Perspectives of People Receiving Dialysis About Climate Change and Environmentally Sustainable Kidney Care: A Knowledge, Attitudes and Practices Survey in Canada

Background: Knowledge, attitudes and practices (KAP) of kidney care providers regarding climate change, environmental impacts of kidney care and environmentally sustainable kidney care have been assessed in diverse regions worldwide, but little is known about the perspectives of people who receive dialysis therapies. We aimed to assess the KAP of people on dialysis about these subjects. Methods: An electronic KAP survey, based on a previous survey of Canadian kidney care providers, was administered to people receiving all available dialysis modalities in a single center in Canada, from December 2024 to May 2025. Results: A total of 69 people responded to the survey, of whom 67% identified as men, and 70% were undergoing in-center hemodialysis (ICHD), 14% home hemodialysis (HHD) and 16% peritoneal dialysis (PD). Most (87%) of the respondents felt informed about climate change to at least an average degree. Nearly half were either extremely or very concerned about climate change (44%) and the waste generated by dialysis treatments (43%), and the levels of concern differed across dialysis modalities. Overall, 51% of respondents never felt guilt or anxiety related to the carbon footprint of dialysis treatment. However, there were significant differences (χ 2 test; P < .001) in the occurrence of these feelings depending on the dialysis modality (more frequent in people receiving home modalities, and more in PD than HHD). Most respondents were either very (45%) or slightly (45%) interested in obtaining more information about the themes explored in the survey. Conclusions: This survey showed that most respondents receiving a dialysis therapy felt informed and at least moderately concerned about climate change. Higher levels of concern about climate change and the amount of waste generated by dialysis treatment, as well as more frequent occurrence of guilt/anxiety about the carbon footprint of dialysis were observed in people on home therapies (PD and HHD) compared with ICHD.