Current measures in healthcare systems are insufficient to reach the EU Green Deal goals. The social, economic and clinical consequences are significant. Reasons that current initiatives fall short include lack of awareness as to the problem, or potential solutions. There is complexity as to what process to choose, the low cost, the low carbon, the one that provides better care or the one which has the better social impact. The current system has insufficient investment in sustainable education, policy or research. Solutions work well in limited areas but are inefficient as a model for true systemic change. There is no agreed system of environmental foot printing in the health system and few partnerships with industry and patients to develop a truly sustainable system. Kidney care is a suited test case with its large resource footprint and well-defined care pathways. KitNewCare’s consortium will solve the problem with leading experts in kidney care, life cycle assessment methodology, education, dissemination and communication, health economics, and data management. KitNewCare will perform an EU-wide mapping of the sustainability landscape to reveal the hotspots across different clinical centres in each impact area. To locate solutions Quality Improvement Cycles will be utilised to analyse clinical pathways and industry innovations. KitNewCare will co-develop and pilot sustainable tools (such as the purposefully developed actionable dashboard, based on the 4-factor LCA model, which will monitor and benchmark the 4 different outcomes) innovative solutions, training, guidelines and recommendations as a proof of concept which can then be applied to the healthcare system; Our work will be informed by a stakeholder interaction and a Patient and Public Involvement programme to ensure proper design, uptake, dissemination and exploitation. This will enable decision makers and healthcare providers to reduce pollution, carbon emissions, and waste.

End stage kidney disease ranks among the most severe chronic non-communicable diseases with an unmet medical need, given the high (between 10 and 15%) and stable annual mortality rates. Kidney replacement therapy is necessary when kidney function is below 10% of the normal value. Much effort is put into developing strategies to prevent chronic kidney disease progression. Regenerative medicine still is in the experimental phase and kidney transplantation is only available for a small number of patients. Indeed, the everyday reality is the growing number of dialysis patients. Haemodialysis treatment is the current standard of care for the vast majority of patients with end stage kidney disease. It is a substantial burden to the patient and for society. Haemodialysis treatment is associated with high risks for fatal and non-fatal cardiovascular disease, for infections, hospitalisation and low quality of life. Improvement in the currently available standard is urgently needed. Over the past decade an alternative for haemodialysis became available, i.e. haemodiafiltration. Both are accepted by regulatory authorities. Haemodiafiltration removes waste products that are accumulated due to kidney failure, more effecticvely than standard hemodialysis. Present evidence supports the idea of superiority of haemodialfiltration compared to standard haemodialysis. However, definite proof is lacking and as a consequence haemodiafiltration is not yet widely applied. This consortium aims to determine the best possible dialysis treatment by comparing the conventional guideline based haemodialysis treatment versus high-dose haemodiafiltration by carrying out a prospective randomized controlled clinical trial addressing clinical endpoints, quality of life and a cost-utility analysis. The study will deliver an answer on the question which intervention gives the best value for money. Therefore, it will be considered a “land mark” study, allowing to publish an “end of discussion” paper