Climate change is pushing up rates of kidney disease and urological cancers

Rising temperatures, pollution, and extreme weather are fueling kidney disease and urological cancers—while carbon-heavy medical treatments add to the problem. How can we make healthcare more sustainable?

Review: Urology on a changing planet: links between climate change and urological disease. Image Credit: crystal light / Shutterstock

In a recent review published in the journal Nature Reviews Urology, researchers explore the impacts of anthropogenic climatic change on urological diseases and the carbon footprint of urological treatment on the environment.

The review aims to educate and inform clinicians, policymakers, and especially patients about the direct, indirect, and systemic pathways through which climate change contributes to urological health risks, including both malignant and benign conditions. It also examines how healthcare disruptions caused by climate-driven natural disasters and carbon-intensive medical procedures exacerbate these challenges.

The review explores the delicate balance between planetary health, climate change, and varied forms of urological diseases while suggesting potential research and policy priorities to lessen patient burden today and in years to come.

Background

The impacts of anthropogenic climate change on human health, while difficult to emphatically measure, cannot be overstated. The United Nations (UN) and the World Health Organization (WHO) both emphasize that anthropogenic-driven climate change is one of the most severe threats to human health and well-being.

Unfortunately, despite several epidemiological studies establishing the impacts of climate change on clinical outcomes, clinicians and especially patients remain unaware of the implications of these processes. Furthermore, climate-associated natural disasters (e.g., floods and droughts) can disrupt healthcare systems, exacerbating the threat to patients in need of urgent or routine care.

Urologic diseases, conditions that affect the urinary tract, kidneys, and reproductive organs, are especially susceptible to climate change influences. These diseases include cancers (e.g., prostate cancer) with established indirect risk associations with climate change and benign conditions such as kidney stones, infections, and fertility problems—many of which are linked to rising global temperatures, pollution, and altered pathogen distribution.

The review introduces a three-tiered framework to explain these climate-urology links:

1. First-order effects: Direct effects such as heat-induced dehydration, increasing the risk of kidney stones and renal disease.
2. Second-order effects: Climate-driven exposure to pollutants, air contamination, and carcinogenic drinking water.
3. Third-order effects: Disruptions in healthcare access due to climate disasters, infrastructure damage, and medical supply shortages.

"The links between climate change and cancer pathogenesis are largely through indirect effects on other more proximate risk factors, such as flooding causing inundation of flood plains and drinking water with carcinogenic chemicals from industrial sites, and interruptions in cancer care delivery."

About the Review

The present review addresses potential knowledge gaps among policymakers, clinicians, and patients by using planetary health concepts to elucidate pathways linking anthropogenic activities to climate change and, in turn, adverse urological outcomes. It subsequently explores epidemiological research on climate change-linked urological diseases, both malignant (cancers) and benign.

The review further highlights climate change's impacts on healthcare delivery and unravels the feedback loop between resource-intensive urological interventions (such as robotic surgery, dialysis, and high-frequency imaging) and climate change acceleration. It estimates that the U.S. healthcare system alone contributes 533 million tonnes of CO₂ annually, with urology being a major contributor due to frequent surgical procedures and high-tech interventions.

Finally, it suggests research-backed policy interventions to address current and future challenges in sustainable urological healthcare, thereby lessening the burden on patients, healthcare systems, and our home planet.

Short-Term Economic Benefit, but at What Cost?

Technological advancements and industrial development following the Industrial Revolution (18th century) have had unprecedented benefits to the human economy at severe costs to the global environment. In the 20th century alone, 30% of biodiversity and 80% of tropical forests were lost, accompanied by a 25% increase in atmospheric carbon dioxide and a threefold increase in methane.

Even without accounting for anthropogenic pollutants, these changes have radically altered global climatic cycles, resulting in globally escalating temperatures and altered rainfall patterns. These changes have led to increased exposure to carcinogens, such as airborne particulate matter and industrial runoff, both of which have been identified as key drivers of urological cancers.

Climate and Urological Disease

Climate change-driven urological diseases include both malignant cancers (e.g., prostate, kidney, and bladder) and benign conditions (e.g., kidney disease, urolithiasis, pathogenic infections, and fertility issues).

Modifiable environmental exposures, notably air pollution, contaminated drinking water (e.g., arsenic contamination), and wildfires have been extensively researched and have been linked to bladder and kidney cancers. According to the International Agency for Research on Cancer (IARC), arsenic in drinking water is classified as a carcinogen, significantly increasing the risk of bladder and kidney cancers.

Prostate cancer risk, while more indirect, is influenced by exposure to nitrogen dioxide (NO₂) and fine particulate matter (PM₂.₅), both of which are exacerbated by industrial emissions and wildfires.

Benign urological conditions have surged, primarily driven by poor diet and health behavior choices, increased chemical pesticide exposure, rising temperatures, and pathogen range expansions. For instance, extreme heat events have been linked to higher rates of kidney disease and urinary tract infections, with studies showing a 13% increased incidence of chronic kidney disease (CKD) per 10 µg/m³ increase in fine particulate air pollution.

Dehydration is increasingly concerning, coinciding with the warming of the Earth's atmosphere caused by climate change (greenhouse effect). One study projected that by 2089, climate-induced kidney stone presentations in the U.S. would increase by up to 3.9% under high-emission scenarios, resulting in an estimated excess cost of $99 million.

Climate and Healthcare

Climate change has resulted in substantial increases in natural disasters (e.g., hurricanes, earthquakes, landslides), all of which cripple healthcare services, leaving patients stranded. In some cases, lack of access to healthcare facilities can be potentially life-threatening.

Research on climate-driven disruptions in oncology care shows that hurricanes and other extreme events result in delayed cancer treatments, medication shortages, and increased mortality.

"A relatively large volume of research has demonstrated increased cardiovascular morbidity and mortality after hurricanes. Patients with cancer are a similar population at high risk. The care of patients with cancer requires frequent contact with the health system and is fairly resource-intensive."

Urological healthcare, in turn, places immense strain on the environment. Transport to specialized urological facilities results in substantial vehicle emissions, exacerbated by the high-tech and frequent surgical procedures needed to treat chronic urological conditions. The review suggests that policymakers should prioritize telemedicine, reduce unnecessary testing, and implement eco-friendly surgical innovations to minimize urology's carbon footprint.

Next Steps and Conclusions

A growing body of epidemiology research explores the differential risks of climate change on urological health. Clinicians and patients can use this data to make informed health decisions, including reducing red meat intake (linked to kidney cancer risk), increasing plant-based nutrition, and opting for active commuting to clinics where possible.

Policymakers can use this research to implement early warning systems for vulnerable patients, enforce emission reduction policies, and promote sustainable hospital practices to mitigate healthcare’s environmental burden.

The review highlights the need for further research into climate-resilient healthcare infrastructure, sustainable medical practices, and proactive interventions to reduce climate-driven urological disease burdens in the coming decades.