A unique role in global nephrology: The International Society of Nephrology, 2011–2020
Authors: John Feehally
Journal: Kidney International (2020)

In 2020, the International Society of Nephrology (ISN) celebrates 60 years since its founding and first congress in 1960. The history of its development until 2010 has been well-documented.1Robinson R.R. Richet G. International Society of Nephrology: a forty year history. 1960-2000.Kidney Int Suppl. 2001; 79: S1-S100Abstract Full Text Full Text PDF PubMed Google Scholar,2Barsoum R. A mission in evolution: the International Society of Nephrology in the past 10 years—2001-2010.Kidney Int. 2011; 79: 935-943Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Since then, in the decade 2011–2020, the ISN's activities around the world have had increasing range and impact, enabling the ISN to maintain its unique role as the leading professional organization in global nephrology. The ISN's Vision and Mission, redrafted in 2018, reflect its global role in nephrology (Table 1). In the decade 2011–2020, the ISN has sought to expand its efforts in low- and middle-income countries (LMICs) while maintaining its responsibility to provide valuable benefits for all its members, including those in high-income countries.Table 1International Society of Nephrology (ISN) vision and mission from 2018VisionA future where all people have equitable access to sustainable kidney healthMissionThe ISN is a philanthropic organization dedicated to advancing worldwide kidney health. We do this for all our stakeholders by:•BRIDGING THE GAPS of available care through advocacy and collaborations with our global partners;•BUILDING CAPACITY in health care professionals via granting programs, education, and research; and•CONNNECTING OUR COMMUNITY to develop a stronger understanding of the management of kidney disease. Open table in a new tab In 2011, the ISN was supported by the Brussels-based association management company Interel. Luca Segantini was ISN Executive Director from 2009 until 2018, and in 2010, there were 8 employed staff members. In 2011, the ISN became self-managing, reducing costs and improving efficiency. The ISN has continued to be served by a highly committed, young, multilingual staff, which has grown as the ISN's activities and infrastructure relentlessly increased; currently, in 2020, the ISN has 36 staff members. Charu Malik succeeded as Executive Director in 2019. In 2011, the ISN Council had 32 elected counselors, determined using geographical boundaries little changed for 30 years. In 2016, regional boards in each of the 10 world regions were established with the goal that they be the "eyes and ears" of the ISN in each region—ensuring dissemination of key information, advising about regional contexts for new proposals, and helping to plan regional implementation. This development was followed in 2018 by a revision of the council structure; there are now only 20 counselors, the chairs and deputy chairs of each regional board. The day-to-day leadership of the ISN has devolved to be the executive committee chaired by the ISN president, and includes past-president, president-elect, secretary-general, treasurer, and executive director, with up to 4 other ISN members selected by the president. In 2017, the role of secretary-general was discontinued, since those administrative responsibilities were taken over by headquarters staff. During the decade 2011–2020, the ISN was served by 5 presidents (Figure 1), 3 secretary-generals (Adeera Levin [Canada], Ricardo Correa-Rotter [Mexico], and Robyn Langham [Australia]), and 3 treasurers (Victor Schuster, Thomas Coffman, and Stuart Shankland [all USA]). The ISN made other governance changes during the decade, including broadening membership to include allied health professionals, as well as more effective implementation of policies for equity, diversity, and inclusion. ISN membership numbers were maintained through the decade; currently in 2020, there are more than 8500 members, with an encouraging shift in the age distribution to a younger membership. Nephrologists still in training are now given free ISN membership for the first year, followed by a reduced fee until they complete training. Those in lower-middle-income countries are offered group ISN membership (2 to 5 members for 1 fee). Membership is free to all in low-income countries. A unique strength of the ISN is its network of more than 100 affiliated national and regional nephrology societies. Some of these societies sign up a proportion of their members and become Collective ISN Members at a special annual rate. In 2020, these include the nephrology societies of Australia and New Zealand, Brazil, Colombia, Canada, Netherlands, Estonia, Hong Kong, Iran, Israel, Jordan, the Philippines, Panama, Paraguay, South Africa, Spain, and Switzerland. The transforming effects of the digital era have influenced the ISN's approach to communications. The website remains a primary source of information. Regular ISN communications with the membership are focused into a fortnightly "e-blast" known as ISN Insight, keeping additional e-mail communications to a minimum for greater impact. The ISN has steadily increased its presence on social media, coordinated by the ISN's Social Media Task Force (Twitter: @ISNKidneyCare, @ISNEducation, and @worldkidneyday). The decade has seen expansion in the range and depth of ISN global efforts in education, advocacy, and research. Many ISN activities involve more than 1 of these elements, but for convenience, they are described here under these headings. The ISN is uniquely placed to have global impact in nephrology, but it does so more effectively when sharing complementary expertise and resources. The ISN has continued to partner extensively with other global and regional nephrology organizations to deliver its programs. The World Congress of Nephrology (WCN) was held in alternate years throughout the decade, moving to different regions of the world by rotation. WCN was held in Vancouver (2011), Hong Kong (2013), Cape Town (2015), Mexico City (2017), and Melbourne (2019) (Table 2). It was agreed that WCN would become an annual meeting from 2020 onward—the chosen cities so far being Abu Dhabi (2020; unfortunately cancelled because of the coronavirus pandemic), Montreal (2021), and Kuala Lumpur (2022).Table 2World Congresses of Nephrology, 2011–2019DateCityPartner societiesChair, Scientific Program CommitteeChair, Local Organizing CommitteeRegistrations2011VancouverCSNRichard Johnson (US)Adeera Levin (Canada)43002013Hong KongAPSNHKSNCarol Pollock (Australia)Philip Li (Hong Kong)58992015Cape TownAFRANSARSPierre Ronco (France)Charles Swanepoel (South Africa)36002017Mexico CitySLANHKai-Uwe Eckardt (Germany)Ricardo Correa-Rotter (Mexico)40002019MelbourneANZSNAPSNMasaomi Nangaku (Japan)Peter Kerr (Australia)3580AFRAN, African Association of Nephrology; ANZSN, Australia and New Zealand Society of Nephrology; APSN, Asian Pacific Society of Nephrology; CSN, Canadian Society of Nephrology; HKSN, Hong Kong Society of Nephrology; SARS, South African Renal Society; SLANH, Latin American Society of Nephrology and Hypertension. Open table in a new tab AFRAN, African Association of Nephrology; ANZSN, Australia and New Zealand Society of Nephrology; APSN, Asian Pacific Society of Nephrology; CSN, Canadian Society of Nephrology; HKSN, Hong Kong Society of Nephrology; SARS, South African Renal Society; SLANH, Latin American Society of Nephrology and Hypertension. Increasing emphasis at WCN is being given to the sustainability of logistics and organization; the 2019 WCN at Melbourne was completely paper-free. The proportion of registrations from within the region where WCN is being held is increasing. The WCN scientific program continues to cover most aspects of nephrology, but it has increasingly provided a focus on issues specific to the region: for example, HIV-related kidney disease and fetal–maternal kidney health issues in Cape Town in 2015, and diabetic kidney disease in Mexico City in 2017. The WCN educational program offers a solid diet of core nephrology teaching, including a renal pathology course, and there are hands-on interventional nephrology workshops. The ISN's many other activities in education, research, and advocacy, such as ISN Programs and World Kidney Day, are now showcased at WCN more clearly than they were in the past. ISN awards are presented during plenary sessions, which also include a number of ISN lectures named in honor of past ISN leaders. From 2013, the ISN instituted Pioneer Awards, given to "unsung heroes" from LMICs who have made outstanding contributions to nephrology in their own country or region (Table 3).Table 3International Society of Nephrology Pioneer Awards, 2013–2019Region2013201520172019AfricaYackoob Seedat (South Africa)Rashad Barsoum (Egypt)Hasan Abu-Aisha (Sudan)Oladipo Olujimi Akinkugbe (Nigeria)Central and Eastern EuropeMomir Polenakovic (FYR Macedonia)Vytautas Kuzminskis (Lithuania)Ayla San (Turkey)Halima Resic (Bosnia and Herzegovina)Latin AmericaNelson Mazzuchi (Uruguay)José Luis Peña (Mexico)Nestor Schor (Brazil)Edgar Sanclemente (Colombia)Middle EastTareq Suhaimat (Jordan)Berhooz Broumand (Iran)Riyad Said (Jordan)No awardaPioneer Awards were not made in 3 regions in 2019 because there were no suitable nominations.Russia and NISNatalia Tomalina (Russia)Maya Ignatova (Russia)Assiya Kanatbayeva (Kazakhstan)Valery Pilotovich (Belarus)North and East AsiaHaiyan Wang (China)Shan-yan Lin (China)Wu-Chang Yang (Taiwan)No awardaPioneer Awards were not made in 3 regions in 2019 because there were no suitable nominations.OSEAVisith Sitprija (Thailand)Zaki Morad (Malaysia)Wiguno Prodjosudjadi (Indonesia)Supat Vanichkarn (Thailand)South AsiaVidya Acharya (India)Adibul Hasan Rizvi (Pakistan)Harun-Ur-Rashid (Bangladesh)No awardaPioneer Awards were not made in 3 regions in 2019 because there were no suitable nominations.FYR, former Yugoslav Republic; NIS, newly independent states; OSEA, Oceania and South East Asia.a Pioneer Awards were not made in 3 regions in 2019 because there were no suitable nominations. Open table in a new tab FYR, former Yugoslav Republic; NIS, newly independent states; OSEA, Oceania and South East Asia. The ISN's Forefronts meetings were focused on topics typically of most interest to laboratory researchers. Seven Forefronts meetings were held during the decade (Table 4). The ISN was a net investor to ensure the scientific success of each Forefronts meeting, which typically did not draw in substantial external financial sponsorship.Table 4International Society of Nephrology Nexus, Forefronts, and Frontiers Meetings, 2011–2020Meeting and yearTopicVenueRegistrationsNexus September 2012Bone and the kidneyCopenhagen, Denmark678 April 2014New era of drug discovery and clinical trials in kidney diseaseBergamo, Italy316 September 2014Hypertension and the kidneyBrisbane, Australia143 April 2016Translational immunology in kidney diseaseBerlin, Germany213Forefronts June 2012Systems biology and the kidneyAnn Arbor, USA119 October 2012Tubulointerstitial disease in diabetic nephropathyMelbourne, Australia126 September 2013Stem cells and regeneration in the kidneyFlorence, Italy92 March 2014Intrinsic regulation of kidney functionCharleston, USA78 September 2014Genetic basis of renal diseaseBoston, USA106 October 2015Immunomodulation of cardio-renal functionShenzhen, China181 September 2016The metabolome and microbiome in kidney diseaseSan Diego, USA99Frontiers February 2018Kidney disease and cardiovascular diseaseTokyo, Japan1584 October 2020Complement-related kidney diseases: classification, genetics, and treatmentBergamo, ItalyIn preparation Open table in a new tab Nexus meetings focused on topics with an established bench-to-bedside spectrum of work, to provide a "nexus" for interaction between laboratory and clinical investigators and clinicians in a series of meetings characterized by plenary discussion across the whole gamut from disease mechanisms to clinical care and therapeutics. Four Nexus meetings were held during the decade (Table 4). As time passed, the distinction between topics suitable for Nexus or Forefronts blurred, and beginning in 2016, they were amalgamated into a new meeting series, ISN Frontiers (Table 4). During this decade, Kidney International (KI) remained ISN's flagship journal. Editors-in-chief were Qais Al-Aqwati (2005–2011), Detlef Schlöndorff (2011–2018), and Pierre Ronco (2018–). The editorial office for KI remained at Washington University, St. Louis, Missouri, USA, under Executive Editor Pat Morrissey. KI's impact factor grew from 6.5 in 2010, and in 2018, its 5-year impact factor was 8.6, placing it third among nephrology journals. KI Supplements provide a parallel opportunity for focused publications, such as Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines or meeting proceedings, sometimes with publication costs met by commercial sponsorship. A decade-long contract for KI with Nature Publishing Group expired in 2015, and a new 10-year contract was signed with Elsevier. An open-access, exclusively online journal, KI Reports, was launched in 2016 with Jai Radhakrishnan (USA) as Editor-in-Chief, and Radha McLean as Executive Editor. KI Reports publishes original research and educational content related to kidney disease, and it encourages submission of original research from LMICs. The ISN developed an online educational offering launched in 2011 as ISN Education and known from 2017 as ISN Academy.3International Society of NephrologyISN Academy.https://www.theisn.org/education-external/isn-academyDate accessed: April 16, 2020Google Scholar There has been a rapid accumulation of varied content, including talks streamed from ISN meetings, podcasts, cases and images, guidelines, and webinars. ISN Academy is distinctive in containing much material that is particularly relevant to emerging nephrology in LMICs. Currently in 2020, the ISN Academy contains some 8000 hours of educational content in 7 languages, attracting around 1000 visitors each month. The ISN's unique capacity-building programs fill important gaps in places with the greatest need and bring global recognition and respect to the society. The 5 programs available only to applicants from LMICs are Fellowships, Continuing Medical Education, Sister Renal Centers, Educational Ambassadors, and Clinical Research (including the ISN Scientific Writing Course).4International Society of NephrologyPrograms: education, training & research.https://www.theisn.org/programsDate accessed: April 16, 2020Google Scholar These were known since 2009 as ISN-GO (Global Outreach), and since 2014 as ISN Programs. Through the collective effort of these capacity-building programs, the ISN has contributed to the growth of kidney care services in large parts of sub-Saharan Africa and South and South East Asia and helped establish long-term partnerships that have endured beyond the term of ISN support. Qualitative feedback about the programs is strongly positive, and efforts continue to quantify their impact.5Feehally J. Brusselmans A. Finkelstein F.O. et al.Improving global health: measuring the success of capacity building programs: a view from the International Society of Nephrology.Kidney Int Suppl. 2016; 6: 42-51Abstract Full Text Full Text PDF Scopus (29) Google Scholar In recent years, some 40% of ISN fellowships have been awarded for training within the recipient's region, rather than in host centers in a developed country. Such in-region training ensures relevant clinical experience, minimizes language and cultural disparities, and has reduced the concern that fellows who go to high-income countries will find attractive career opportunities there and never return home. For example, since 2010, more than 90% of fellows from sub-Saharan Africa, who have trained in centers in South Africa, have returned home. One reason for the change in emphasis toward supporting fellowship training within region is the increasing number of centers in LMICs with the expertise and capacity to provide such training, several of which have graduated from the Sister Renal Center Program. Since 2016, ISN has recognized the best of these, 9 throughout the world, as ISN Regional Training Centers (Table 5).Table 5International Society of Nephrology Regional Training Centers from 2016RegionCenterAfricaRed Cross Children's Hospital, Cape Town, South AfricaGroot Schuur Hospital, Cape Town, South AfricaEastern and Central EuropeNephrology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, LithuaniaLatin AmericaDepartment of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, MexicoFundacion Valle de Lili, Cali, ColombiaNewly Independent States and RussiaNational Center of Nephrology and Renal Replacement Therapy, Minsk, BelarusNorth and East AsiaInstitute of Nephrology, Peking University, Beijing, ChinaDivision of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, ChinaNational Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, ChinaSouth AsiaDepartment of Pediatric Nephrology, St. John's Medical College Hospital, Bangalore, India Open table in a new tab A recent feature of the Sister Renal Center Program is "trios"—center pairs that have "graduated" and in turn support another emerging center. A Sister Transplant Center Program was also established in 2013 in partnership with The Transplantation Society. Among many notable successes, one Sister Transplant Center has successfully established a kidney transplant program in Palestine, West Bank. The ISN supports speakers to attend continuing medical education meetings in LMICs for which the program has been developed to meet local needs. These programs increasingly include practical skills training (e.g., in interventional nephrology). Local organizers provide opportunities for visits to hospitals and teaching ward rounds and meetings with local health leaders. Support is also being given to larger regional meetings, which affords opportunities for not only education but also strategic discussions among nephrology leaders in the region. The first of these were held in West Africa and East Africa in 2018. In the Educational Ambassador Program, experts undertake short visits to an emerging center to support development of an aspect of clinical care (e.g., renal pathology or vascular access care). The expert can be accompanied by supporting personnel (e.g., a nurse or technician). Many of these visits lead to longer-term mentorship. Some of the investigators who receive funding through the Clinical Research Program are now offered training in critical evaluation, data analysis, and writing through the residential ISN Scientific Writing Course, first held in Bangalore, India in 2018 and 2019 (where it was co-funded by the ISN and the American Nephrologists of Indian Origin) and now being given in other regions. The ISN's Renal Disaster Relief Task Force works in partnership with Médecins Sans Frontières (Doctors Without Borders) to rapidly deploy clinical teams that can institute measures to prevent acute kidney injury (AKI), facilitate acute dialysis, and support those already on chronic dialysis. The last major earthquake requiring Renal Disaster Relief Task Force deployment was in Port au Prince, Haiti in 2011. Local nephrology services within the affected country or its regional neighbors increasingly have capacity to handle such crises, and the Renal Disaster Relief Task Force is shifting its emphasis toward supporting local and national disaster preparedness plans. Recognizing the lack of data on patients with kidney disease in LMICs, the ISN SharE-RR (SHARing Expertise to support the set-up of Renal Registries) was established in 2017 to develop resources to support the development of renal registries in LMICs. Starting in 2012, the Saving Young Lives Program—a partnership of the ISN, the International Pediatric Nephrology Association, the International Society for Peritoneal Dialysis, and EuroPD—established "proof of principle" that sustainable acute peritoneal dialysis programs treating adults and children with AKI can be developed and maintained in very-low-resource settings through education, training, and mentorship.6Smoyer W.E. Finkelstein F.O. McCulloch M.I. et al."Saving Young Lives" with acute kidney injury: the challenge of acute dialysis in low-resource settings.Kidney Int. 2016; 89: 254-256Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar The clinical approach is based on the International Society for Peritoneal Dialysis clinical practice guideline for acute peritoneal dialysis,7Cullis B. Abdelraheem M. Abrahams G. et al.Peritoneal dialysis for acute kidney injury.Perit Dial Int. 2014; 34: 494-517Crossref PubMed Scopus (179) Google Scholar which emphasizes when necessary the utility of locally produced, low-cost peritoneal dialysis fluid and improvised peritoneal dialysis catheters. In 2013, ISN President Giuseppe Remuzzi launched the 0by25 initiative with the goal of reducing avoidable deaths from AKI to zero by 2025.8Mehta R.L. Cerdá J. Burdmann E.A. et al.International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology.Lancet. 2015; 385: 2616-2643Abstract Full Text Full Text PDF PubMed Scopus (758) Google Scholar Projects were developed to increase knowledge and awareness of AKI9Mehta R.L. Burdmann E.A. Cerdá J. et al.Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study.Lancet. 2016; 387: 2017-2025Abstract Full Text Full Text PDF PubMed Scopus (281) Google Scholar and develop practical interventions for low-resource settings. Starting in 2017, an 0by25 project (Macedo EM, Sharma SK, Hemmila U, et al. Risk factors and definition of kidney dysfunction in the community setting: The ISN 0BY25 Initiative [abstract]. Kidney Int Rep. 2019;4:S79) evaluated the feasibility of improving AKI detection and management of AKI in the community in LMICs using a symptom-based risk score and point-of-care serum creatinine testing, supported by education and training. Its generalizability into routine practice in LMICs is now being evaluated. As the year 2025 approaches, the ISN is focused on showing measurable progress toward the original 0by25 challenge of zero avoidable deaths, even though this will not be fully achieved by 2025. During the presidency of Adeera Levin (2015–2017), she developed an additional emphasis on the growing challenge of CKD as a noncommunicable disease that is increasingly prevalent but of which there is variable awareness among health policymakers. Country-by-country information about expertise and access to care, as well as relevant health policy, is now available in the ISN Global Kidney Health Atlas, first published in 2017, with a second edition in 2019 that collected data from 160 countries.10International Society of NephrologyGlobal Kidney Health Atlas.https://www.theisn.org/all-articles/665-global-kidney-health-atlasDate accessed: April 16, 2020Google Scholar Sequential information can now be used to monitor progress, and where necessary, provide challenge to health systems that lag in delivering care. The ISN's first global health summit to review these issues was held in Vancouver in 2016, leading to a "road map" providing recommendations on closing gaps in care, research, and policy.11Levin A. Tonelli M. Bonventre J. et al.Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy.Lancet. 2017; 390: 1888-1917Abstract Full Text Full Text PDF PubMed Scopus (652) Google Scholar During the presidency of David Harris (2017–2019), he led an effort to provide additional emphasis on the worldwide challenges of end-stage kidney disease care. Few countries, even high-income countries, have truly integrated end-stage kidney disease care, including renal replacement therapy by dialysis and transplantation, and conservative care. To address these disparities, the ISN held its second global health summit in Sharjah, United Arab Emirates in 2018, which produced an action plan for progress.12Harris D.C.H. Davies S.J. Finkelstein F.O. et al.Increasing access to integrated ESKD care as part of universal health coverage.Kidney Int. 2019; 95: S1-S33Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar The ISN does not have the resources to be a major research funder, but in this decade, it has developed projects through which the ISN's global networks and influence can best be used to support renal research worldwide. ISN—Advancing Clinical Trials works to improve the clinical trials capacity of the global nephrology community through networking and training, and by standardizing high-quality trial conduct. This group provides a monthly inventory of important clinical trials, which is published on the ISN Academy website. The ISN—International Network of CKD Cohort Studies has built a network of existing CKD cohort studies from across the world; the network currently contains more than 20 cohorts from 6 continents, and it has already published 2 meta-analyses. The ISN has developed the International Consortium of CKDu Collaborators (i3C), bringing together many voices to promote better understanding of the epidemics of CKD of uncertain origin (CKDu), which are occurring in poor agricultural communities in equatorial LMICs, such as Sri Lanka and countries in Central America. In 2011, the ISN led advocacy efforts to ensure that the political declaration that emerged from the United Nations and World Health Organization High-Level Meeting on Noncommunicable Disease recognized the impact of kidney disease on worsening health outcomes. In 2012, the ISN came into "official relations" with the World Health Organization and now provides regular input into its policy discussions on kidney disease and health. The World Health Organization has commissioned the ISN to develop guidance on establishing chronic dialysis programs in low-resource settings. The ISN has established regional policy forums held during WCN, first in Mexico City in 2017, then in Melbourne in 2019. Representatives of health professionals, patients, and policymakers assemble to address issues related to kidney health in the region and seek commitments from health ministers to policy change and investment to address gaps in care. The first 2 forums produced substantial statements of intent, including a set of 12 recommendations to improve kidney health.13International Society of NephrologyGlobal Kidney Policy Forum Series: Focus on Latin America.https://www.theisn.org/images/Policy_Forum_8_pager_DEF_26072017_interactive_jh_aug_9.pdfDate accessed: June 21, 2020Google Scholar,14International Society of NephrologyGlobal Kidney Policy Forum Series: Focus on South East Asia and Oceania.https://www.theisn.org/advocacy#policy-papers-publicationsGoogle Scholar The ISN played a key role in partnership with The Transplantation Society in the 2008 Declaration of Istanbul against organ trafficking and transplant tourism and for the promotion of ethical transplant practices. A joint ISN and The Transplantation Society Declaration of Istanbul Custodian Group continues to challenge, through local professional societies and governments, any re-emergence of unacceptable transplant practices. World Kidney Day was throughout the decade a successful advocacy opportunity. It continued to be a partnership between the ISN and the International Federation of Kidney Foundations. Various aspects of kidney health were chosen as themes year by year. In 2020, there were World Kidney Day events in 99 countries worldwide, and the web and social media visibility of World Kidney Day continues to increase. The ISN's range and depth of work has grown remarkably in this decade. The ISN has maintained its relevance for kidney professionals worldwide with a special focus on LMICs.