Recommendations of the Brazilian Society of Nephrology for sustainable nephrology in Brazil.

Climate change has increased the vulnerability of patients with non-dialysis chronic kidney disease (CKD) and those receiving kidney replacement therapy (KRT), who depend on healthcare systems that are highly sensitive to disruptions in electricity, potable water supply, and logistics. At the same time, KRT services are among those with the greatest environmental impact within the healthcare sector, characterized by high water and energy consumption and substantial generation of solid waste. In this context, the incorporation of sustainable practices has become an ethical, clinical, and strategic imperative. In 2023, the Brazilian Society of Nephrology (SBN) established the Committee on Sustainable Nephrology with the objective of developing national guidelines to reduce the environmental impact of kidney care services. After two years of work, the Committee developed ten recommendations structured across key domains, including education, environ-mental indicator monitoring, waste management, efficient use of resources, climate contingency planning, promotion of prevention and kidney transplantation, technological innovation, and sustainability certifications. These recommendations were discussed and approved at the 2nd Convention of the SBN Board of Directors and its Regional Chapters, achieving a 98.5% level of agreement. This document presents the consolidated recommendations, with the aim of supporting the implemen-tation of sustainable practices in kidney care services across the country and pro-moting an environmentally responsible, efficient nephrology practice aligned with the emerging challenges posed by climate change.