Eco-Efficient Hemodialysis: Clinical and Environmental Strategies for a Sustainable Renal Care Model

Hemodialysis is life-sustaining for several million people worldwide and is among the most resource-intensive treatments in routine medical practice. A single session can consume 300–500 liters of water, alongside continuous energy demand, extensive single-use plastics, and a substantial biomedical waste stream. Repeated three times weekly across a growing global dialysis population, this burden accumulates considerably. Healthcare systems account for an estimated 4–5% of global greenhouse gas emissions, and nephrology ranks among the most water- and carbon-intensive specialties within that footprint. The relationship runs in both directions: water scarcity, rising temperatures, and environmental exposures increasingly affect kidney disease burden and the resilience of dialysis provision, particularly in water-stressed and resource-limited regions. Sustainability has therefore moved from a peripheral concern to a central question for the future of kidney care.Evidence on sustainable dialysis remains fragmented. Most published work is single-center and descriptive, applies inconsistent metrics, and originates predominantly from high-income settings. Critically, the field lacks robust evidence that eco-efficiency measures can be adopted without compromising dialysis adequacy, vascular access outcomes, infection control, or patient safety - the assurance clinicians need before changing practice.This Research Topic aims to map and quantify the environmental footprint of current hemodialysis practice across water, energy, waste, and consumables, using transparent and comparable methods. Building on that foundation, it seeks to identify and rigorously evaluate the clinical, technical, and organizational innovations capable of reducing environmental impact while preserving or improving treatment quality and patient safety. It further aims to promote exchange between nephrology, environmental science, engineering, and health policy, so that evidence generated in this field translates into practice and policy rather than remaining confined to individual centers. Collectively, these contributions should help move sustainable dialysis from isolated initiatives toward a coherent, evidence-based model of renal care.We welcome contributions addressing, but not limited to:- Footprint assessment: life cycle assessment, carbon and water accounting, standardized metrics, and benchmarking of dialysis centers- Water: consumption and treatment efficiency, reverse osmosis reject water recovery and reuse, and the effect of water security and climate pressures on dialysis provision- Energy: facility energy demand, heat recovery, and renewable integration- Waste and consumables: single-use versus reusable components, plastic reduction, dialyzer reuse, and sustainable procurement- Clinical strategies with sustainability co-benefits: home and nocturnal hemodialysis, peritoneal dialysis, incremental and individualized prescriptions, reduced dialysate flow, and telehealth monitoring- Safety and quality assurance: evidence that eco-efficient practice maintains dialysis adequacy, vascular access outcomes, and infection control- Health economics, policy, and equity: cost-effectiveness, regulatory and procurement barriers, and sustainable kidney care in low-resource and water-stressed settingsWe welcome Original Research, Reviews, Mini Reviews, Systematic Reviews, Brief Research Reports, Methods, Perspectives, Opinions, Study Protocols, Community Case Studies, and Policy and Practice Reviews. Topic editors: Adolfo Marco Perrotta, Gopalakrishnan Natarajan, Youssef Bouchriti, Mohamed Ait Haddou, Drasko Pavlovic Source: https://www.frontiersin.org/research-topics/85170/eco-efficient-hemodialysis-clinical-and-environmental-strategies-for-a-sustainable-renal-care-model