Health care is responsible for one-tenth of all greenhouse gas emissions in the United States.1 Compared to other medical treatments, hemodialysis has a high environmental impact because it requires large amounts of energy, supplies, and water.2,3 Quality improvement methods may be a useful way to understand and reduce hemodialysis-related emissions. Such methods involve quantifying the magnitude of variation in a key measure, identifying providers with high or low performance, and using processes among high performers as models to improve outcomes among all providers.