Projects

KIDNEY FAILURE (ESKD)

In consultation with, and requested by the World Health Organization (WHO), the ISN is developing a technical package outlining the minimum requirements and operational considerations for use by decision-makers, health program managers, and hospitals when planning or expanding dialysis programs for patients with kidney failure. The package is intended as a tool to support member states in developing sustainable strategies for the treatment of patients with kidney disease.

Held in Sharjah, UAE, in March 2018, the summit’s goal was to design a high-level global strategy to improve universal access to integrated care for kidney failure, to be published as a Supplement to Kidney International.

Additional action plans were published in Kidney International Supplements on:

  • Capturing and monitoring global differences in untreated and treated kidney failure, KRT modality, and outcomes;
  • Developing a framework for establishing integrated kidney care programs in low and middle-income countries;
  • Workforce challenges for sustainable care for kidney failure in low and middle-income countries;
  • Developing a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis;
  • Considering equity in the management of kidney failure in low and middle-income countries;
  • Developing an ethical care framework for kidney failure: from practice to policy;
  • The role of kidney transplantation as a component of integrated care; and
  • Supportive care for kidney failure treatment across a range of income settings around the world.

15 case studies were developed documenting context-driven variability in approaches to kidney care across countries while demonstrating the potential advantages of multi-stakeholder engagement. These were included in the Kidney International Supplements publication elaborating the ISN’s action plans.

A Strategic Plan for Integrated Care of Patients with Kidney Failure has been developed based on the action plans above. Selected activities are planned in conjunction with several partners to be implemented over the next 5 to 10 years.

The ISN surveyed nephrologists from low and lower-middle-income countries on their experiences in the following areas:

  • Dialysis funding and eligibility;
  • Dialysis procurement mechanisms;
  • Clinical protocols for dialysis;
  • Monitoring of dialysis outcomes; and
  • Barriers to care for kidney failure.

120 responses from 31 low and middle-income countries from 8 ISN regions were included in the analysis. An additional 88 documents from 18 countries were uploaded for analysis, including country or institutional guidelines, protocols, and standard operating procedures. Results of this survey, published in Kidney International Supplements, have informed the development of activities and recommendations in the ISN’s kidney failure action plans (see ISN’s 2nd Global Kidney Health Summit: Increasing Access to Integrated Care for Kidney Failure and the technical package ISN is developing in consultation with the WHO).

The ISN Global Kidney Policy Forum was held at the World Congress of Nephrology 2019 in Melbourne, Australia, and brought international focus to key health policy issues related to the prevention and management of kidney diseases, including kidney failure, affecting the region.

Download the second edition of the ISN Global Kidney Policy Forum publication. This valuable advocacy tool helps raise awareness of the need for equitable access to kidney care, including the prevention, detection, and management of kidney diseases in Australia, New Zealand, and Southeast Asian and Pacific Island countries.

It presents the that are considered as a checklist to assess gaps in kidney care requiring policy-related solutions and make local policymakers aware of best practices.

  • ISN Global Kidney Health Atlas (GKHA)The 2nd edition of the ISN GKHA aimed to define the current global capacity to deliver care for kidney failure, including metrics of availability, accessibility, quality, and affordability. The survey assessed the readiness of nations to achieve universal access to equitable and integrated care for kidney failure, including KRT and conservative kidney management. By generating evidence relevant to country capacity for care of kidney failure, the survey complements existing data on the global burden of kidney failure. It is a useful tool for policymakers to facilitate equitable access to kidney care for patients with kidney failure, especially in low and middle-income countries. This edition of the GKHA survey reveals high variability in the delivery of care for kidney failure globally. the full report here.

 

  • Affordable Dialysis Prize
    In 2015, The George Institute for Global Health, the Asian Pacific Society of Nephrology (APSN), and the ISN established the Affordable Dialysis Prize with support from the Farrell Family Foundation. Vincent Garvey was awarded the prize for his innovative dialysis system design. Garvey and The George Institute set up Ellen Medical Devices to build prototypes and commercialize the system. A Clinical Advisory Board is in place to move through the procedure toward regulatory approval.

A two-day meeting was held in Vancouver, Canada, from January 31 to February 1, 2020, which brought together the ISN executive leadership, members of ISN Research groups, patients, clinicians, clinical trialists, academics, industry, and regulators to establish momentum for international collaborative work in clinical trials and research in kidney disease across the world.

The meeting introduced current ISN research activities and described the overall landscape in international clinical research. Six patient partners shared their kidney journeys and their perspectives on participating in research. The focus of the meeting was to present, vet, and clarify draft definitions of kidney failure as endpoints in clinical trials, and to understand the nuances and issues related to different definitions, in specific circumstances, in order to achieve international consensus.

A publication is being drafted, which will describe the recommended components of kidney failure endpoints for use in clinical trials, based on the totality of the work done by the conference participants. Dissemination activities are subsequently planned.

This was the first attempt by the international nephrology community to identify reproducible, robust definitions of kidney failure outcomes and acceptable surrogates for clinical trials, to be used worldwide, in any resource setting. The value of these consensus definitions will be to improve consistency and understanding of results in clinical trials. This is a first step toward a long-term goal to improve the evidence base from which to treat patients with kidney diseases worldwide.