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Salvatore Viscomi MD, CEO and cofounder of Carna Health, is an entrepreneur with a passion for digital health.
Climate change isn’t just altering weather patterns; it’s reshaping disease. Among its most dangerous consequences is the impact on people suffering from chronic kidney disease (CKD). The combination of rising temperatures, more frequent heat waves and severe weather events, including flooding and power outages, creates a growing emergency for kidney health and its supporting systems.
For individuals living with CKD or end-stage renal disease (ESRD), extreme heat can worsen symptoms and increase the risk of hospitalization. According to the American Kidney Fund, research has linked heat-related illness with acute kidney injury (AKI), and patients with impaired kidney function are especially vulnerable to dehydration and heat stress. The climate-driven breakdown of infrastructure through flooding and energy loss creates delays in life-saving dialysis treatments, which exposes patients to severe medical complications.
The intersection of climate change with chronic disease and healthcare infrastructure creates a critical and underreported public health emergency. Here’s how heat stress, treatment ecology and systemic inequities are converging—and what steps we can take to respond with urgency and intention.
Heat Stress Is Accelerating Kidney Decline
While heat-related illness is often framed around dehydration and heat stroke, for individuals with CKD, high temperatures can quickly become far more dangerous. Heat stress doesn’t just complicate daily management—it can accelerate kidney decline. In warmer climates, CKD patients have been shown to lose kidney function more rapidly than those in temperate regions. This is more than a physiological vulnerability; it’s a climate-driven crisis unfolding simultaneously with rising temperatures.
CKD patients face challenges in preserving their fluid and electrolyte equilibrium. The attempt to cool down during thermal stress makes it harder for these individuals to adapt, thus increasing their risk of AKI, hospitalization and end-stage disease progression. The duration and frequency of heat waves continue to increase while their intensity becomes stronger, which transforms these events from seasonal occurrences into regular high-risk situations for vulnerable populations. Those who lack dependable cooling systems, transportation services and proper medical care face the highest risk.
Acceleration Of CKD Among Laborers
Beyond those with pre-existing kidney conditions, a troubling new pattern is emerging: Otherwise healthy, young laborers in hot regions are developing CKD at alarming rates. This phenomenon is often referred to as CKDu. Repeated exposure to extreme heat—combined with strenuous physical exertion, inadequate hydration amd exposure to environmental toxins—creates a perfect storm that ultimately damages kidney function.
What’s particularly alarming is that these rapidly progressive kidney injuries often go unnoticed until advanced stages, making early detection and prevention a critical public health priority. Addressing this emerging epidemic requires not only improved workplace protections and hydration strategies but also a broader recognition of climate change as a fundamental driver of health inequities.
Dialysis: Lifesaving, But Costly To The Planet
The progression of CKD to end-stage kidney disease forces patients to turn to life-sustaining treatments such as dialysis. While dialysis can be lifesaving, it also carries a significant environmental footprint that demands urgent attention. The water consumption for a single hemodialysis session reaches between 300 to 500 liters and the purification process discards half of this amount. The energy requirements for dialysis sessions match those of a typical household’s daily power consumption because each treatment needs 7 to 12 kWh. The dialysis process produces 8 kilograms of medical waste during each session, which includes mostly plastic materials that cannot be recycled.
Globally, millions depend on dialysis. In the UK alone, approximately 70,000 people receive kidney replacement therapy, with nearly half undergoing dialysis and around 55% living with functioning kidney transplants. In countries such as the U.S., Europe, Canada and Japan—where reliance on dialysis is particularly high—the cumulative environmental impact is significant, contributing substantially to healthcare’s carbon footprint.
The dialysis sector needs to adopt sustainability innovations together with systemic changes to achieve alignment between patient care and planetary health targets.
Toward Climate-Smart Kidney Care
There is no single solution to the complex challenges climate change poses to kidney health, but an integrated, multi-faceted approach offers hope for stabilizing outcomes—for both patients and the planet. The first step to protect kidney health requires early diagnosis followed by timely medical intervention. Serial monitoring may detect early acute kidney injury during warmer seasons in high-risk workers so interventions can be recommended. The combination of adaptive clinical guidance with AI-driven systems that monitor hydration and metabolic stress levels enables healthcare providers to detect damage before it becomes irreversible.
The protection of outdoor workers through occupational measures needs to become an immediate priority. The implementation of scheduled rest breaks and access to shade and adequate hydration has demonstrated promising results, which decrease heat-related kidney injuries among outdoor workers. The implementation of these preventative measures on a global scale would protect populations who face the highest risk from heat stress.
On the treatment side, moving dialysis toward more sustainable, “green nephrology” models is essential. This involves recycling wastewater, transitioning dialysis units to renewable energy sources, adopting recyclable consumables and exploring emerging technologies such as sorbent-based home dialysis devices that dramatically cut water usage. These innovations not only reduce dialysis’s ecological footprint but also align patient care with broader environmental sustainability goals.
Finally, addressing infrastructure and equity is paramount. The most disadvantaged communities experience the worst heat impacts because they lack access to cooling facilities, shaded outdoor areas and well-insulated homes. The implementation of heat-resilient infrastructure represents both a vital public health measure and a social equity requirement to protect vulnerable populations from climate change’s transformative impact on disease patterns.
A Turning Point For Kidney Care And Climate Action
The global prevalence of chronic kidney disease exceeds 850 million people worldwide, while standing at a critical intersection between climate change and health equity. The growing heat stress threats and climate-related treatment complications require immediate innovation together with systemic transformation.
The time has come to enhance kidney care through a complete restructuring that unites sustainability with equity and resilience throughout all treatment and prevention practices. Our actions today will safeguard at-risk communities while establishing a healthcare system that can endure future environmental conditions.
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