Knowledge and practices on sustainability in nephrology in Brazil

ABSTRACT Introduction: Climate change has a bidirectional relationship with kidney diseases: environmental stressors may increase the incidence and progression of renal conditions, while dialysis therapy is among the treatment modalities with the highest environmental impact in healthcare. Despite the growing international debate on sustainable nephrology, this topic remains underexplored in the Brazilian context. Objective: To investigate the level of knowledge, perceptions, and practices related to environmental sustainability among nephrology professionals in Brazil and to identify barriers to the adoption of sustainable strategies in dialysis services. Methods: This cross-sectional study was conducted using an online questionnaire targeting nephrology professionals. The instrument assessed knowledge regarding climate change and kidney health, sustainability practices implemented in dialysis services, and institutional barriers to their adoption. Results: A total of 180 responses from professionals across 20 Brazilian states and the Federal District were analyzed, with a predominance of nephrologists and nurses. Most participants recognized the impact of climate change on kidney health; however, limited knowledge was observed regarding public policies and structured sustainability strategies. The most frequently reported practices involved waste management, whereas initiatives such as water reuse, renewable energy sources, and sustainable transportation strategies were less prevalent. The main barriers identified included financial constraints, lack of institutional incentives, and absence of strategic planning. Conclusion: These findings highlight gaps between perceptions, knowledge, and the implementation of sustainable practices in Brazilian nephrology, reinforcing the need for policies, professional training, and institutional strategies to promote environmentally sustainable kidney care.