{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:56:51Z","timestamp":1787237811473,"version":"build-2736575974"},"reference-count":59,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dialysis is a life\u2010sustaining therapy for patients with end\u2010stage renal disease, yet it is among the most resource\u2010intensive treatments in modern healthcare. Hemodialysis requires large volumes of treated water, substantial energy input, and extensive single\u2010use consumables, resulting in significant greenhouse gas emissions and clinical waste when scaled to millions of treatments performed annually. Climate change further threatens kidney health through heat stress, dehydration, and climate\u2010related disruptions, creating a bidirectional relationship in which kidney care both contributes to and is adversely affected by environmental degradation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This white paper synthesizes current evidence surrounding environmentally sustainable dialysis practices, collectively termed \u201cgreen dialysis,\u201d reviewing technical and system\u2010level interventions across water stewardship, energy management, waste reduction, and clinical practice innovation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Green dialysis strategies, including dialysate flow optimization, improved reverse\u2010osmosis efficiency and water reuse, energy\u2010efficient infrastructure, renewable energy integration, waste segregation, central concentrate delivery systems, and incremental dialysis, have been shown to reduce water consumption, energy use, waste generation, and operational costs while maintaining dialysis adequacy and clinical outcomes. Adoption remains uneven due to operational complexity, regulatory gaps, and financial constraints, particularly in low\u2010 and middle\u2010income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Context\u2010sensitive implementation, staff education, standardized monitoring, and transparent reporting are essential for overcoming these barriers. Broader integration of sustainability into routine dialysis care represents a critical opportunity to reduce the environmental footprint of kidney replacement therapy without compromising patient safety or treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sdi.70028","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T02:34:33Z","timestamp":1776220473000},"page":"76-87","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Green Dialysis: A Framework for Environmentally Sustainable Renal Replacement Therapy"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8488-0691","authenticated-orcid":false,"given":"Pranav","family":"Sivaram","sequence":"first","affiliation":[{"name":"College of Medicine Northeast Ohio Medical University  Rootstown Ohio 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