Dialysis represents a big challenge for the environmental sustainability, because it is bound to high consumption of water and electricity, hazardous waste incineration and subsequent greenhouse gas emissions. In recent years, it has been recognized the urgent need to preserve our environment together with the people’s health, starting from making dialysis greener. This awareness has led to a new paradigm in the history of dialysis, the concept of Green Nephrology. The Italian Society of Nephrology published 10 affordable actions in the Position Statement with the aims to increase awareness, propose joint actions and coordinate industrial/social interactions. Starting from these, there are four key points to pave the way for environmental sustainability: 1) Sustainable technologies (i.e., machines, filters, water treatment systems, acid concentrates, lighter materials, electronic patient record); 2) Green dialysis centers; 3) Environmental improvement project, using tools to define targets and their monitoring; 4) Nurse role, as he is the main environmental sustainability promoter. To achieve Green Nephrology it’s necessary a partnership between all the stakeholders of the healthcare system. Since the growing awareness of the problem and the existence of ways to solve it, it’s time to act and the effective way to do it is to implement all the solutions provided in this article in an immediate future.