World Kidney Day 2026 carries a powerful and timely message: “Kidney Health for All: Caring for People, Protecting the Planet.” This theme compels us to recognise that kidney health is not determined solely by genetics, diabetes, or hypertension; it is increasingly shaped by our environment, climate, and working conditions. As a transplant surgeon who has witnessed the evolution of kidney care in Nepal, I believe this year’s theme speaks directly to our national reality.

The rising burden of kidney disease in Nepal

Chronic Kidney Disease (CKD) is steadily increasing in Nepal. While diabetes and hypertension remain leading causes, we are observing a concerning pattern among a different group—young and middle-aged migrant workers. Research conducted at Shahid Dharmabhakta National Transplant Centre (SDNTC), Nepal, has shown that nearly one-third of kidney failure patients are migrant workers. This is a significant and alarming proportion.

Most of these individuals have worked abroad in extremely hot climates. They are often employed as security guards, outdoor labourers, gardeners, seaside watchers, or construction workers. These occupations require prolonged exposure to high temperatures, often with inadequate hydration and limited access to medical care. Many work long shifts under direct sunlight, frequently ignoring early signs of dehydration and heat stress.

Among the 217 returnee migrants surveyed at SDNTC, 56 percent had returned from Gulf countries, with two-thirds working in temperatures above 40°C. Most respondents worked in temperatures of 41–50°C, with 1 in 5 working in conditions over 51°C. More than 3 in 4 worked for more than 10 hours daily. Alarmingly, 78 percent drank less than 2 litres of water daily. Among the respondents, 22 percent used painkillers like Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), with 23 percent reporting the use of three painkillers in a day. Long-term NSAID usage has been linked to hypertension, kidney difficulties, stomach troubles, and fluid retention.

Around one-third of the respondents skipped drinking water despite the urge to drink. Despite the urge to urinate, 40 percent sometimes skipped urination. Nearly all returnee migrant workers in this study belonged to the economically most productive age group of 20–49, with 42 percent aged 30–39 years, and 95 percent were male. Nearly half were diagnosed with end-stage kidney disease (ESKD) before returning home. Nearly 3 in 10 kidney transplant recipients at SDNTC had worked abroad.

Heat stress and kidney injury

Prolonged heat exposure leads to repeated dehydration. When the body becomes dehydrated, blood flow to the kidneys decreases, placing enormous strain on these vital organs. Recurrent episodes of heat stress can cause acute kidney injury, which, over time, may progress to chronic kidney disease. Globally, a form of kidney disease known as heat-stress nephropathy has been increasingly recogniszed among agricultural and manual labourers. The situation among Nepalese migrant workers reflects a similar pattern. Climate change is intensifying this risk. Rising global temperatures mean longer and hotter summers. Workers in Gulf countries and other hot regions face extreme environmental conditions. Upon returning home, many present with advanced kidney failure—often requiring lifelong dialysis or transplantation. This is not just a medical issue; it is a socio-economic and environmental crisis.

Environmental pollution and kidney health

Beyond heat exposure, environmental toxins also contribute to kidney damage. Air pollution, contaminated water sources, pesticides, and heavy metals can silently injure the kidneys over time. Nepal, like many developing countries, faces challenges in maintaining clean air and safe water systems. Protecting the environment is therefore an essential strategy in preventing kidney disease.

Ironically, while environmental damage contributes to kidney disease, kidney treatment itself has a significant environmental footprint. Dialysis is life-saving but resource-intensive. It requires large volumes of purified water, continuous electricity, plastic tubing, disposable medical supplies, and biomedical waste management.

As kidney services expand in Nepal, we must also consider sustainability. The theme of World Kidney Day 2026 urges us to develop eco-conscious healthcare systems that reduce waste and conserve resources while maintaining high standards of care. Innovation in water recycling for dialysis units, energy-efficient hospital systems, and responsible waste disposal are steps toward greener nephrology.

Transplantation: A life-changing and sustainable solution

Kidney transplantation remains the best treatment for end-stage renal disease. Compared to lifelong dialysis, a successful transplant improves quality of life, allows patients to return to productive work, and may reduce long-term resource consumption. Nepal has made historic progress in organ transplantation. What once required travel abroad is now available within our own country. However, many migrant workers return with advanced disease and limited financial resources, making early detection and prevention even more critical. Strengthening deceased donor programs, expanding screening services, and ensuring equitable access to care must remain national priorities.

Prevention: Our most powerful tool

If one-third of our kidney failure patients are migrant workers exposed to heat, then prevention must include education on adequate hydration, workplace policies ensuring rest and shade, regular health screening for migrant workers before departure and after return, international labour agreements promoting worker health protection, and early kidney function testing for high-risk individuals. Kidney health awareness must extend beyond hospitals—it must reach airports, recruitment agencies, labour ministries, and communities.

The kidneys and the planet share a silent but vital role—both filter, regulate, and sustain life. When the environment suffers, human health suffers. When healthcare ignores sustainability, we contribute to the very problem we seek to treat. This World Kidney Day, let us recognise that climate action is kidney protection, clean water is preventive medicine, safe working environments save kidneys, and sustainable healthcare safeguards the future.

A call to action

On World Kidney Day 2026, I urge the government authorities to integrate climate and occupational health into kidney disease prevention strategies; healthcare institutions to adopt environmentally sustainable practices; employers and labour agencies to prioritise worker hydration and heat protection; communities to promote early screening and organ donation; and individuals to protect both their kidneys and their environment. Kidney health for all is not achievable without environmental responsibility. The health of our migrant workers, our families, and future generations depends on it. Let us commit to caring for people—and protecting the planet—together.