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Human-induced climate change is a significant threat to global public health. The healthcare sector contributes significantly to environmental impact through resource depletion and greenhouse gas emissions. Nephrology care is responsible for a disproportionately higher share of the healthcare carbon footprint. This review aims to map the published evidence concerning environmentally sustainable kidney care (green nephrology) in the literature to better understand the current lacunae in the evidence and challenges faced while adopting eco-friendly practices.
A search strategy was developed to be used in Medline, and adapted for other databases (PubMed, Embase, Cochrane Library, CINAHL). A secondary hand search of all references from included studies was undertaken (snowballing approach). All publications (including original studies, case reports, editorials, review articles, editorial letters, positional statements from professional societies, and conference abstracts), in any language, addressing any environmental impact of activity in kidney care; current knowledge or awareness of environmental impact of kidney care; any activity, strategy or effort focused on environmental sustainability of kidney care activity; or any barrier or challenge faced in adopting environmentally sustainable kidney care activity were included. A data extraction table was used to record the key components and information from the retrieved papers. Extracted data was analyzed qualitatively using preidentified and newly identified themes. Complete results are summarized using descriptive statistics and narrative summaries around the identified themes.
A total of 13 987 references were initially screened. After exclusion of 13 606 references based on title or abstract, 381 records were retrieved for assessment. Hand search of all references from included studies will help identify additional records. Data extraction of 150 included records has identified the following themes: strategies in water conservation (1), energy conservation (2) and waste management (3); environmental impact of kidney care (4), preventive nephrology (5) and lean healthcare delivery (6); economical aspects/cost effectiveness of green nephrology (7); green nephrology initiatives and policies (8). Complete list of included records and analyses are expected to be finalized by early 2024. Most selected records are editorials, reviews or commentaries, whereas original research articles only represent a small proportion (20%) of included papers.
This scoping review highlights a paucity of published original research in the field of green nephrology while showing a marked increase in the number of publications on the subject in the last few years albeit predominantly in the form of opinion pieces and reviews. This review also helped facilitate the formulation of a toolkit, based on the key themes identified, which can direct healthcare professionals to available resources vital to ensuring environmentally sustainable kidney care.