If we’re going to fight a disease, let’s fight one of the most terrible diseases of all, indifference.

Robin Williams as the main character in the film Patch Adams

The KDIGO team recently announced an upcoming Controversies Conference on Green Nephrology, an initiative that clearly demonstrates how this point of view, initially embraced by only a handful of freethinkers, is now becoming an issue we have to consider in the choices we make, both as managers, when we plan a new nephrology or dialysis center or choose dialysis machines and reverse osmosis, and as clinical nephrologists, when we need to bear in mind that wise prescriptions, avoidance of futility, attention to identifying the best moment to start dialysis, and the best way to do it, are not only good for the patient, but also better for the planet.

Indifference is not an option.

In this issue dedicated mainly to dialysis, we find good examples of this common focus, with contributions on incremental and personalized dialysis, evaluations of the effects of technical choices on the environment, but also a warning on how the quality of our environment is associated with kidney diseases, not only in the developing world, where much has yet to be done to ensure work safety, but also in polluted, highly resourced settings.

Things are moving, and there is much that we must do.

Not only nephrology is changing. In high-income settings people are increasingly rediscovering the charm of old-fashioned fabrics, the beauty of that which is handmade, the importance of time dedicated to repairing things; what was thrown away has become a luxury, or at least a resource [1, 2] The economic crisis allowed sites like Vinted to prosper; Leonard Cohen’s Suzanne’s “rags and feathers from Salvation Army counters” are now mainstream. Will this apply to medicine?

Incentives are needed both culturally (and the new KDIGO initiative is one of them), and economically, leading to new models of care, slowing down the rhythm of obsolescence and waste production. In this battle against time, there is still hope.

Hence, to close this editorial with hope, here are two images of recycling.

The first one is a portable sink in Campeche, Mexico, one of the poorest areas in this beautiful country. The best place to go for a shrimp cocktail is a small place near a gas station, where providing customers with hydroalcoholic solution and clean water for handwashing led to this ingenious solution: two paint buckets, one faucet, some metal pipes. No waste. Water in the lower bucket is used for flushing toilets (Fig. 1).

Heroes of recycling. No waste. Author unknown. Campeche, Mexico

The “Goddess of Ecology” (Fig. 2) is a work by ALB, the acronym used by Almanto, Alain Blanchard [3]. This humble, shy physician and artist is exhibiting for the first time his work, previously seen only by his friends. A few sculptures made with recycled materials are included in this large retrospective exhibit gathering more than 300 pieces, mainly works on paper, and large sculptures made of iron. His irony cannot hide his profound kindness. The Goddess is more an insect than a snake (both food for the future) embellished with flowers and (plastic) butterflies. Her skeleton is recycled plastic. She is upsetting, and beautiful.

The Goddess of Ecology. Courtesy of Alain Blanchard. Mixed techniques with recycled materials

You may wonder how these two images are linked.

The authors are recycling heroes, making useful objects out of trash, and making art from broken, discarded things.

Let us hope the recycling heroes’ inventive resilience, passion and imagination will guide green nephrology’s next steps.