Climate Change and Environmentally Sustainable Kidney Care in Canada: A Knowledge, Attitudes, and Practices Survey of Kidney Care Providers.

Background: Climate change impacts health and threatens the stability of care delivery systems, while healthcare is mobilizing to reduce its significant environmental impact. Objective: This study aimed to assess knowledge, attitudes, and practices (KAP) about climate change among Canadian kidney care providers. Design setting participants measurements and methods: An electronic KAP survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to kidney care providers across Canada, from March to April 2023. Results: A total of 516 people responded to the survey. Most respondents (79%) identified as women; 83% were aged 30 to 59 years. Nurses and nephrologists made up 44% and 23% of respondents, respectively. About half of the participants felt informed about climate change to an average degree. Most respondents (71%; 349/495 and 62%; 300/489) were either extremely or very concerned about climate change and waste generated in their kidney care program, respectively. The vast majority of respondents (89%; 441/495) reported taking steps to lower their personal carbon footprint. People who felt more informed about climate change presented higher degrees of concern. Similarly, both those who felt more informed and those who reported higher degrees of concern about climate change were more likely to take steps to reduce their carbon footprint. Over 80% of respondents (314/386) were at least moderately interested in learning sessions about environmentally sustainable initiatives in care. Limitations: This survey is at risk of social acceptability, representative, and subjective bias. Overrepresentation from Quebec and British Columbia, as well as the majority of respondents identifying as women and working in academic centers, may affect generalizability of the findings. Conclusions: Most kidney care providers who responded to this survey are informed and concerned about climate change, and their knowledge is directly associated with attitude and practices. This indicates that educational initiatives to increase awareness and knowledge on climate change will likely lead to practice changes.

Contexte: Les changements climatiques ont des répercussions sur la santé et menacent la stabilité des systèmes de distribution des soins médicaux, pendant que le système de santé se mobilise pour réduire son impact significatif sur l'environnement. Objectif: Cette étude visait à évaluer les connaissances, les comportements et les pratiques (CCP) en lien avec les changements climatiques chez les prestataires canadiens de soins rénaux. Conception cadre participants mesures et méthodologie: Un sondage électronique évaluant les CCP, créé par le comité Sustainable Nephrology Action Planning (SNAP) de la Société canadienne de néphrologie, a été distribué aux prestataires de soins rénaux de partout au Canada, de mars à avril 2023. Résultats: Un total de 516 personnes a répondu au sondage. La majorité des répondants (79 %) se sont identifiés comme femmes; 83 % étaient âgés entre 30 et 59 ans. Le personnel infirmier et les néphrologues représentaient respectivement 44 % et 23 % des personnes répondantes. Environ la moitié des participants se disaient moyennement informés sur les changements climatiques. La plupart des répondants se disaient extrêmement préoccupés (349/495; 71 %) ou très préoccupés (300/489; 62 %) par les changements climatiques et les déchets générés par leur programme de soins rénaux. La grande majorité des répondants (441/495; 89 %) déclaraient avoir pris des mesures pour réduire leur empreinte carbone personnelle. Les personnes qui se disaient mieux informées sur les changements climatiques présentaient des degrés plus élevés de préoccupation. Parallèlement, les personnes qui se disaient mieux informées et celles qui se déclaraient plus préoccupées par les changements climatiques étaient plus susceptibles de prendre des mesures pour réduire leur empreinte carbone. Plus de 80 % des répondants (314/386) étaient au moins modérément intéressés par des séances d'information sur les initiatives durables sur le plan environnemental dans le domaine des soins. Limites: Cette enquête présente un risque d'acceptabilité sociale et de biais représentatif et subjectif. La surreprésentation du Québec et de la Colombie-Britannique, ainsi que de la grande proportion de répondants s'identifiant comme femmes et travaillant dans des centers universitaires, peuvent affecter la généralisabilité des résultats. Conclusion: La plupart des prestataires de soins rénaux ayant répondu à cette enquête sont informés sur les changements climatiques et en sont préoccupés; et leurs connaissances sont directement liées à leurs comportements et à leurs pratiques. Ces constats suggèrent que les initiatives éducatives visant à accroître la sensibilisation et les connaissances sur les changements climatiques mèneront probablement à des changements dans les pratiques.

Redesigning Kidney Care for the Anthropocene: A New Framework for Planetary Health in Nephrology.

Climate change is one of the greatest threats to human health in the 21st century. The human health impacts of climate change contribute to approximately 1 in 4 deaths worldwide. Health care itself is responsible for approximately 5% of annual global greenhouse gas (GHG) emissions. Canada is a recent signatory of the 26th United Nations Climate Change Conference (COP26) health agreement that is committed to developing low carbon and climate resilient health systems. Kidney care services have a substantial environmental impact and there is opportunity for the kidney care community to climate align clinical care. We introduce a framework of redesigned kidney care and describe examples of low carbon kidney disease management strategies to expand our duty of care to the environment which completes the triple bottom line of optimal patient outcomes and cost effectiveness in the Anthropocene.

Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Home and In-Center Dialysis Guidance.

PURPOSE OF THE PROGRAM: This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team's safety. SOURCES OF INFORMATION: The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis. METHODS: The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines. KEY FINDINGS: We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas. LIMITATIONS: At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article's advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms' length peer-review processes. IMPLICATIONS: We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources.