key: cord-1029577-ymonufz4 authors: Feehally, John title: A unique role in global nephrology The International Society of Nephrology 2011-2020 date: 2020-05-25 journal: Kidney Int DOI: 10.1016/j.kint.2020.05.011 sha: 3c00c512bd15be41f7191bbbfd380c8b544f6dbe doc_id: 1029577 cord_uid: ymonufz4 nan In 2020, the International Society of Nephrology (ISN) celebrates 60 years since its foundation and first congress in 1960. The history of its development until 2010 has been well documented 1, 2 . Since then, in the decade 2011-2020, ISN's activities around the world have had increasing range and impact, enabling ISN to maintain its unique role as the leading professional organisation in global nephrology. ISN's Vision and Mission, redrafted in 2018 reflect its global role in nephrology ( Table 1 ). In the decade 2011-2020, ISN has sought to expand its efforts in low and middle income countries (LMIC) while maintaining its responsibility to provide valuable benefits for all its members including those in high income countries (HIC). In 2011, ISN was supported by the Brussels-based association management company, Interel. Luca In 2011, the ISN Council had 32 elected councillors using geographical boundaries little changed for 30 years. In 2016 Regional Boards in each of the ten world regions were established with the goal that they should be the 'eyes and ears' of the ISN in each region -ensuring dissemination of key information, advising about regional contexts for new proposals, and helping to plan regional implementation. This was followed in 2018 by a revision of the Council structure; there are now only twenty councillors, the chairs and deputy chairs of each Regional Board. The day to day leadership of the ISN is devolved to the Executive Committee chaired by the ISN President, and including past-President, President-elect, Secretary-General, Treasurer and Executive Director, with up to four other ISN members selected by the President. In 2017 the role of Secretary General was discontinued, since those administrative responsibilities had now been taken over by HQ staff. During the decade, the ISN was served by five presidents (Figure 1.) , three secretary-generals (Adeera Levin (Canada), Ricardo Correa-Rotter (Mexico), and Robyn Langham (Australia)) and three treasurers (Victor Schuster, Thomas Coffman, and Stuart Shankland (all USA)). The ISN made other governance changes during the decade including broadening membership to include allied health professionals, as well as more effective implementation of policies for equity, diversity and inclusion. ISN membership numbers were maintained through the decade, in 2020 there are more than 8500 members with an encouraging shift in the age distribution to a younger membership. Nephrologists still in training are now given free ISN membership for the first year, followed by a reduced fee until they complete training. Those in lower middle income countries are offered group ISN membership (two to five members for one fee). Membership is free to all in low income countries. A unique strength of ISN is its network of more than one hundred affiliated national and regional nephrology societies. Some of these societies sign up a proportion of their members and become Collective ISN Members at a special annual rate. In 2020, these include the nephrology societies of Australia and New Zealand, Brazil, Colombia, Canada, Netherlands, Estonia, Hong Kong, Iran, Israel, Jordan, Philippines, Panama, Paraguay, South Africa, Spain, and Switzerland. The transforming effects of the digital era have influenced ISN's approach to communications. The website remains a primary source of information. Regular ISN communications with the membership are focused into a fortnightly 'e-blast' known as ISN Insight, keeping additional e-mail communications to a minimum for greater impact. ISN has steadily increased its presence on social media, coordinated by ISN's Social Media Task Force (Twitter: @ISNKidneyCare, @ISNEducation and @worldkidneyday). The decade has seen expansion in the range and depth of ISN global efforts in education, advocacy, and research. Many ISN activities involve more than one of these elements, but for convenience, are described here under these headings. ISN is uniquely placed to have global impact in nephrology but does so more effectively when sharing complementary expertise and resources; ISN has continued to partner extensively with other global and regional nephrology organisations to deliver its programs. The World Congress of Nephrology (WCN) was held in alternate years throughout the decade, An increasing feature of WCN is sustainable logistics and organisation, by 2019 WCN at Melbourne was completely paper-free. The proportion of registrations from within the region where WCN is being held is increasing. The WCN scientific program continues to cover most aspects of nephrology, but it has increasingly provided a focus on issues specific to the region: for example HIV-related kidney disease and fetal-maternal kidney health issues in Cape Town in 2015, and diabetic kidney disease in Mexico City in 2017. The WCN educational program offers a solid diet of core nephrology teaching, including a renal pathology course, and there are hands-on interventional nephrology workshops. ISN's many other activities in education, research, and advocacy, for example ISN Programs and World Kidney Day, are now showcased at WCN more clearly than they were in the past. ISN Awards are presented during plenary sessions, which also include a number of ISN lectures named in honour of past ISN leaders. From 2013, ISN instituted Pioneer Awards, given to 'unsung heroes' from LMIC who have made outstanding contributions to nephrology in their own country or region ( Table 3) . ISN's Forefronts meetings were focused on topics typically of most interest to laboratory researchers. Seven Forefronts meetings were held during the decade (Table 4. ). ISN was a net investor to ensure the scientific success of each Forefronts meeting, which typically did not draw in substantial external financial sponsorship. Nexus meetings focused on topics with an established bench to bedside spectrum of work, to provide a 'nexus' for interaction between laboratory and clinical investigators and clinicians in a series of meetings characterised by plenary discussion across the whole gamut from disease mechanisms through to clinical care and therapeutics. Four Nexus meetings were held during the decade (Table 4.). As time passed, the distinction between topics suitable for Nexus or Forefronts blurred, and from 2016 they were amalgamated into a new meeting series, ISN Frontiers (Table 4. Qualitative feedback about the programs is strongly positive, and efforts continue to quantify their impact 5 . In recent years some 40% of ISN fellowships are awarded for training within their region, rather than in host centers in a developed country. Such in-region training ensures relevant clinical experience, minimises language and cultural disparities and has also reduced the concern that fellows going to HIC find attractive career opportunities there and never return home. For example, since 2010, more than 90% of fellows from sub-Saharan Africa, who have trained in centers in South Africa, have ISN supports speakers to attend Continuing Medical Education (CME) meetings in LMIC for which the program has been developed to meet local needs. These programs increasingly include practical skills training (for example in interventional nephrology). Local organisers provide opportunities for visits to hospitals and teaching ward rounds, and meetings with local health leaders. Support is also being given to larger regional meetings which afforded opportunities not only for education but also for strategic discussions among nephrology leaders in the region. The first of these were held in West Africa and East Africa in 2018. In the Educational Ambassador program, experts undertake short visits to an emerging center to support development of an aspect of clinical care (for example, renal pathology or vascular access care). The expert can be accompanied by supporting personnel (for example a nurse or a technician). Many of these visits lead on to longer term mentorship. As the year 2025 approaches, ISN is focused on showing measurable progress towards the original 0by25 challenge of zero avoidable deaths, even though this will not be fully achieved by 2025. During the presidency of Adeera Levin (2015-17) she developed an additional emphasis on the growing challenge of CKD as a non-communicable disease (NCD) with increasing prevalence but variable awareness among health policy makers. Country by country information about expertise and access to care, as well as relevant health policy is now available in the ISN Global Kidney Health Atlas first published in 2017, with a second edition in 2019 which collected data from 160 countries 11 . Sequential information can now be used to monitor progress, and where necessary provide challenge to health systems which lag behind in care. The ISN's first global health summit to review these issues was held in Vancouver in 2016 leading to a 'road map' providing recommendations on closing gaps in care, research , and policy 12 . During the presidency of David Harris (2017-19) , he led an additional emphasis on the worldwide challenges of ESKD care. Few countries, even HIC, have truly integrated ESKD care including renal replacement therapy by dialysis and transplantation, and also conservative care. To address these disparities, ISN held its second global health summit in Sharjah in 2018 which produced an action plan for progress 13 . guidance on establishing chronic dialysis programs in low resource settings. ISN has established regional policy forums held during WCN, first in Mexico City in 2017, then in Melbourne in 2019. Representatives of health professionals, patients, and policy makers assemble to address issues related to kidney health in the region and seek commitments from health ministers to policy change and investment to address gaps in care. The first two forums produced substantial statements of intent including a set of twelve recommendations to improve kidney health 14, 15 . International Society of Nephrology: a forty year history A mission in evolution: the International Society of Nephrology in the past 10 years -2001-2010 Improving global health: measuring the success of capacity building programs: a view from the International Society of Nephrology Saving Young Lives" with acute kidney injury: the challenge of acute dialysis in low-resource settings Peritoneal dialysis for acute kidney injury International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study Risk factors for Community-Acquired Kidney Disease Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy Increasing access to integrated ESKD care as part of universal health coverage ISN Global Kidney Policy Forum Focus on Oceania