Angie Aguilar-Gonzalez, an ISN-H4KH new investigator, focused her research on an area in Guatemala with high incidences of renal disease of unknown cause.
Given the high variability of fluid intake across the globe and the health consequences of these variations, she chose to measure hydration patterns and renal function markers in a group of children and adolescents.

Recognizing that community engagement plays an important role in the success of research studies, Angie drew data for this sample through engagement with the local community. She was able to build collaborative relationships with regional stakeholders and health practitioners.

The project raised awareness of kidney health in the region. So far, 36 children are enrolled in the study and 400 people participated in the first “kidney walk” organized in Guatemala. Locals visited the health center asking how to evaluate their kidneys and prevent damage. Doctors responded by requesting information to improve diagnosis and treatment.

Angie acknowledged that the research project provided “a huge opportunity to grow professionally and to make a change in Guatemala”. She’s confident that it’s an important step towards the creation of Guatemala’s own renal research centre in the future.

ISN’s H4KH initiative is supported by Danone Nutricia Research to stimulate the interest of established and new researchers to explore the role of hydration in kidney health.

Find out more here:


This second edition of the ISN Global Kidney Health Atlas (GKHA) 2019 focuses on improving understanding of the regional burden of end-stage kidney disease (ESKD) and the capacity for care delivery.

The latest findings will help encourage relevant stakeholders across countries and regions to advocate for improved access to and quality of kidney care. The data have valuable policy implications, providing a benchmark for measuring country and regional progress in kidney care and encouraging member states to bridge regional and national gaps.

Name: Geraldo Silva Junior

Hospital/Affiliation: Universidade de Fortaleza

Home Country: Brazil

Year: 2017

Status of the program: ONGOING


Title of the project:
Renal Health self-monitoring application

AKI, CKD, HD, PD, Transplantation

Short description of the project or abstract: This study will explore an inovative application for smartphones (“Renal Health” app) and integrated sensor devices, aiming to increase the knowledge of the general population on the disease prevention and help CKD patients on treatment adherence and self-monitoring. The first version of the application was developed to patients on dialysis and for kidney transplanted patients, at Android platform, based on their opinion on needs and was first tested with a group of selected patients and healthcare professionals. A new version will be developed for the IOS platform and the sessions to patients undergoing treatment without hemodialysis (conservative treatment) and undergoing peritoneal dialysis. The first version is in Portuguese and will be tested in Brazil. Further versions will also be provided in English and Spanish, and we intend to perform usefulness tests in other countries. In the same time, tools are being developed to be integrated with the application, for example, medication smart box (for registration through bluetooth of the use of medicines), portable digital scale (for the patients weight themselves where they are and this information will be sent to the application through Bluetooth, which is of huge importance for those on dialysis, to control interdialytic weight gain) and a device for increasing functioning of arteriovenous fistula for hemodialysis. We are also developing educational videos to be integrated to this app, to increase people’s knowledge about kidney disease. In the next phase, the application and its tools will be tested with a broad range of patients (individuals without CKD, patients undergoing treatment without hemodialysis (conservative treatment), patients undergoing hemodialysis, peritoneal dialysis and kidney transplantation) during a period of 3 years, and outcomes will be evaluated. The main outcomes will be mortality and graft loss. We hypothesize that the use of this app increase patients’ adherence to treatment and then decrease CKD complications, including need for dialysis, interdialytic overweight, hydroelectrolyte disturbances, hospitalizations related to preventable causes, renal allograft loss related with nonadherence and early death. It may also decrease CKD incidence and progression in the general population, once increasing knowledge about kidney disease and the ways to prevent it people will adopt healthier lifestyles.

Learning or research objectives:

  • To develop and test an application to CKD patients undergoing treatment without hemodialysis (conservative treatment), patients on dialysis and those kidney transplanted patients (Renal Health app). 

  • To screen the general population for CKD, through self-testing kidney function and CKD risk, and this will help people adopt healthier lifestyle. 

  • To develop and test tools that will be connected to the application by Bluetooth (medication smart box and portable digital scale).
  • To assess whether the use of this app and the devices has impact on patients clinical outcomes (need for dialysis, interdialytic overweight, hydroelectrolyte disturbances, hospitalizations related to preventable causes, renal allograft loss related with nonadherence and early death). 

  • To help CKD patients cope with treatment, in different modalities, including dialysis and transplantation.

Name: Channa Jayasumana

Hospital/Affiliation: University of Sri Lanka

Home Country: Sri Lanka

Year: 2017

Status of the program: ONGOING


Title of the project:

Screening of CINAC Among Adolescents


CKD, Pathology

Short description of the project or abstract: Since early the 1990s, an increase in CKD prevalence related to non-traditional risk factors primarily affecting agricultural communities and male agricultural workers has been reported in several tropical countries. Histopathological characteristics consist in a tubule-interstitial disease with glomerular (sclerosis) involvement. Considering demographic, clinical and histopathological findings disease is named as chronic interstitial nephritis among agricultural communities (CINAC).  

We hypothesized that initial kidney damage may begin in childhood prior to entering the workforce. However, rise in serum creatinine is a relatively late finding in the development of CINAC, we used novel biomarkers of early kidney damage as the primary measure of outcome.
Protein measurement in urine has been used for many years for diagnosing and monitoring of diseases. The pattern of urinary protein excretion can be used to diagnose and monitor renal injuries at particular sites within the nephron.  In the present study a series of urinary proteins/enzymes will be measured that may be indicative for the presence of a particular renal pathology.  In a next stage of the study, in patients showing a positive urinary protein excretion, a proteomics analysis will be performed in a renal biopsy which in turn may provide further mechanistic insight in the pathology and potentially provide new, more specific early markers of CINAC.

A cross-sectional study will be conducted among school children aged 15-16 years in different schools at 5 locations in Sri Lanka. Medawachchiya, Padavi Sripura and Medirigiriya are CINAC endemic areas. Colombo and Mannar are CINAC non-endemic areas. Children in Colombo and Mannar will be considered as negative controls. Mannar is the hottest area in Sri Lanka. By selecting Mannar we may assess the effect of heat stress and dehydration  on the concentration of urinary biomarkers in school children. 20 positive controls with renal biopsy compatible with CINAC will also be included.

Renal markers indicative of damage of primarily glomerular, tubular or both will be measured in mid-stream morning urine. All children will undergo a second screening 4 months later. Only the children who present with increased urinary markers at both screenings will undergo a third screening 4 months later Renal biopsy will be performed in subjects in whom the same two markers were positive in two out of three screenings For histological and proteomic analysis of the renal biopsy. In these subjects urinary proteomics will be performed also. 50 school children (25 boys/25 girls) will be recruited at grade 10 classes from the various places. So there will be 250 participants in total for the study; 125 boys and 125 girls. The sealed envelope method will be used for randomization. Questionnaires will be completed by an experienced interviewer to collect demographical data as well as to evaluate the possible exposure to agrochemicals. A series of (early) markers of renal injury will be measured in a first urine fraction at the University of Antwerp.

Learning or research objectives:
Hypothesis: Glomerular or tubular, lesions in CINAC begin in childhood. Nephron segment specific markers of early
renal damage are present at abnormal concentration in urine samples of school children living in CINAC
endemic areas.
Aim: To assess the presence and type of early sub-clinical kidney damage in CINAC endemic areas

Name: Khaled Elzorkany

Hospital/Affiliation: Menoufia Faculty of Medicine, Menoufia University

Home Country: Egypt

Year: 2017

Status of the program: ONGOING


Title of the project:
CKD screening in Menoufia and Assiut, Egypt



Short description of the project or abstract: Chronic kidney disease (CKD) often diagnosed late creating a public health problem with adverse outcome and high cost such as kidney failure, cardiovascular diseases and premature death. CKD is the end result of DM, hypertension, at the same time CKD predisposes to CVD and hypertension. The developing world cannot afford to manage its rapidly rising CKD patients. The best long term option is to resort to preventive and early detection methods for these non-communicable chronic diseases. Objectives: 1) Early detection of CKD by cost-effective methods and simple laboratory testing at a time when intervention may favorably affect outcomes. 2) Prevention of renal failure by; Early identification of modifiable risk factors for CKD progression and good control of them such as diabetes mellitus, hypertension, obesity, anemia, smoking and proteinuria. Also, our objectives are treatment of correctable causes of CKD in addition to increase community awareness by the problem. 3) Building database about these diseases and implementation of preventive program in our country. 4) Sharing in the Egyptian data system for NCDs. Subjects: This is a community based mass screening program with multicenter study linked together through a web based program ( ) for early detection and prevention of NCDs. The total number will be 4000 general community participants' ≥18 years old. Participants will be subjected to screening by questionnaire, physical measures and simple laboratory tests in addition to confirmation of albuminuria and estimate GFR by CKD Epi equation. Expected outcomes: decreasing bad outcomes, morbidity and mortality of these non-communicable chronic diseases in the participants. The total cost of the project on this number of participants highlight the support we require to reach our experimental goals and targets. At the end of this project, we would share to implement the program to the surrounding Egypt community and the Egyptian data system through our evidence based web based program.

Learning or research objectives:
• Increased percentage of participants with CKD discovered to have CKD for the first time and many of them in a late stage of CKD, with adequate control of risk factors for renal disease progression in those participants.
• Early intervention for curable CKD as obstructive uropathy, UTI and analgesic abuse nephropathy.
• Appropriate management of participants with diabetes, hypertension, cardiovascular diseases (CVD) and obesity with decrease in their morbidity and mortality.
• Increased level of awareness by the problem on individual, society, healthcare providers and policy maker levels, and building database for these non communicable chronic diseases.
• Active participation of non-governmental organizations in solving of community problems.

Monday, 16 October 2017 15:53

Great news from SWC 2017 graduate in Nepal

Congratulations to Dr Kirshna Agarwal from Nepal, one of the 2017 ISN Scientific Writing Course (SWC) graduates.

This recent commentary featured in The Lancet Diabetes Endocrinal 2017 focuses on the need for coordinated efforts and a large international database of patients with diabetes and nephropathy.

J.Plange Rhule

Jacob Plange-Rhule

Hospital/Affiliation: Komfo Anokye Teaching Hospital

Home Country: Ghana

Host Country: Ghana

Year: started in 2011 extended in 2014

Status of the program: COMPLETED

Title of the project:
10 and 12 year follow up of cohort of 1,013 40-75 year olds in 12 village communities in the Ejisu-Juabeng and Kumasi Districts: observations on changes in glomerular filtration rate (GFR) and blood pressure


Short description of the project or abstract:
The inhabitants of the countries of Sub-Saharan Africa are experiencing a double burden of disease. There has been a substantial rise in morbidity and mortality of noncommunicable diseases but the countries involved still have to deal with the problems of communicable diseases, though there is some evidence now that their prevalence is beginning to fall.
Renal disease is likely to become much more noticeable by virtue of its contribution to morbidity and mortality. Consequently, efforts to collect basic data from normal populations are urgently needed. As yet nephrological research in Africa is at an early stage, and reliable data are few. Indeed, as far as we know, there are no nephrological data at all from normal populations in rural Africa. This is why we are hoping to conduct this follow-up study. Only with such data will it be possible to formulate a reasoned Public Health strategy for kidney disease.

Learning or research objectives:
1. To determine changes in the prevalence of high blood pressure 10 years later
2. To investigate the clinical outcomes including morbidity and mortality in participants with and without high blood pressure in the original study
3. To determine changes in GFR/eGFR 10 years later
4. To assess rate of loss of GFR in these unselected normal individuals
5. To assess GFR/eGFR changes in those with and without high blood pressure in the original study   

Arpita Roy Chowdhury

Hospital/Affiliation: IPGMER, Kolkata

Home Country: India

Host Country: India

Year: started in 2012

Status of the program: COMPLETED

Title of the project:

SSCARE - Screening School Children for asymptomatic renal abnormalities and evaluation.

Pediatric Nephrology

Short description of the project or abstract:

Learning or research objectives:

Dr. Sequeira Reyes

PI: Maria Josè Sequeira Reyes; Supporting investigators: Antonino Sidoti and Paolo Mazzacani

Hospital/Affiliation: Nephrology Clinic-Fundacion Coen, Chinandega, Nicaragua

Home Country: Nicaragua

Host Country: Italy

Year: started in 2017

Status of the program: IN PROGRESS

Title of the project:
CKD in High Risk Areas in Chinandega department, Nicaragua


Short description of the project or abstract:

In high risk area for CKD due to mesoamerican nephropathy an epidemiological study in 12-22 y.o. people in Chinandega department an area in the Pacific coastal part of Nicaragua, involving four municipalities: El Viejo, Chichigalpa, Corinto, El Realejo. Sugarcane Plantations, the largest of Nicaragua and the biggest port of Nicaragua are  present in this area. Work activities at sea level like sugarcane and work in ships' holds at port are already been described as connected with kidney damage and with mortality from CKD in very young age.
A double stage cluster randomization with recruitment of 1600 people in 10 schools and more than 20 barrios and comarcas, with visit and exams performed at participants home or at schools, via a mobile clinic, would allow the investigation of factors not connected with labor or indicating area of residency as risk factors, drinking water supply, alcool and smoke habits, automedication drugs and attitude giving a questionnaire.
Anthropometric measurements, blood pressure measurements, evaluation of familiarity for diabetes. Estimated glomerular filtration rate is calculated,  urinary abnormalities are detected.
A follow up of two years after baseline visit is performed. This facilitates access to nephrology treatments to people unaware of CKD with the possibility of free anti-hypertensive, multivitamins, oral hypoglycemic drugs.

Learning or research objectives:

a) measure prevalence of CKD at young age in the area with the higher risk of CKD in Nicaragua

b) investigate associations of CKD cases with risk factors connected or not connected with occupation

c) Treat early kidney failure in a low income country without a national program of dialysis and transplantation

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