A Gap Analysis to Assess the Implementation of Environmentally Sustainable Kidney Care Strategies in Canada.

Background: There is growing interest in the nephrology community for environmentally sustainable kidney care (ESKC) to alleviate the environmental impact of kidney care services.

Objective: This study aimed to assess the knowledge of Canadian kidney care providers regarding their program's ESKC strategies.

Design setting participants measurements and methods: An electronic survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to Canadian kidney care providers.

Results: A total of 421 Canadian kidney care providers responded to the survey. Various degrees of implementation of ESKC practices across the country were reported, with higher proportions of respondents reporting the use of strategies related to medication stewardship, clinical care consumables, virtual care options, office consumables, office equipment, and general waste management. It also highlighted the lack of knowledge of kidney care providers about many areas related to ESKC practices, such as energy sourcing, reverse osmosis reject water savings, procurement and product sourcing, as well as policies within the kidney program and contact with environmentally sustainable officers. Knowledge of respondents about certain strategies was also dependent on their role within the unit (eg, nephrologist vs nurse vs management), with nephrologists being relatively more aware of strategies that directly involve them, such as medication stewardship. Finally, variation across provinces was noted in terms of the incorporation of climate change adaptation or preparedness and environmental planning strategies.

Limitations: The overrepresentation of people working in academic centers, as well as those from Quebec and British Columbia, may affect the generalizability of results. As respondents may be affiliated with the same units, results reflect knowledge of the individuals regarding the strategies, rather than the presence or implementation of such strategies across units.

Conclusions: The ESKC practices from various domains are incorporated at different levels across the country, and there are important gaps in providers' awareness of such strategies, depending on their role within the unit.