Global warming poses significant risks to human health and the planet. If allowed to continue unchecked, its consequences will be devastating. While all populations will be effected with time, vulnerable groups, including those with kidney disease, are likely to be at primary risk. This paper summarizes the current state of scientific knowledge relevant to climate change. It discusses the contribution of the health-care system, and particularly dialysis programmes, to greenhouse gas emissions, and pathways that exist for nephrologists to mitigate their environmental impact.