Finding the sweet spot in green nephrology: the intersection of environmental sustainability and excellence in patient care.

Sustainability in kidney care is often perceived as requiring trade-offs in clinical quality, yet green nephrology can strengthen clinical excellence by identifying "sweet spots" where improved outcomes and reduced environmental impact align. Organized along the chronic kidney disease (CKD) trajectory, this review highlights opportunities for responsible practice at each stage. Dialysis, the most resource-intensive component of kidney care, finds a sweet spot in reducing redundancy, personalizing treatment, optimizing vascular access, and empowering patients. Approaches such as incremental dialysis, water-efficient systems, and well-planned vascular access improve both clinical and environmental performance. Upstream, CKD prevention remains the most powerful strategy for increasing survival and reducing human and planetary burden. The sweet spot on early diagnosis and optimized CKD care may be identified in shifting away from medication escalation toward lifestyle-focused interventions, deprescribing when appropriate, and reducing treatment burden. Research also plays a critical role, with substantial potential to reduce waste by minimizing redundancy, promoting data sharing, adopting efficient trial designs, and leveraging digital tools. Options that are resource sparing are however usually more time-consuming, thus highlighting the central role of the nephrologists in individualized kidney care. In essence, green nephrology is not "less" care; it is better care, sitting at the intersection where clinical excellence and environmental stewardship reinforce one another.