Nepal’s dedicated nephrologistsiclaron
ISN Fellows are actively changing the state of care for Nepal’s growing number of kidney patients.
In many developing countries, the burden of noncommunicable diseases is increasing. In Nepal, it is estimated that there are 2900 new cases of end-stage renal disease (ESRD) every year. This means 100 cases per million people. With no registry, the exact incidence and prevalence of ESRD is still not known.
Hemodialysis has been available for almost 30 years, with high drop out rates due to the treatment’s cost. In the last few years, the Nepalese Government has partially supported the cost of maintenance hemodialysis and Peritoneal Dialysis (PD).
ISN has funded training for doctors from Nepal since 1998. There are few qualified nephrologists in the country. ISN Fellows are improving the state of nephrology care in the capital Kathmandu and in the periphery of the country.
Expanding PD and transplant programs
Live donor transplants have been possible since 2008. Former ISN Fellow Dibya Singh Shah, after training in Australia, led the first successful renal transplant program at Tribhuvan University Teaching Hospital. Transplants have also taken place at Bir Hospital and the Human Organ Transplant Centre in Kathmandu.
However, a regular renal transplant service is not available outside Kathmandu. Shailendra Shrestha, consultant nephrologist and associate professor at the Nobel Medical College and Teaching Hospital got advanced exposure to Dr. Singh’s work and the renal transplantation program at Monash Medical Center. He hopes to keep the collaboration going to bring transplantation to patients at his institution in Eastern Nepal.
He adds: “The ISN Fellowship Program has made me more confident and competent as a nephrologist and renal transplant physician.” Dr Shrestha also learned more about the adequacy and membrane characteristics of chronic PD patients and endovascular interventions in vascular access.
Based at the Charak Memorial Medicare Hospital in Pokhara, Klara Paudel’s experience echoes how ISN helps doctors learn new skills and encourages them to set up new programs. After training at the Royal London Hospital (UK), Dr. Paudel established a PD program in Western Nepal and will conduct a community study to screen the regions population for signs of kidney disease.
On expanding PD and the plans for developing a training program, she insists on training “the whole team,” including nephrologists, physicians, surgeons and nurses.