Advocacy

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Policy & Advocacy

Advocacy is one of the three strategic priorities of the International Society of Nephrology.

Alongside Research and Education, ISN is committed to Advocacy in order to facilitate the implementation of sustainable, equitable, ethical care for people with kidney disease in all regions and countries of the world.

ISN’s Advocacy objectives are threefold:

1) Ensure that kidney health is represented by a truly international voice on health-related global, regional and national policy developments

2) Provide input to health policy discussions relevant to improving kidney health e.g. surveillance and prevention, organ donation, transplantation and trafficking, renal replacement therapy access and others

3) Integrate kidney disease into the ongoing global debate and drive towards Universal Health Coverage (UHC) by leveraging kidney disease as a model for monitoring progress and achieving UHC

Advocacy 3 Pillar Structure

Strategy

RESEARCH: ISN aims to produce key evidence and analysis to support its advocacy positions and calls for action.
POLICY DEVELOPMENT: Based on the research results, ISN aims to make concrete policy proposals, offering potential solutions and examples of best practice, in order to actively contribute to relevant policy action and debates.
OUTREACH: ISN engages in targeted communication and public affairs activities in order to engage in the policy development process and generate awareness about kidney health.
MOBILISATION: ISN strives to build internal capacity and support among the healthcare community with a view to creating a network of kidney health supporters that are able to echo the need for improved kidney care to key decision-makers and stakeholders at global, regional and national level.
ALLIANCE BUILDING: ISN aims to build alliances with external stakeholders including organisations from other disease areas in order to strengthen mutual objectives and advocacy efforts vis a vis key decision-makers and relevant stakeholders.

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Projects & Campaigns

EVIDENCE AND RESEARCH

ISN is building the case and producing the evidence to support policy asks and recommendations in the area of kidney disease:

We are currently producing a Global Kidney Health Atlas with the aim to review the management of kidney disease globally and demonstrate the gaps in the capacity and competence of individual countries to deliver high quality kidney health care. Initial results of the Atlas were presented in July 2016 at the Global Kidney Health Summit in Vancouver. The final results of the Atlas will be presented in April 2017 in occasion of ISN’s World Congress of Nephrology.

Check out the main results of the AKI Global Snapshot, a far reaching cohort study providing brand new evidence on the burden of Acute Kidney Injury globally.

Stay tuned for more information!

RAISING AWARENESS

As part of our Advocacy activities, we are raising awareness about the pressing need to tackle kidney disease through far-reaching global campaigns aimed at increasing understanding about the burden of kidney disease with governments, international institutions, health professionals, patients and the general public. Here are our global awareness raising campaigns:

World Kidney Day
The Lancet Kidney Campaign

Help us showcase our campaigns with your national and regional decision-makers!

ISN INITIATIVES

ISN is committed to curb deaths from kidney disease globally and to this end, we have developed two far-reaching Initiatives to tackle Chronic Kidney Injury (CKD) and Acute Kidney Injury (AKI).

ClosingTheGaps aims to develop a new Global Blueprint for CKD with strong and clear policy recommendations to decision makers on how to improve kidney care and management globally.

0by25 aims to curb preventable deaths from AKI by 2025 by implementing globally applicable strategies that permit timely diagnosis and treatment of AKI for patients with potentially reversible diseases.

Stay tuned for more information!

Policies & Positions

ISN is getting involved in an increasing number of policy issues and activities including Universal Health Coverage (UHC), Non Communicable Diseases and Sustainable Development Goals (SDGs), Ethical and Equitable Dialysis and Organ Donation & Transplantation.

UNIVERSAL HEALTH COVERAGE

One of the overarching objectives of ISN's advocacy strategy is to integrate kidney disease into the ongoing global debate and drive towards Universal Health Coverage (UHC). In this context, ISN seeks to propose kidney disease as a model for monitoring progress, achieving Universal Health Coverage and improving global health.

To this end, ISN is actively engaging in the current WHO and UN discussions around the subject of UHC and the broader efforts to meet the UN’s Sustainable Development Goals (SDGs).

In December 2015, ISN signed up to the Global Coalition for Universal Health Coverage calling for more progress to deliver UHC, including in kidney care. The coalition includes the WHO, World Bank Group, Rockefeller Foundation and hundreds of leading NGOs, healthcare organisations and academic institutions.

In December 2015, ISN responded to a UN consultation on the tracer indicators to be used in tracking UHC, one of the key health-related targets of the SDGs. In the consultation, ISN underlined the following key recommendations:

ISN supports the use of tracer indicators as an appropriate and effective way of monitoring progress towards the Universal Health Coverage (UHC) target.
In order to provide a good indication of the ‘health’ of the healthcare system, ISN also recommends that the defined package of tracer interventions should cover the full spectrum of health services that should be made available to the population. This package should include interventions targeted at disease prevention, diagnosis, treatment and rehabilitation.
Kidney disease, a non-communicable disease (NCD) with a growing global burden, particularly in low and middle-income countries (LMICs), is a good example of how such a package of interventions might be developed. While the greatest health benefit will come from delivery of the whole package, limited resources may require prioritization of interventions and a phased approach to implementation in order to achieve scale-up over time.

ISN contribution to the UN consultation on the UHC tracer indicators is available here.

ISN will continue to actively seek to demonstrate the impact and relevance of kidney disease in achieving the UHC.

Stay tuned for more information!

SUSTAINABLE DEVELOPMENT GOALS

ISN strongly welcomes the inclusion of health and non-communicable diseases in the UN Agenda 2030 for Sustainable Development and its 17 Sustainable Development and Sustainable Development Goals.

In particular, ISN welcomes the clear recognition of health and, specifically, tackling the burden of non-communicable diseases (NCDs) as key priorities in the 2030 Agenda. We hope that the international community and member states will demonstrate strong progress in the implementation of the UN Agenda 2030 framework as a successful model to be used as inspiration and impetus for other regions of the world.

ISN in particular strongly supports a system-wide approach to tackle the problem of kidney disease. Many structural factors including poverty, education, nutrition, gender inequality, substance abuse, lack of access to primary care and overall health all directly increase the risk of kidney disease, therefore the holistic approach of Agenda 2030 and the Sustainable Development Goals (SDGs) promises to have a positive impact on kidney disease globally.

In the continued fight against kidney disease, ISN therefore strongly supports the goals and implementation of the 2030 Agenda. At the same time, it also calls for heightened awareness of the clinical, economic and social burdens of kidney disease, which are at present frequently underestimated.

For more information about ISN's position on the role and contribution of SDGs and Agenda 2030 in the fight against kidney disease, please view ISN's statement at the 66th Session of the WHO Regional Committee for Europe in September 2016.

More information about the relevance of the SDGs to kidney disease can also be read in the recent contribution of Dr. Valerie Luyckx on this topic in The Lancet Kidney Campaign.

Stay tuned for more information!

NON COMMUNICABLE DISEASES

Kidney disease is one of the “neglected” NCDs in spite of the clear indication that across the world deaths from kidney disease are increasing globally as highlighted by the recently published Global Burden of Disease study.

Kidney disease does not indeed currently feature among the 4 major non-communicable diseases (NCDs) specifically targeted by the World Health Organisation (WHO) or other relevant international organisations.

ISN recognises the current status as a challenge and therefore the focus of its efforts is currently to build a stronger profile and understanding of kidney disease and to identify specific opportunities where ISN can make a relevant and valuable contribution to the ongoing work of the WHO and other related international organisations (e.g. the UN).

Through these efforts, ISN hopes to demonstrate the importance of acting on kidney disease – as a major NCD and as an amplifier of other NCDs such as diabetes and cardiovascular disease (CVD).

As a first step in this direction, in June 2016, ISN joined the World Heart Federation and other leading health organizations in signing the Mexico Declaration on Circulatory Health for All People which calls on international organisations such as WHO and national governments to ensure better prevention, diagnosis and management of circulatory disease, its risk factors and other related non-communicable diseases, including kidney disease.

In September 2016, ISN was invited to participate to a WHO stakeholder consultation on the revision of Appendix 3 of the WHO Global NCD Action Plan 2013-2020. In the consultation response, ISN stressed the importance of kidney disease as a ’neglected’ disease which raises important public health concerns worldwide and should be put high on the agenda. ISN has also brought the attention of the international healthcare community to the underestimated link between diabetes, cardiovascular diseases and kidney disease by recommending early detection of kidney disease in diabetes and CVD patients in order to improve outcomes.

The WHO is currently reviewing the responses received, including ISN's and it is expected to publish the revised Appendix by end of 2016.

ISN's response to WHO Appendix 3 consultation is available here.

Stay tuned for more information!

Obesity

Obesity increases the risk for a variety of chronic conditions but the important role it plays in the development and progression of kidney disease is rarely acknowledged. By adopting a healthy diet, increasing physical activity, ensuring healthy fluid intake and getting adequate sleep, individuals can prevent obesity and many other possible risk factors of CKD. The fight against obesity however cannot rely entirely on personal responsibility. Governments, healthcare professionals, the private sector, educators and community leaders must acknowledge the magnitude of the burden of obesity and kidney disease and implement the following population based policies and strategies to complement individual efforts.

On World Kidney Day 2017, ISN together with the International Federation of Kidney Foundations and the World Obesity Federation published a joint position statement. The position provides facts on the important role obesity plays in the development and progression of kidney disease. The position also illustrates joint risk factors shared by obese and kidney disease patients such as cardiovascular disease, diabetes and hypertension. Hence the policy measures presented in the final part of the position provide pertinent strategies for policy-makers to tackle the root causes of kidney disease and obesity as well as of a variety of other chronic diseases in a cost-effective way.
You can download the position paper HERE

ORGAN DONATION AND TRANSPLANTATION

In December 2006, concerned by the ongoing problems of international organ trafficking and the global shortage of organs for transplantation, representatives from the International Society of Nephrology met with representatives of The Transplantation Society and conceived the idea of developing a formal Declaration that would serve to inspire and unite all those engaged in combating unethical practices in organ transplantation.

This debate culminated with the Declaration of Istanbul on Organ Trafficking and Transplant Tourism.

ISN continues to strive to raise awareness about the challenges and large differences between countries in access to suitable and equitable renal replacement therapy including transplantation and in the level of safety, quality, efficacy of donation and transplantation of human cells, tissues and organs.

Stay tuned for more information!

News and Events

April 2017

ISN Global Kidney Policy Forum, 21 April 2017, World Congress of Nephrology, Mexico City

In partnership with the Mexican Ministry of Health and with the participation of The Lancet, on 21 April 2017, ISN grought together high-level decision-makers and stakeholders to address the burden of kidney disease in the Americas region and share strategies for prevention and improved management of the disease at both the regional and global level. Participants included representatives from national health ministries, international and regional health organisations, key opinion leaders, and representatives of the wider health community.

The main outcome of the Policy Forum for the endorsement by participants the Conclusions of Mexico City, a 12-point set of measurable actions to curb the burden of kidney disease worldwide, specifically focusing on Latin America. The Conclusions are available in English as well and they call for key measures aimed at developing and implementing integrated non-communicable disease programs addressing chronic kidney disease (CKD) risk factors; implementing and support surveillance mechanisms such as robust national and regional registries for acute kidney injury, CKD and end-stage kidney disease, and crucially ensuring just and equitable access to kidney disease care including dialysis and transplantation.

For more infomation about the outcome of the first Policy Forum, please click here.

The Global Kidney Policy Forum will be the first in a series of ISN Policy Forum meetings that will take place at regular intervals. The unique format will provide an opportunity to bring an international viewpoint on key issues related to the prevention and management of kidney care disease, which impact a particular country or region. The meeting will culminate in a clear call for action to national, regional and global policy makers.

March 2017

New study finds: Cost of kidney dialysis poses ethical dilemma in sub-Saharan Africa

A recent article co-uthored by ISN Associate Dr. Valerie A. Luyckx summaries the findings of a systematic literature review to dialysis care in Sub Saharan Africa. The article finds that access to dialysis for end-stage kidney disease is limited by insufficient infrastructure and catastrophic out-of-pocket costs. This leads to most patients either remaining undiagnosed or untreated. The majorrity of those who manage to pull together the money needed to stat dialysis, discontinue quickly within the first weeks, most likey indebted and fatally ill. Equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa are urgently needed.
To read the full article, pleasse see: http://thelancet.com/journals/langlo/article/PIIS2214-109X(17)30057-8/fulltext

World Kidney Day 2017 - Joint position on obesity and kidney disease with World Obesity Federation

February 2017

Ethical dialysis: New article presents preliminary recommendations to guide practice and policy

In a new article ISN's Ethical Dialysis Task Force adresses the lack of ethical analysis and guidance available to decision makers on the dilemmas linked to renal-replacement therapy. These include how to: promote patients' best interests; increase access to dialysis while maintaining procedural and distributive justice; minimise the influence of financial incentives and competing interests; ensure quality of care in service delivery and access to non-dialytic supportive care when needed; minimise the financial burden on patients and health-care system; and protect the interests of vulnerable groups during crisis situations.
To acccess the full article, please see: http://thelancet.com/journals/lancet/article/PIIS0140-6736(16)32408-4/fulltext

ISN DICG at Vatican City Summit on organ trafficking and transplant tourism

January 2017

ISN speaks at the first 2017 meeting of the World Health Organisation’s Executive Board

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In its capacity as a non-state actor in formal ‘official relations’ with WHO, ISN attended the 140th World Health Organization (WHO) Executive Board meeting in Geneva which took place from 23 January – 1 February 2017. ISN made two statements commenting on WHO's ongoing processes, relevant to ISN’s advocacy work, namely the WHO’s action plan on non-communicable diseases and the progress made with regards to health in the Sustainable Development Goals agenda 2030.Both statements underlined the need to address the global burden of kidney disease and adopt a holistic and service integrated approach to tackling kidney disease throughout the entire life course.
For more information on the 140th session of the Executive Board, please see: http://www.who.int/mediacentre/events/2017/eb140/en/
To read ISN statements, please go to: https://extranet.who.int/nonstateactorsstatements/meetingoutline/7

December 2016

ISN marks Universal Health Coverage Day!

On 12 December 2017, ISN will mark Universal Health Coverage Day (UHC)! ISN believes that everyone has the right to quality health care without suffering ﬁnancial hardship and calls on governments to integrate strategies for prevention, early detection and treatment of kidney disease into their efforts to achieve UHC and to ensure access to essential care to delay the progression of kidney disease. For more information about UHC Day, please view: http://universalhealthcoverageday.org/welcome/

November 2016

The ISN Meeting on CKDu, 20 November 2016, Conference Chicago University Center, Chicago

In order to support the creation of a systematic, nephrology-based approach to investigating the epidemiology and etiology of CKDu, ISN brought together key opinion leaders and experts with a view to examine what is currently known in the area of CKDu from published data, to review the ongoing work and frameworks proposed in specific research areas and subsequently highlight the scientific 'unknowns' of CKDu and the next steps to tackle them appropriately.

Stay tuned for more information on the outcome and key output of the meeting!