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Dr. Devarajan (wearing a suit) with the SAT Team at the National Pediatric Nephrology Conclave 2022, supported by the ISN

An ISN Sister Renal Centers (SRC) collaboration between Sree Avittam Thirunal (SAT) Hospital in Kerala, India, and Cincinnati Children’s Hospital Medical Center (CCHMC), USA, has played a transformative role in developing pediatric nephrology services at SAT Hospital, significantly advancing the quality and scope of pediatric kidney care in the region.

This partnership is a compelling example of how the ISN strategically layers its grant programs to create lasting impact. By combining the SRC framework with support from the ISN Educational Ambassadors and Continuing Medical Education programs, the ISN established a comprehensive pipeline for growth — strengthening infrastructure, expanding clinical expertise, and fostering academic and research capacity — positioning SAT as a national leader in pediatric nephrology.

As the only pediatric nephrology facility in Kerala — a state with a population of more than 33 million spread across nearly 39,000 square kilometers — SAT Hospital serves a vast population with previously limited access to specialized kidney care for children. The department urgently needed support in developing and implementing strategies for delivering advanced treatment, establishing training programs, and initiating research efforts in pediatric nephrology.

Throughout the seven-year partnership, which began in 2018, the department has strengthened its infrastructure, expanded access to essential equipment, and increased its human resource capacity, leading to measurable improvements in clinical outcomes and lives saved.

Initially staffed by a single faculty member, the pediatric nephrology department operated just one outpatient clinic per week, with four inpatient beds and a single hemodialysis machine. Today, all children under 18 continue to receive free treatment, and the hospital has expanded its pediatric nephrology capacity fivefold — from 10 to 50 dedicated beds.

The SAT Hospital successfully expanded its clinical capabilities to establish a comprehensive kidney replacement therapy program. The department now offers a full range of modalities, including acute peritoneal dialysis (PD), sustained low-efficiency dialysis, intermittent hemodialysis, continuous renal replacement therapy, and plasmapheresis.

The team also launched specialized AKI follow-up and transplant clinics during the partnership and participated in the ISN-IPNA Grand Rounds, presenting a complex pediatric case on resistant hypertension in ESKD on dialysis. A virtual academic series, NEPHQUEST (2021–2024), became a highly regarded educational forum, addressing key pediatric nephrology topics ranging from fluid and electrolyte disorders to genetic diseases. Among the partnership’s most notable achievements is the establishment of a postdoctoral (DM) program in pediatric nephrology, which will help sustain and grow the field in India for years to come.

The centers have collaborated on research projects, including studies such as “Management of pediatric ESKD – change in the trend over 12 years” and “CKD in pediatric AKI survivors from ICU,” both of which were accepted as abstracts at WCN 2020. Additionally, a study on inflammatory markers in chronic kidney disease was honored with the Best Poster Award at ISPNCON 2022.

Over time, SAT Hospital has evolved into a key referral and training center for pediatric kidney care in the region. It now serves as a hub for educating doctors and allied health professionals, including dialysis technicians and nurses. The team has implemented structured training programs and conducted multiple workshops to share expertise with healthcare providers from other hospitals across the state. As a result, SAT Hospital is now nationally recognized for its contributions to collaborative research, professional training, and the advancement of kidney care services for children.

Various speakers at the National Pediatric Nephrology Conclave 2022

The partnership has also raised the profile of pediatric nephrology in the region, enhancing both local visibility and national interest in the field. While the short-term impact is already evident in improved care delivery and service organization, the long-term effects will unfold as more specialists graduate from the DM program, paving the way for comprehensive kidney care, including pediatric kidney transplantation.

Building on this progress, SAT Hospital has launched the “Project PRATIKSHA” (meaning HOPE) initiative that uses software-based registration and follow-up to enable risk stratification, timely intervention, and ongoing care for all babies born in Kerala with congenital anomalies of the kidney and urinary tract (CAKUT). The program aims to serve as a model for comprehensive care of chronic kidney disease related to CAKUT in children.

According to Susan Uthup, the SRC liaison officer from SAT, the leadership and unwavering support of Dr. Prasad Devarajan and the team at CCHMC have been instrumental throughout the collaboration. She comments, “Their dedication extended beyond institutional support to hands-on involvement in webinars, clinical training, and exchange visits, offering both guidance and inspiration,” adding, “We are truly grateful to have been selected for this program. Completing all levels of the partnership has been a deeply fulfilling journey for our team. Thank you, ISN, for making this possible.”

Building on the progress achieved through the SRC partnership, the hospital aims to further strengthen its role as a center of excellence in pediatric kidney care by forming an ISN TRIO collaboration with CCHMC and the pediatric nephrology team at Assam Medical College in Dibrugarh, expanding access to advanced, high-quality kidney care for children across the region.