Below is an overview of projects carried out under the 0by25 Initiative.

To gain a better understanding of the way AKI is managed globally, the ISN developed the AKI Global Survey in 2014, available in eight different languages.

More than 10,000 nephrologists from 72 countries around the world provided data on over 4000 patients and their diagnoses and treatments of AKI in their respective countries.

The survey generated data for the AKI Global Snapshot.

The data collected from the AKI Global Survey generated the AKI Global Snapshot which summarized the main findings of the global burden and management of AKI worldwide. These findings were published in The Lancet on April 13, 2016.

Key Findings:

  • Community versus hospital-acquired AKI is more frequent.
  • Most common AKI causes are hypotension and dehydration.
  • Nearly 10% of patients in need of dialysis fail to receive it.
  • AKI mortality is high across all countries.

Based on these findings, the ISN set up the AKI Pilot Feasibility Study to launch a series of pilot projects in selected health centers in Africa, Asia, and Latin America to test education interventions designed to reduce the number of preventable AKI deaths focusing principally on community-acquired AKI patients in LMIC settings.

These pilot projects were implemented in “clusters” within each continent containing 4-6 health care clinics for local communities, 1-2 regional hospitals, and 1 referral hospital.

Building on the main findings of the AKI Global Snapshot, the 0by25 Pilot Feasibility Study was carried out between 2016 and 2017 to establish a sustainable infrastructure according to local needs and resources in the prevention and detection, education and training, and management of AKI.



  • Determine the barriers for the recognition and management of AKI in different settings.
  • Compare outcomes from AKI before and after interventions.
  • Establish a global network of stakeholders to raise public awareness of AKI.
  • Assess the feasibility of implementing interventions to optimize education, training, and care of AKI based on a comprehensive 5R approach.


Initial results of the 0by25 Pilot Feasibility Project were presented at the World Congress of Nephrology 2019 in Melbourne. The study’s main findings will be released in a scientific journal in 2020.

Launched in July 2017, the Kidney Care Network project assesses whether a successful intervention from the Pilot Feasibility Study can become routine health care in low and middle-income countries and achieve sustainable, locally-led improvement in AKI detection and management. The Kidney Care Network is carried out across four project sites in Bolivia, Brazil, South Africa, and Nepal.

These sites deliver education and training in AKI care through local experts and in full collaboration with local institutions to improve the standard of care in AKI detection and management in a way that is appropriate to and sustainable within the local setting. Local experts train all relevant healthcare workers at the sites using educational materials evaluated as successful during the Pilot Feasibility Study.

The project is currently collecting data to measure the impact of these interventions. All four centers are supported by the initiative when engaging with local health authorities to ensure the routine and long-term implementation of the proposed interventions.

In Action:

AKI Training in Dharan, Nepal, October 1-2, 2018
AKI trainers, healthcare workers and patients at KCN Bolivia site in 2018

The Saving Young Lives (SYL) Project is a partnership to deliver AKI care in low-income countries. Working in low-resource health settings, SYL helps to establish and maintain hospital centers for the care of AKI, including facilities for acute PD. The project focuses on hospital development and training and education activities in the community to improve awareness and equip local health practitioners for prevention, as well as identification of cases needing hospital care.

Learn more about this project on its main page here.