Closing the Gaps

The ISN CKD ‘Closing the Gaps’ initiative will provide a comprehensive strategy to address issues related to chronic kidney disease (CKD) care delivery worldwide. The strategy involves international leaders to understand and address issues related to gaps in clinical care delivery, research and advocacy.
Through different projects, ‘Closing the Gaps’ sets out to define the global needs, the current state and a ’blueprint’ for moving forward and closing the gaps in CKD care, using ISN research, education and advocacy activities:
It is a complementary strategy to the ISN 0by25 initiative, which aims to eliminate preventable deaths from acute kidney injury (AKI) worldwide by 2025.
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Kidney disease is increasingly seen as a public health problem, a risk multiplier for many other conditions, and for its association with cardio-vascular diseases, diabetes and infections. Its fastest growth rate is in low- and low-middle-income countries, which will require support to face the challenge of this growth.
Although renal replacement therapy has been available for decades in high-income countries, relatively little is known about the optimal way to coordinate, finance and regulate the care for people with CKD throughout the spectrum ( from diagnosis, care and access to renal replacement therapies). Throughout the world inequalities exist within emerging countries as well as in wealthier countries.
Health Atlas


The new report on global kidney health highlights the growing burden of kidney disease and significant inequities in accessing treatment across countries and regions worldwide.
The second edition of the GKHA reports on global kidney health and highlights the growing burden of kidney disease as well as significant inequities in accessing treatment across countries and regions worldwide.
Critical gaps in knowledge about the prevalence and incidence of chronic kidney disease (CKD) and existing care structures is affecting global healthcare planning for patients. The ISN Global Kidney Health Atlas (GKHA) gives a comparative analysis and data synthesis about the trends on the burden of CKD and its consequences worldwide. It raises awareness about the cause of CKD, identifying gaps modelled on the Universal Health Coverage (UHC) domains and builds the foundation for a global CKD care surveillance network.
This edition informs local and international bodies about key activities to improve healthcare policy within the global health agenda. Future work will include developing tools and implementing regional and national strategies. The ISN GKHA will track progress in each region and country.
The ISN GKHA helps ISN determine the capacity and readiness of nations to achieve universal access to equitable integrated end-stage kidney care, including kidney replacement therapy and conservative care.
Health Summit


A selected group of 85 international key opinion leaders and researchers met for two and a half days in July 2016 in Vancouver, Canada to set in motion a roadmap for action to change the status of kidney health worldwide, building on current knowledge, research and clinical activities.
Under discussion were CKD issues of global relevance, in the context of the ISN Global Kidney Health Atlas, the interfaces between CKD and AKI, and the link between kidney disease and cardiovascular and metabolic disorders.
The road map stemming from discussions has now been published in The Lancet Health Review. It identifies and prioritizes key activities for the next 5–10 years in the domains of clinical care, research, and advocacy and creates an action plan and performance framework based on ten themes.
Below you will find a summary report of the road map, the publication in the Lancet and the comprehensive report of this summit.
The ISN Global Kidney Health Summit is supported by the following organizations:
Policy Forum


ISN Global Kidney Policy Forum, 21 April 2016, 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 is 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 first meeting culminated in a clear call for action to national, regional and global policy makers. Read it below in English or Spanish:
Publications

The Lancet Kidney Campaign (http://www.thelancet.com/campaigns/kidney)
On World Kidney Day (WKD) 2016, ISN and The Lancet launched The Lancet Kidney Campaign to raise awareness about acute and chronic kidney diseases and bring together the best available evidence to inform strategies to reduce national, regional and global burden of the disease and its risk factors.
The Campaign built on the ISN’s 2015 Lancet Commission, which amplified ISN's call for the elimination of preventable deaths from AKI by 2025. It also contributed to and reinforced the Policy Forum at the World Congress of Nephrology in 2017, where participants endorsed the Conclusions of Mexico City, a 12-point set of actions to curb the burden of kidney disease worldwide.
Hosted on The Lancet website, the Campaign brings together research and analysis on AKI, CKD, and dialysis and transplantation from across the journal’s database. Over 22 months, it also provided monthly updates on advances in nephrology as well as expert commentaries and interviews on key health and policy issues relevant to kidney disease. By the campaign’s end in January 2018, a full complement of 33 updates were published. Links to these updates are available below.
Eight key society partners (SLANH, ISPD, IPNA, TTS, IFKF, APSN, ISHD, ERA-EDTA) also formally joined the campaign in 2016, and each society contributing an update to the campaign. Thanks to this increased exposure, the Campaign website was visited over 21,500 times over 22 months, and the campaign updates count over 9,300 reads.
The campaign updates are listed below by topic.
New Nephrology Developments
Onco-Nephrology: valuing link between cancer and kidney disease
Nephrology — an innovative speciality moving forward
The kidney at the origins of human health and disease
Healthcare policy
Conclusions of Mexico City – Latin America unites against Kidney Disease
Universal health coverage for dialysis in India – First steps towards change
Sustainable, affordable, quality dialysis for universal kidney care
Role of kidney health advocacy organizations in reducing the global burden of kidney disease
Reflections on the global needs for renal transplantation
The ISN 0by25 Global Snapshot Project: Tackling acute kidney injury worldwide
The Sustainable Development Goals: hope for kidney disease
Mind the gap: transitioning from child to adult kidney services
Nephrology Event Commentaries 2016-2017
Highlights from ASN Kidney Week 2016
The ISN Global Kidney Health Summit: setting a blueprint for tackling global CKD epidemic
Renal community meets in Melbourne to discuss peritoneal dialysis
Kidney Disease - Geographic Case Studies
Unraveling the clues behind a mysterious form of kidney disease
How to set up PD centres: the Chinese perspective
Facing the challenge of kidney disease in Latin America
Peritoneal Dialysis: perspectives from Hong Kong, Asia Pacific and beyond
The sorry state of children with kidney disease in Nigeria
Syrian refugee children with kidney disease
Ramadan and chronic kidney disease patients
Kidney disease in Indigenous populations
Rhabdomyolysis: disaster medicine and preventable acute kidney injury
CKD
Can water intake prevent CKD: A brief review of the evidence
Chronic kidney disease: impact on the global burden of mortality and morbidity
Diabetes
Obesity and overweight populations in Latin America
Transplantation
Kidney transplantation across the globe: the good and bad
Strategies to increase living donor transplantation
Women & Kidney Disease
The case of neonatal acute kidney injury: Don't forget the babies!
Pregnancy in young women with kidney disease — a most worthwhile journey
HIV nephropathy, a ‘vanishing’ disease in the era of antiretroviral therapy?
Pediatric Kidney Disease
Challenges of paediatric acute kidney injury in low-income and middle-income countries
Partners


The ISN CKD ‘Closing the Gaps’ is possible thanks to grants provided by the ISN and is partly supported from various sponsors and partners.
The ISN Global Kidney Health Summit is supported by the following organizations:
Leadership & Team


The ISN CKD ‘Closing the Gaps’ initiative is led by ISN President Adeera Levin.
For further information about the different projects within this initiative, please contact the relevant Project Manager.
The ISN Global Kidney Health Atlas
- Aminu Bello (Canada)
- David Johnson (Australia)
- Project Manager: Sandrine Damster (Belgium)
The ISN Global Kidney Health Summit
- Adeera Levin (Canada)
- Kai-Uwe Eckardt (Germany)
- Marcello Tonelli (Canada)
- Project Manager: Ilaria Pastorino (Belgium)
The ISN Global Kidney Policy Forum
(taking place at WCN 2017 in Mexico City)
- Magdalena Madero (Mexico)
- Gregorio Obrador (Mexico)
- Ricardo Correa-Rotter (Mexico)
- Project Manager: Matthieu Van Der Straten (Belgium)
The Lancet Kidney Campaign