CME in Fiji raises CKD and AKI awarenessiclaron
A first ISN Continuing Medical Education course took place in Fiji’s capital Suva, from September 18 to 19, 2015, uniting the country’s medical community to talk about better kidney health. This meeting was made possible thanks to a developing ISN Sister Renal Center partnership with Australia.
Dr Amrish Krishnan (Fiji) and Dr Angus Ritchie (Australia) worked together to set up the course. Dr Krishnan is the only formally-trained nephrologist in Fiji.
The two-day course covered the policies and processes surrounding Chronic Kidney Disease (CKD) awareness, screening, and management as well as specific nephrology topics including approaches to Acute Kidney Injury (AKI). The country’s Health Minister, Hon Jone Usamate, addressing the audience on the first day, gave his commitment to further recognize CKD as part of Fiji’s non-communicable disease (NCD) strategy.
A recent STEPS survey identified 30% of Fiji’s adult population as diabetic. The incidence of stage 5 CKD was recently estimated to be the highest in the world, at around 680/million. Facilities for treating early stage kidney disease remain limited. Significant efforts need to be put into weight control, NCD prevention and down-streaming treatment. This symposium provided a significant stimulus for this, on the back of considerable prior efforts.
Fiji has significant financial constraints and an under-developed health system. It does have its own medical school, which has 40% of its enrolment from neighboring countries. Hemodialysis (HD) is available on a user pays basis only. There are currently 107 dialysis patients in Fiji but longterm survival is almost unheard of because of financial constraints. Living donor transplants are performed in India and the Government does provide some assistance with this. However, no data on transplant outcomes is available. There is concern that transplant loss is high once finances run low.
No peritoneal dialysis is available. Most AKI cases are treated, in recent times, by acute HD in intensive care. Exploration of acute peritoneal for AKI is underway following the symposium.