic kidney disease (n=19), transplantation (n=6), peritoneal dialysis (n=5), and conservative management (n=1). Some studies addressed multiple modalities; therefore, categories are not mutually exclusive. The most frequent sustainability categories were water use, waste management, procurement optimisation, energy efficiency, and travel reduction. Interventions ranged from dialysate flow reduction and RO water reuse to telemedicine and supply chain redesign. While many demonstrated environmental and economic benefits, reporting was heterogeneous, and studies were concentrated in high-resource settings. Conclusions: There is growing interest in sustainability within kidney care, particularly in haemodialysis. However, adoption across other modalities remains limited. Future work should prioritise underrepresented areas, standardise metrics, and ensure inclusion of low-resource contexts. Co-design of interventions with patients and staff, combined with consistent reporting using frameworks such as SQUIRE 2.0, is essential. Integration of sustainability into clinical practice and policy is urgently needed to align kidney care with global climate and health goals.