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Q&A: The American Society of Nephrology calls for action against climate change

UW Nephrology's Dr. Sarah Struthers is co-author of the statement.

In April, the American Society of Nephrology released a statement calling on kidney health professionals to take action against climate change.

The ASN wrote in its statement, “The American Society of Nephrology calls on kidney health professionals to take action to address the impact of climate change on the 850 million people — including more than 37 million Americans — living with kidney diseases across the world who are uniquely vulnerable to the effects of climate change.”

Citing the Intergovernmental Panel on Climate Change, the ASN highlighted that global surface temperatures may increase by as much as 5.7°C if current emission levels remain, and as climate change worsens, extreme weather patterns will continue to lead to negative kidney outcomes around the world.

According to the group, kidney health care contributes disproportionately to the environmental footprint of health care, including greenhouse gas emissions. Hemodialysis, for example, requires approximately 156 billion liters of water and 1.62 billion kW/h of power in the treatment of around 2 million people per year and creates approximately 625,000 tons of plastic waste per year.

In the statement, the ASN urged health care professionals to take steps against climate change, such as advocating for public policy, conducting research on the effects of climate change on kidney patients and developing sustainable technologies. Changes in practice, such as the implementation of telehealth or minimizing medical waste, can also be beneficial.

Healio sat down with Ankur Shah, MD, an assistant professor of medicine at the Warren Alpert Medical School of Brown University and co-author of the statement, and Sarah Struthers, MD, a clinical assistant professor in the division of nephrology at the University of Washington and co-author of the statement, to further discuss the message by the ASN on climate change.

Ankur Shah, MD

Healio: What prompted the recent ASN statement on climate change?

Ankur Shah: What prompted the ASN statement on climate change is the myriad of ways that climate change impacts kidney health. For example, things like heat exposure and dehydration lead to epidemics of kidney health. Mesoamerican nephropathy, or CKDU, is a type of chronic dehydration that causes kidney diseases. Patients with kidney stones are at greater risk of stone formation in the setting of warmer climates and dry climates. There is bidirectionality from climate change to kidney health, and then from the health care systems to climate changes. The health care system has a drastic impact on climate change. There are a lot of areas for improvement, particularly in our specialty of nephrology. We are resource-intensive specialty, particularly because hemodialysis is a water and power machine. After recognizing the impact of kidney health on climate change and the impact of climate change on kidney health, ASN felt we could not sit by.


Sarah Struthers, MD

Sarah Struthers: There is a bidirectional relationship between climate change and kidney diseases. Climate change will increase the incidence and prevalence of kidney diseases. Also, the provision of kidney care and health care in general is a major contributor to greenhouse gas emissions which drive climate change. While our intentions as kidney health professionals are good, the fact is that the way we currently provide care is contributing to the problem of climate change and climate related kidney diseases. It is incumbent upon us to try to figure out how to deliver therapy in a more environmentally sustainable way.

Healio: Are there any kidney patients who will be hit the hardest from climate change?

Struthers: In recent years, there has been increased awareness in nephrology about the role social determinants of health (such as financial security, housing and access to health care) play in affecting a population’s risk for kidney diseases and overall clinical outcomes. These same social determinants of health will also affect how vulnerable a population is to climate change and other environmental hazards. There is a large body of data showing that socioeconomically disadvantaged communities experience increased exposure to a variety of environmental hazards, including water pollution, air pollution and extreme heat, as well as increased risk of flooding during severe weather events. They also have more limited means by which to recover from these exposures and then adapt to future environmental risks. As such, it is the most socially and economically disadvantaged people who are going to be impacted first, and most severely, by climate change.

Healio: How does the U.S. health care sector compare with other countries as a contributor of global emissions?

Shah: The U.S. health care sector, as its own entity and relative to health care sectors and other countries, is a major producer of greenhouse gases. The health care sector globally accounts for about 5% of greenhouse gas emissions. In the United States, it accounts for 10%. So, our relative contribution is double that of other countries. If the U.S. health care sector were its own country, we would be the 13th greatest producer of greenhouse gas emissions. There is a lot of room for improvement.

Healio: What can health care professionals do to combat climate change?

Struthers: Health care professionals are generally well regarded and trusted by the public, so we need to use those trusted voices to build awareness about the health impacts of climate change. That includes not only educating patients about climate-related risks to their health, as well as how to mitigate those risks, but also educating policymakers that climate change is a huge public health problem and that we need to act urgently at a national level to lower our emissions. Education and advocacy are huge. I would encourage any health care professional who is concerned about climate change to get involved. They say that action is the antidote to despair. That is what led me toward climate change advocacy.

Healio: In the statement, ASN suggests health care professionals take action by joining advocacy groups. What specific groups would you recommend?

Struthers: I am a member of the Washington state chapter of Physicians for Social Responsibility. I would also direct anyone interested in health care-related climate change advocacy toward Health Care Without Harm and The Medical Society Consortium on Climate and Health.

Shah: ASN is also available as an organization that kidney health professionals can join.

Healio: What countries can the United States look to for guidance?

Struthers: Australia has been a leader in this area. Drs. John Agar and Katherine Barraclough are nephrologists in Australia who have published extensively about green dialysis. Australia is an extremely hot and water-scarce country, so its residents have had to come up with creative ways to conserve water and use solar power to their benefit. They have been at the forefront of this for many years.

Healio: What are future climate change goals for ASN?

Shah: There are a lot of ways that ASN hopes to combat climate change. Some of the largest goals are increasing research and innovation in the nephrology space. We are a climate-intensive specialty, and our modalities are resource intensive. Again, dialysis is an important and life-saving therapy and also a massive producer of waste, so it’s important to foster innovation that will lead to new therapies and techniques to provide care in a less resource-intensive manner. ASN is also working to broaden access to home therapies and transplant, which are ways to treat end-stage kidney disease in both more patient-friendly and climate-friendly manners. ASN is focusing on diminishing risk by targeting upstream. We talked about how kidney diseases lead to climate change, but as climate change can lead to more kidney diseases, ASN is focusing on pre-dialysis care, chronic kidney disease care and prevention.

Healio: Is there anything you would like to add?

Struthers: Transportation is the largest contributor to greenhouse gas emissions in the U.S., accounting for about one-third of our total emissions. There is an increasing body of data to show that telehealth has a significantly lower carbon footprint than in-person care, even when accounting for the emissions produced from using telehealth equipment. That savings is mainly due to a reduction in emissions from travel. While I think there is always going to be a necessity for in-person care, we have seen with the COVID-19 pandemic that in many clinical situations you can provide safe and effective care virtually. Telehealth has the potential to not only reduce emissions, but also to improve access to care, particularly for rural communities.


Statement on climate change. Published April 22, 2022. Accessed July 5, 2022.

American Society of Nephrology Urges Action on Climate Change. Published May 25, 2022. Accessed July 5, 2022.

Read this article in Healio Nephrology