Green CKD care: 10 tips to make nephrology outpatient clinics more environmentally sustainable.

Green nephrology has often focussed on dialysis, with its intensive use of water and energy. In comparison, non-dialysis outpatient care of chronic kidney disease (CKD) has received less attention. This is surprising, given how much time most of us spend in outpatient clinics. For most of us, this is where we not only see the majority of our patients but also have regular encounters with their relatives and loved ones. Non-dialysis outpatient clinics are therefore an important opportunity to start a dialogue on green nephrology with our patients and with the general public. It is also where we can act as role models for the next generation of nephrologists and where it is easier to talk about green nephrology than in a busy inpatient setting or ward environment. Excellent and modern CKD care is in itself highly effective in reducing the environmental footprint of nephrology, where it delays progression, facilitates early and pre-emptive transplantation and avoids dialysis. CKD medication also has an environmental footprint, which can be addressed through medication reviews and fixed combinations. Innovative provision of care, e.g. through video consultations, needs to consider how patients will access medication in this scenario. Recycling and avoiding waste are also very important, although in practice they face many challenges. Reducing paper use is another option to improve sustainability, but transition to paper-free outpatient care takes time and effort. Simple steps can be taken to reduce paper use where clinic letters are still paper based. Video consultations are increasingly used where safe and appropriate and reduce the environmental footprint of care. Artificial intelligence will, in the near future, help us to triage new and existing patients and prioritize scarce resources and face-to-face care on those at highest risk. Outpatient clinics, although busy, offer an opportunity to interact with colleagues, patients and relatives to educate about green nephrology.