Climate Change, Kidney Health, and Environmentally Sustainable Kidney Care: A Multinational Survey of Health Care Professionals.

Abstract

Given the threat of climate change to kidney health and the significant environmental impact of kidney care, calls are increasing for healthcare professionals and organizations to champion climate advocacy and environmentally sustainable kidney care. Yet, little is known about their engagement and existing literature is primarily emerging from high-income countries. We conducted a cross-sectional survey to understand the knowledge, attitude, and practice of healthcare professionals on the interconnectedness of climate change and kidney health; to identify personal and organizational initiatives in sustainable kidney care and strategies to increase their engagement; and to compare responses by their country's income level as classified by the World Bank. Participants (n=972) represented 108 countries with 64% from lower- or middle-income countries. Ninety-eight percent believed that climate change is happening, yet <50% possessed knowledge about the impact of climate change on kidney health or the environmental impact of kidney care. Only 14% were involved in climate change and kidney health initiatives (membership, knowledge/awareness, research, advocacy); 22% in sustainable kidney care initiatives (education/advocacy, preventative nephrology, sustainable dialysis, promoting transplant/home therapies, research); and 26% reported organizational initiatives in sustainable kidney care (sustainable general or dialysis practices, preventative/lean nephrology, focused committees). Participants from lower-income countries generally reported higher knowledge and variable level of concern. Engagement in sustainable kidney care did not vary by income level. Guidance/toolkit (79%), continuing education (75%) and opportunities (74%) were the top choices to increase engagement. National initiatives (47%), preventative measures (35%) and research endeavors (31%) were the top avenues for organizational engagement. These varied by income level suggesting that the vision and priorities vary by baseline resource setting. We have identified knowledge and practice gaps among healthcare professionals on the bidirectional relationship between kidney disease and climate change in a multinational context and several avenues to increase their engagement.