Advancing Nephrology Around the Globe
Authors: Jan J. Weening
Journal: Journal of the American Society of Nephrology (2004)

The International Society of Nephrology (ISN) has made it a global mission to prevent the development and progression of chronic kidney disease (CKD). CKD is being recognized as a worldwide public health problem. More than 1.5 million people worldwide are currently alive on renal replacement therapy (RRT) either by dialysis or with a functioning graft. The incidence of renal failure has doubled during the past 15 yr, a trend that is likely to continue in the next decade largely as a result of the pandemic of type 2 diabetes. It has been forecast that by 2010, more than 600,000 patients in the United States alone will need RRT, with annual costs rising to US $28billion. On a worldwide basis, the total cumulative cost for RRT over the next 10 yr is expected to exceed US $1trillion. These costs will be prohibitive and will add to the global inequity in patient care, as RRT is commonly available in high-income countries but limited to selected patients in middle-income countries. In low-income countries end stage renal failure (ESRF) still implies death in more than 95% of the cases. Furthermore, CKD and its marker, albuminuria, have become recognized as important independent risk factors for the development of cardiovascular disease and stroke which have a far greater impact on morbidity and life expectancy. This global threat to human health is of major concern to nephrologists around the world. Not only is it our clinical and scientific duty to act now to help prevent the progression of renal diseases, but we also have a responsibility to proactively come together as an international community and share knowledge to counter this epidemic of end-stage renal disease (ESRD). It is critical to raise awareness within the general public and within national health services on all continents. Education and training is necessary for primary health care workers and nurses around the globe as well as for physicians in developing countries with limited access to formal nephrology education and practice. Programs and methodology must be customized to suit local needs. As a global organization committed to advancing nephrology around the world, the ISN is devoted to facilitating international collaborations, programs and activities. Supported by its 8,500 members from 108 countries and affiliations with 72 national and regional nephrology societies, the ISN has developed an extensive network of global outreach programs which allow physicians from the developed world to actively participate in, support, and enhance nephrology science, education and care in the emerging world. Post-graduate continuing medical education (CME) programs are designed by ISN in conjunction with national and regional nephrology societies, to address the clinical and educational needs of local physicians and assist in capacity building within the local health care system. With a view to ultimately advancing knowledge and patient care, nephrologists from the developed world are encouraged to volunteer their time, knowledge, and expertise to travel the globe in support of this outreach program. Many may seek opportunities to help their countries of origin. Long-term training, allowing for in-depth study and learning, is also essential to address the global inequity in basic patient care and knowledge. Through ISN's International Fellowship Program leading physicians from developed countries can offer to mentor young physicians from emerging countries and provide them with relevant and contemporary nephrological training. The ISN fellowship program facilitates hands-on training in leading nephrology centers focused around basic and clinical nephrology, dialysis, transplantation, and epidemiology. ISN Fellows return to their home countries with newly developed skills and knowledge that enable them to provide advanced care and treatment and pursue research leading ultimately to the early diagnosis of renal disease and the prevention of progression to ESRF. Partnerships are essential not only between individual trainees and their mentors but also between hospitals and renal centers in various parts of the globe. The ISN Renal Sister Center Program encourages nephrology centers in the developed world to aid centers in emerging countries by exchanging and sharing faculty, fellows, students and equipment, as well as by cooperating in clinical research projects and educational courses. Ultimately our common aim as physicians and as citizens of the international community remains the advancement of education, science and patient care in medicine. Physicians in the developed world have a special obligation toward those who are most in need of medical care. ESRD is no different from other diseases with global impact such as HIV-AIDS, malnutrition and malaria that require international aid and cooperation to combat. The good news is that as the incidence of ESRD worldwide has reached epidemic proportions, our ability to administer early detection programs and to successfully intervene to slow or halt progression has increased dramatically as well. As the only global organization dedicated to pursuing those efforts, ISN will take the lead to educate, influence, raise awareness, and actively participate in the global prevention of chronic kidney diseases. For this purpose, I call on you to support these efforts, join the network of the ISN, and thus contribute toward global equity in renal care. For more information about the ISN, please visit: www.isn-online.org, where you can also register as a member.