World Kidney Day reminds us each year of the scale of chronic kidney disease (CKD) and the urgency of prevention, early detection, and equitable access to care. In 2026, that call carries an additional dimension. Sustaining kidney health requires us not only to treat disease, but to safeguard the systems that make treatment possible.
A single dialysis session is the product of an entire ecosystem. Water must be extracted and purified to exacting standards. Electricity must remain stable. Machines must function precisely. Consumables must move across borders. Clinical teams must coordinate seamlessly. Patients must reach the clinic safely and consistently. In other words, for every treatment delivered, a complex web of systems must align, precisely and repeatedly.
Dialysis does not exist apart from the world around it. It depends on it. Yet that world is under increasing environmental and social strain. After decades spent improving how we deliver care to dialysis patients, the next frontier is ensuring the sustainability and resilience of the systems that make that care possible.
Sustainable renal care now rests on two fundamental shifts: reducing the environmental intensity of dialysis, and using data intelligently to prevent avoidable disease progression & treatment instability.
Achieving this requires attention not only to the environmental foundations of dialysis, but also to the operational resilience of treatment systems, the intelligent use of clinical data and, ultimately, the prevention of kidney disease progression.
Dialysis in a changing climate
Climate change is increasingly recognised as a health determinant, and kidney patients are particularly vulnerable. Heat exposure has been associated with higher rates of acute kidney injury and clinical instability in our CKD patients. Air pollution has emerged as an independent risk factor for CKD, and accelerated decline in kidney function.
Dialysis itself is resource-intensive. A single haemodialysis session may require 300–500 litres of water, generate approximately 1.5–2.5 kg of predominantly single-use plastic waste, and be associated with 20–40 kg of CO₂ equivalent emissions depending on the local energy mix. Multiplied across millions of treatments annually, the environmental footprint is substantial.
Across Diaverum’s 457 clinics in 24 countries, approximately 14,500 professionals care for around 44,500 patients and deliver 6.7 million treatments each year. At this scale, environmental stewardship is inseparable from clinical governance.
For dialysis-dependent patients, system fragility is not theoretical. Water scarcity, energy instability, extreme weather events and supply chain disruption can interrupt treatment continuity, with immediate clinical consequences. For providers like Diaverum, the question is therefore not whether these pressures exist, but how dialysis services can adapt to them. This means integrating environmental responsibility into the design and operation of dialysis services.
Adapting the systems of care
Adapting dialysis systems requires translating environmental awareness into operational practice. Across Diaverum’s network, this means embedding resilience into the design and operation of dialysis services. Spain offers one practical example of this approach. Across our clinics in the country, efforts focus on improving the efficiency and resilience of dialysis delivery itself. This includes reducing water and energy consumption, strengthening supply chain responsibility & monitoring environmental risk across operations. At a system level, all electricity purchased for Diaverum’s Spanish clinics now comes from renewable sources. Moreover, environmental performance is tracked through a climate risk dashboard applied across the countries in which we operate. These measures are not peripheral initiatives; they strengthen treatment continuity in a system that depends on reliable water, energy and supply chains.
Water efficiency enhances treatment security and energy resilience protects continuity of care. Responsible renal care now includes responsible resource stewardship. But resilience in renal care is not only physical. Increasingly, it also depends on how effectively clinical information is used to anticipate instability and guide treatment decisions.
From reactive to anticipatory care
Resilience in renal care depends not only on physical infrastructure, but increasingly on how clinical information is used to anticipate patient instability and guide treatment decisions. Digital innovation, however, is not environmentally neutral. Data storage, computational power and AI model development consume energy and require infrastructure. As healthcare becomes increasingly digital, we must remain conscious of its footprint.
The clinical question, right now, is whether digital systems reduce greater inefficiencies.
CKD progresses silently. Too often, intervention occurs late, at the point of emergency dialysis initiation rather than planned transition. Artificial intelligence and predictive analytics may allow earlier identification of high-risk patients, improved detection of deterioration and more precise treatment decisions.
AI applications in nephrology are demonstrating value in predicting intradialytic hypotension, forecasting hospitalisation risk and identifying early CKD progression. These tools do not replace clinical judgement; they enhance it. They support a shift from reactive management to anticipatory care.
Avoidable hospitalisations, unstable dialysis sessions and emergency starts are resource-intensive - clinically, financially and environmentally. Earlier intervention reduces instability. More precise risk stratification improves allocation of clinical resources. Personalised treatment reduces complications and unnecessary utilisation.
Used responsibly, intelligent data systems reduce variability, prevent escalation and optimise resource use. Digital technology becomes part of sustainable renal care, not because it is impact-free, but because it enables smarter medicine.
Yet the most effective way to reduce the burden on dialysis systems is to intervene earlier in the course of kidney disease.
Sustainability begins with prevention
From both a clinical and environmental perspective, preventing or delaying the need for dialysis remains the most sustainable approach to kidney care.
Diabetes and hypertension remain leading drivers of CKD. Early identification and structured intervention can slow progression and reduce transition to end-stage kidney disease. For suitable patients, kidney transplantation represents the most sustainable long-term treatment option, improving quality of life while reducing the ongoing treatment burden associated with dialysis. At Diaverum, strengthening access to transplantation has been a longstanding priority within our approach to responsible renal care.
Kidney health is also shaped by social context. Income stability, employment and transport access significantly influence dialysis adherence and outcomes. Missed treatments are associated with increased hospitalisation and mortality. In Diaverum Saudi Arabia, a Community Empowerment Partnership addresses these determinants through employment pathways, vocational training, financial assistance and transport support. As a result of the Partnership’s initial launch, 50 patients gained employment, while over 660 participated in vocational and skills training, and were connected to recruiters. 140 received transport support, enabling more than 43,000 treatment journeys.
These initiatives protect continuity of care. Social stability strengthens clinical outcomes.
Renal care in a fragile world
CKD affects an estimated 850 million people worldwide, and demand for renal replacement therapy will continue to grow. Environmental pressures will intensify. Social inequities will persist.
For adequate dialysis delivery, we must ensure that the enabling systems - environmental, digital and social - are resilient, responsible and equitable.
For a single dialysis session to take place, a complex web of systems must align, precisely and repeatedly. On this World Kidney Day, our responsibility extends beyond the treatment we provide. It is to strengthen that alignment, so that renal care remains secure in an increasingly fragile world.
Dr Carlos Lucas
Vice President Medical
