Green dialysis: Aligning Renal care with Oman Vision 2040, global climate health goals – Toward a sustainable future for nephrology

THE ENVIRONMENTAL AND CLIMATE IMPERATIVE

Hemodialysis remains one of the most resource-intensive medical interventions. According to reviews under the “Green Dialysis” framework, key challenges include excessive water and energy use and the generation of non-recyclable waste.^[2,3] Estimates indicate that up to 60% of treated dialysiswater may be discarded as waste through reverse osmosis (RO) reject.^[2] The ecological footprint of renal care extends beyond water consumption: Energy requirements for water-treatment systems, dialysis machines, facility utilities, and waste disposal contribute significantly to greenhousegas emissions and environmental degradation.^[3,4]

As the planet warms and climate variability increases, natural resources grow more constrained. Healthcare systems – including renal care – cannot remain neutral: We must act to reduce our ecological footprint.

GLOBAL AND NATIONAL ALIGNMENT

Internationally, global health and environmental agendas increasingly emphasize sustainable and climate-resilient health systems. The nexus between ecological sustainability and human health is now a central concern for international bodies, including those advocating for reducing the carbon, water, and waste footprints of medical services. Nationally, Oman Vision 2040 provides a roadmap for sustainable development, resource efficiency, environmental protection, and social welfare. By embedding sustainability into healthcare infrastructure – including dialysis services – Oman can honor both its health and environmental commitments.

THE SUR HOSPITAL DIALYSIS UNIT: BLUEPRINT FOR GREEN DIALYSIS

The planned Sur Hospital unit – 56 dialysis stations over two floors, with an initial operational phase of 20 beds – offers a “blank canvas” to build a dialysis center grounded in sustainability. According to Zayan et al., the unit design envisages the integration of efficient water systems, energy-conscious utilities, and waste-management strategies.^[1] Key design and operational strategies proposed include:

• Waterefficient and circularwater management: Use of high-efficiency waterpurification systems; optimization of dialysate flow; and reuse of ROreject water for non-medical purposes (e.g., cleaning and landscaping) to reduce freshwater demand and wastage

• Clean energy and energy efficiency: Integration of renewable energy (e.g., solar power) to supply dialysis machines, water treatment pumps, HVAC (heating, ventilation, and air conditioning system), and lighting – reducing reliance on fossil-fuel electricity and lowering carbon emissions

• Waste minimization and sustainable consumables: Transition from single-use plastic acid/dialysate concentrate containers to a central-concentrate delivery system with reusable containers, minimizing plastic consumption, strict waste segregation, and safe disposal – collectively reducing environmental burden and pollution^[4-6]

• Resource-conscious dialysis protocols: Adapting dialysis prescriptions – session duration, frequency, and dialysate flow rate – to patient-specific needs and resource availability. For instance, reducing dialysate flow (while maintaining dialysis adequacy) has been shown to mitigate water use effectively^[6]

• Monitoring, evaluation, and transparency: Implementing metrics – water used per session, energy consumed, waste generated per session – and publicly reporting data to support continuous improvement and accountability. Recent “green nephrology” initiatives have demonstrated that combined interventions (waste reduction, energy efficiency, centralized concentrate delivery, and optimized dialysis protocols) can yield substantial reductions in carbon footprint and operational costs over time.^[7]

If implemented faithfully, Sur Hospital’s dialysis unit could demonstrate that “green nephrology” is not only aspirational but also pragmatically achievable – even at scale.

WHY THIS MATTERS — FOR PATIENTS, COMMUNITY, AND PLANET

• Conserving vital resources: In a water-scarce environment like Oman’s, reducing per-session water usage and reusing water helps safeguard freshwater reserves for broader community and environmental needs

• Lowering greenhousegas emissions: By leveraging renewable energy sources and optimizing energy consumption, the dialysis unit can contribute to global efforts to mitigate climate change, consistent with international climate-health objectives

• Sustainable expansion of renal care: As demand for dialysis grows, sustainable design prevents runaway growth in water, energy use, and waste – ensuring that increased access does not come at the planet’s expense

• Setting a replicable model: A green dialysis unit in Oman could serve as a model for other Gulf and regional healthcare systems, showing that sustainability and high-quality clinical care can coexist

• Healthenvironment co-benefits: Reduced emissions, minimized waste, and water conservation – all contribute to improved environmental health, community well-being, and intergenerational equity.

A CALL TO ACTION

As UnderSecretary for Health Planning and Regulation, I call on policymakers, hospital leaders, clinicians, funders, regulators, and international partners to support and adopt sustainable practices. Let the Sur Hospital dialysis unit be not only a facility for patient care but also a demonstration that we can treat disease while protecting the planet.

The planet is warming. The window to act is closing. By embracing green dialysis now, we contribute to a global movement – led by organizations such as the World Health Organization, the United Nations, and national governments – to reduce emissions, conserve resources, protect human and ecological health, and leave a sustainable legacy for future generations.