Digital Transformation in Nephrology as a Strategy for Reducing theCarbon Footprint of Kidney Care: A Systems Engineering Perspective

Abstract

Healthcare and dialysis services have substantial environmental footprints because of repeated patient travel, intensive water and energy use, and high consumption of medical materials. This study examines how Information and Communication Technologies (ICT) can support lower-carbon kidney care through telemedicine, remote patient monitoring, interoperable electronic health records, artificial intelligence, connected devices, and digitally enabled home care. Evidence from structured literature reviews, an exploratory survey of healthcare professionals in Portugal and Spain, and an integrated systems engineering analysis was synthesized. The findings indicate that ICT contributes to sustainability mainly indirectly: digital tools improve information exchange and multidisciplinary coordination, enabling organizational integration, workflow redesign, more efficient resource use, decentralized care, and reduced patient mobility. Interoperability and organizational readiness emerged as critical implementation conditions. A Digital Carbon-Smart Nephrology Framework is proposed in which organizational integration mediates the pathway from ICT adoption to clinical, operational, and environmental outcomes. Digital transformation should therefore be treated as a socio-technical and organizational strategy, rather than as technology deployment alone, within future low-carbon nephrology policies.