{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:18:13Z","timestamp":1787937493071,"version":"build-2784847793"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Climate change poses an increasing threat to global health, demanding urgent action from healthcare systems. Nephrology contributes substantially to healthcare-related environmental impact and must adopt sustainable practices. Peritoneal dialysis (PD) patients are key stakeholders in these efforts, yet their perspectives remain underexplored. This study assessed PD patients\u2019 practices and attitudes regarding recycling, transport logistics, and digital healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An observational study was conducted in two centers\u00a0using a 17-item questionnaire developed through literature review and expert input. The survey addressed recycling behaviors, delivery logistics, and use of telemedicine. Associations between patient characteristics and sustainability-related behaviors were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety PD patients were included (mean age 54.4 \u00b1 14.3 years; 64.4% male). Most patients (84.4%) reported recycling at least one PD-related material, mainly paper (83.3%) and plastic packaging (66.7%). PD solution and drainage bags were recycled in 21.3% of the cases, despite their classification as hospital waste. Recycling habits were not associated with age, residence, or PD modality (P &amp;gt; .05). Most patients received monthly deliveries (85.6%) and were satisfied with delivery frequency (88.9%), while alternative delivery options were largely rejected. Telemedicine was approached cautiously, with 84.4% preferring in-person visits; however, most patients accepted digital information, particularly younger individuals (P = .005; P = .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PD patients demonstrate high engagement in recycling, mainly reflecting pre-existing household recycling habits. Transport-related sustainability challenges require system-level solutions, beyond approaches that focus solely on patient mobility. Despite preferring face-to-face care, patients show openness to digital tools, underscoring the importance of incorporating patient perspectives into greener nephrology practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag073","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:47:51Z","timestamp":1773330471000},"page":"1005-1011","source":"Crossref","is-referenced-by-count":1,"title":["A sustainable future for peritoneal dialysis: a patient survey on green nephrology"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6508-2161","authenticated-orcid":false,"given":"Filipa","family":"Trigo","sequence":"first","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade do M\u00e9dio Tejo , Avenida Xanana Gusm\u00e3o, Torres Novas 2350-399 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Bessa","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio , Largo do Professor Abel Salazar, Porto 4050-366 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Tavares","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio , Largo do Professor Abel Salazar, Porto 4050-366 ,","place":["Portugal"]},{"name":"UMIB \u2013 Unit for Multidisciplinary Research in Biomedicine , Rua Jorge de Viterbo Ferreira, 228, Porto 4050-313 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Alves","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade do M\u00e9dio Tejo , Avenida Xanana Gusm\u00e3o, Torres Novas 2350-399 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jo\u00e3o","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio , Largo do Professor Abel Salazar, Porto 4050-366 ,","place":["Portugal"]},{"name":"UMIB \u2013 Unit for Multidisciplinary Research in Biomedicine , Rua Jorge de Viterbo Ferreira, 228, Porto 4050-313 ,","place":["Portugal"]},{"name":"ITR \u2013 Laboratory for Integrative and Translational Research in Population Health , Rua das Taipas 135, Porto 4050-600 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hern\u00e2ni","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade do M\u00e9dio Tejo , Avenida Xanana Gusm\u00e3o, Torres Novas 2350-399 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Santos","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade do M\u00e9dio Tejo , Avenida Xanana Gusm\u00e3o, Torres Novas 2350-399 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anabela","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Nephrology Department, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio , Largo do Professor Abel Salazar, Porto 4050-366 ,","place":["Portugal"]},{"name":"UMIB \u2013 Unit for Multidisciplinary Research in Biomedicine , Rua Jorge de Viterbo Ferreira, 228, Porto 4050-313 ,","place":["Portugal"]},{"name":"ITR \u2013 Laboratory for Integrative and Translational Research in Population Health , Rua das Taipas 135, Porto 4050-600 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"2026082812313865500_aajag073-B1","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1016\/S0140-6736(15)60854-6","article-title":"Health and climate change: policy responses to protect public health","volume":"386","author":"Watts","year":"2015","journal-title":"Lancet"},{"key":"2026082812313865500_aajag073-B2","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(09)60935-1","article-title":"Managing the health effects of climate change. Lancet and University College London Institute for Global Health Commission","volume":"373","author":"Costello","year":"2009","journal-title":"Lancet"},{"key":"2026082812313865500_aajag073-B3"},{"key":"2026082812313865500_aajag073-B4","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1016\/S0140-6736(24)01822-1","article-title":"The 2024 report of the lancet countdown on health and climate change: facing record-breaking threats from delayed action","volume":"404","author":"Romanello","year":"2024","journal-title":"Lancet"},{"key":"2026082812313865500_aajag073-B5","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1016\/j.kint.2017.03.047","article-title":"Climate change and kidney disease\u2014threats and opportunities","volume":"92","author":"Barraclough","year":"2017","journal-title":"Kidney Int."},{"key":"2026082812313865500_aajag073-B6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/ndt\/gfab258","article-title":"Climate change and nephrology","volume":"38","author":"Sasai","year":"2023","journal-title":"Nephrol Dial Transplant"},{"key":"2026082812313865500_aajag073-B7","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1053\/j.ajkd.2022.11.002","article-title":"Climate change, heat-related acute kidney disease, and the need for action","volume":"81","author":"Gallagher","year":"2023","journal-title":"Am J Kidney Dis."},{"key":"2026082812313865500_aajag073-B8","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000500344","article-title":"Climate change and the kidney","volume":"74","author":"Johnson","year":"2019","journal-title":"Ann Nutr Metab."},{"key":"2026082812313865500_aajag073-B9","author":"New Global Initiative on Environmentally Sustainable Kidney Care"},{"key":"2026082812313865500_aajag073-B10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.kint.2022.12.015","article-title":"Our shared responsibility: the urgent necessity of global environmentally sustainable kidney care","volume":"104","author":"Stigant","year":"2023  1","journal-title":"Kidney Int"},{"key":"2026082812313865500_aajag073-B11","doi-asserted-by":"publisher","first-page":"6","DOI":"10.32932\/pjnh.2021.04.110","article-title":"Portuguese nephrology: we can be greener","volume":"35","author":"Francisco","year":"2021","journal-title":"Port J Nephrol Hypert [Internet]"},{"key":"2026082812313865500_aajag073-B12","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1038\/s41581-019-0245-1","article-title":"Green nephrology","volume":"16","author":"Barraclough","year":"2020","journal-title":"Nat Rev Nephrol"},{"key":"2026082812313865500_aajag073-B13","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1007\/s40620-020-00734-z","article-title":"Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology","volume":"33","author":"Piccoli","year":"2020  1","journal-title":"J Nephrol"},{"key":"2026082812313865500_aajag073-B14","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1111\/hdi.12063","article-title":"It is time for \u201cgreen dialysis\u201d","volume":"17","author":"Agar","year":"2013","journal-title":"Hemodial Int."},{"key":"2026082812313865500_aajag073-B15","doi-asserted-by":"publisher","first-page":"454","DOI":"10.3390\/kidneydial2030041","article-title":"Green nephrology","volume":"2","author":"Vanholder","year":"2022","journal-title":"Kidney Dial."},{"key":"2026082812313865500_aajag073-B16","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1093\/ndt\/gfae159","article-title":"Haemodialysis versus peritoneal dialysis in children: an eco-audit","volume":"39","author":"Makhloufi","year":"2024  30","journal-title":"Nephrol Dial Transplant"},{"key":"2026082812313865500_aajag073-B17","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1053\/j.ajkd.2025.04.019","article-title":"Carbon emissions from different dialysis modalities: a life cycle assessment","volume":"86","author":"Barraclough","year":"2025","journal-title":"Am J Kidney Dis."},{"key":"2026082812313865500_aajag073-B18","doi-asserted-by":"publisher","first-page":"20543581241308642","DOI":"10.1177\/20543581241308642","article-title":"Environmental sustainability is needed in kidney care: patient, donor, and provider perspectives","volume":"12","author":"Verdin","year":"2025","journal-title":"Can J Kidney Health Dis"},{"key":"2026082812313865500_aajag073-B19","doi-asserted-by":"publisher","first-page":"sfaf276","DOI":"10.1093\/ckj\/sfaf276","article-title":"Green teams drive sustainability: a European rare kidney disease reference network survey on dialysis environmental practices","volume":"18","author":"de Simone","year":"2025","journal-title":"Clin Kidney J."},{"key":"2026082812313865500_aajag073-B20","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.1016\/j.ekir.2024.03.008","article-title":"Combining patient care and environmental protection: a pilot program recycling polyvinyl chloride from automated peritoneal dialysis waste","volume":"9","author":"Berman-Parks","year":"2024  1","journal-title":"Kidney Int Rep"},{"key":"2026082812313865500_aajag073-B21","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1159\/000530439","article-title":"Green dialysis: let us talk about dialysis fluid","volume":"48","author":"Zawierucha","year":"2023","journal-title":"Kidney Blood Press Res."},{"key":"2026082812313865500_aajag073-B22","doi-asserted-by":"publisher","first-page":"sfae144","DOI":"10.1093\/ckj\/sfae144","article-title":"Ten tips from the Swiss working group on sustainable nephrology on how to go green in your dialysis unit","volume":"17","author":"Pruijm","year":"2024","journal-title":"Clin Kidney J."},{"key":"2026082812313865500_aajag073-B23","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1093\/ndt\/gfaf027","article-title":"Nephrology meets AI\u2014environmental perspective","volume":"40","author":"Laranjinha","year":"2025  19","journal-title":"Nephrol Dial Transplant"},{"key":"2026082812313865500_aajag073-B24","author":"Wheeler"},{"key":"2026082812313865500_aajag073-B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ckj\/sfae267","article-title":"Telemedicine in nephrology: future perspective and solutions","volume":"17","author":"Sugawara","year":"2024","journal-title":"Clin Kidney J."},{"key":"2026082812313865500_aajag073-B26","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1053\/j.ajkd.2020.09.005","article-title":"Telehealth for home dialysis in COVID-19 and beyond: a perspective from the American Society of Nephrology COVID-19 home dialysis subcommittee","volume":"77","author":"Lew","year":"2021  1","journal-title":"Am J Kidney Dis."},{"key":"2026082812313865500_aajag073-B27","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.ekir.2023.10.034","article-title":"Impact of remote monitoring on standardized outcomes in nephrology-peritoneal dialysis","volume":"9","author":"Centellas-P\u00e9rez","year":"2024  1","journal-title":"Kidney Int Rep"},{"key":"2026082812313865500_aajag073-B28","author":"Galv\u00e3o"}],"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/5\/1005\/68627517\/aajag073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/article-pdf\/39\/5\/1005\/68627517\/aajag073.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:31:43Z","timestamp":1787934703000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/article\/39\/5\/1005\/8718965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8,28]]},"published-print":{"date-parts":[[2026,8,28]]}},"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag073","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6]]}}}