Human-driven climate and broader environmental changes are accelerating, with increasing impacts on human health, including kidney health.1,2 In response, there is increasing momentum and regulatory pressure for health systems to transition toward environmentally sustainable, net–zero-emissions models. Hemodialysis is widely recognized as one of the most carbon-intensive and resource-depleting medical therapies on a recurrent per-capita basis.3 Rethinking how it is delivered is therefore an urgent, high-impact priority.