Green teams drive sustainability: a European Rare Kidney Disease Reference Network Survey on dialysis environmental practices.

Background: the environmental impact of healthcare is a growing concern, and nephrology, particularly dialysis, is a resource-intensive field. Dialysis involves high energy use, water consumption, significant waste generation, and transport-associated emissions. However, the extent to which "green" dialysis practices have been implemented remains largely unexplored.

Methods: A comprehensive survey assessing the adoption of sustainable practices in dialysis covering water, energy, waste, transport and procurement policies was distributed through the European Rare Kidney Disease Reference Network (November 2024 to January 2025). The questionnaire covered key sustainability domains, including water and energy management, waste reduction, transport, and procurement policies. A "Green Score" was developed to quantify the implementation of eco-friendly initiatives. Additionally, a patient survey was conducted to evaluate perceptions of dialysis-related environmental impact and willingness to act.

Results: A total of 34 nephrology centers (43% response rate) participated. The mean Green Score indicated that only 39.4% of achievable sustainability measures were in place. Despite widespread awareness, only 26.5% of centers had formal sustainability strategies, 17.6% had dedicated "Green Teams," and just 12.1% utilized measurable indicators to track interventions. Water reuse systems were absent. Plastic recycling programs were present in 79.4% of centers, yet waste-saving initiatives were rare. Notably, the presence of a Green Team was significantly associated with higher Green Scores (P < .05). Patient responses (n = 45) revealed strong interest in sustainability, with 95.6% willing to take action.

Conclusions: This study highlights critical gaps in sustainable dialysis practices across European nephrology centers. Despite interest, implementation remains limited. The strong association between Green Teams and sustainability scores highlights the need for formalized institutional efforts. Given the significant ecological footprint of dialysis, urgent action is required to integrate sustainable strategies into routine nephrology care.