Green, Sustainable Nephrology: State of the Art Needs for Education and Implementation.

Green nephrology, also often called sustainable nephrology, has become a field of interest in our discipline in recent years. Although several reviews have been published, comparatively few original articles have appeared, witnessing interest but also lack of original data. Greater awareness of the effect nephrology has on the planet, including, but not limited to its carbon footprint, is needed to promote education and research on these issues. Increasing awareness entails increasing knowledge at various levels, and it is for this reason that we are presenting this review focusing on educational activities that have been and could further be undertaken to spread knowledge of these topics. We start from a description of the various approaches to green nephrology: technical, mainly focused on dialysis, clinical, encompassing medical and nonmedical treatments in all CKD phases, and comprehensive, embedding kidney care in the society. We further summarize what is known and the fundamental needs and problems we presently face in reducing dialysis carbon-print, optimizing the pathways of care, avoiding futility in clinical work and research, and implementing lifestyle interventions and education. We further acknowledge the lack of data on lifecycle of items and procedures, including commonly used drugs, and identify research needs at various levels. We finally discuss some examples of educational programs on green nephrology that are already available at various levels, from medical schools (an educational game), to medical meetings (healthy eating and reduction of plastic and paper waste), and daily clinical practice, in which teaching passes also through examples (personalizing dialysis and adapting schedules to each patient). Finally, we identify some barriers that educational approaches may offer ways to overcome, to promote effective, targeted interventions that will make us advance on the road to reduce nephrology's carbon footprint.