A sustainable future for peritoneal dialysis: a patient survey on green nephrology

INTRODUCTION: 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' practices and attitudes regarding recycling, transport logistics, and digital healthcare. METHODS: An observational study was conducted in two centers using 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. RESULTS: Ninety PD patients were included (mean age 54.4 ± 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 > .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). CONCLUSION: 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.