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The seventy-eighth World Health Assembly\u2019s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, \u201cKidney Health for All: Caring for People, Protecting the Planet\u201d, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if quality of life may be worsened by dialysis initiation. 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