Introduction to Presidential Strategy for 2013-2015€¦ · 4 Raising public awareness of kidney...
Transcript of Introduction to Presidential Strategy for 2013-2015€¦ · 4 Raising public awareness of kidney...
Introduction to Presidential
Strategy for 2013-2015
Giuseppe Remuzzi
Hong Kong, June 03, 2013
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46 slides
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● Raising public awareness of kidney disease (World Kidney
Day - WKD)
● Nephrology education and training worldwide (Fellowship
programs, CME courses, Educational Ambassadors
Program)
● Promotion of prevention programs in emerging
countries (Research & Prevention program)
● Intervention in times of crisis and natural disaster (Renal
Disaster Relief program)
● Dissemination of knowledge and scientific results (Kidney,
International, NRN, web-based resource ISN Education)
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It is just a challenge in itself to
maintain the number and variety of
initiatives ISN has undertaken to
pursue kidney health equity world-wide
However newer and possibly greater
tasks are to be assumed if we wish to
face the challenge of global health
equity
8 Perico et al., Nephrol Dial Transpl, 2012
PREVALENCE OF ESRD (DIALYSIS AND
TRANSPLANTATION) WORLDWIDE
North and Latin America
USA: 1752 pmp
Honduras: 34 pmp
Europe
Portugal: 1494 pmp
Ukraine: 139 pmp
Africa
Tunisia: 713 pmp
Nigeria: 10 pmp
Asia/Oceania
Taiwan: 2311 pmp
India: 48 pmp
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A new gap in capacity has emerged
between scientifically proficient developing
countries (China, India, Brazil, Argentina,
Mexico, Chile, Malaysia and South Africa)
and scientifically lagging developing
countries (Cuba, Perù, Guatemala,
Honduras, Ukraine, Nigeria, Bangladesh,
Pakistan) – The South-to-South gap
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ISN should promote actions that enable the
increase in the number of post-graduated
and post-doctoral fellows moving from one
part of the Southern hemisphere to another
where excellence's centers are in place to
obtain further training
A common language, a similar life-style,
and a similar educational curriculum may
be add-on factors for better training
Which strategies to meet this task?
-South-to-South education
-Diffusion of information technology
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Encouraging diffusion of
informatics by ISN requires the
participation of companies around
the world, especially from rapidly
growing economies, that are leaders
in this field
Which strategies to meet this task?
-South-to-South education
-Diffusion of information technology
-Clinical research and science
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Promoting clinical research by ISN, at
least in middle-income countries
where resources are potentially
available, requires commitment to
encourage strong partnership between
universities/hospitals, largely funded
by governments, and nascent private
sector
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Opportunities for young
nephrologists of poor countries
to be exposed to top science
focused on key health problems
of the region at ISN World
Congress of Nephrology
WCN 2017
- Renal tuberculosis
- Meso American
Nephropathy
- Hypertension
- Diabetes
- Parasitic diseases
Mexico
WCN 2015
South
Africa - Low birthweight
- Maternal malnutrition
- HIV nephropathy
- Treatable ARF
- Viral hemorrhagic fevers
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Which strategies to meet this task?
-South-to-South education
-Diffusion of information technology
-Clinical research and science
-Attracting interest to kidney of large public
and private funding organizations
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Approaching kidney disease, especially in
poor countries, from the radical perspective
that renal failure starts in uterus will attract
attention from funding agencies and private
donors that traditionally care for cancer,
AIDS, malaria, maternal and infant health
AN ISN MOTHER AND CHILD HEALTH
PROMOTION PROGRAM
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Low birthweight
It is responsible for kidney structural changes, such
as lower nephron number, which can increase
susceptibility to late kidney damage
Maternal malnutrition
Optimal maternal and early childhood nutrition is
mandatory, particularly when considering the link
between maternal malnutrition and hypertension
and kidney disease
Children and young adult continue to
die in emerging world as a direct result
of acute kidney injury which in many
cases is a preventable and treatable
condition with few if any long-term
health consequences
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THE GLOBAL BURDEN OF ACUTE KIDNEY INJURY
13.3 million/year (2100 pmp/year)
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High-income countries:
Low- and middle-income countries:
2 million/year
11.3 million/year*
*Calculations made assuming a similar incidence as in high-income countries
Lewington et al., Kidney Int, 2013
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THE DIFFICULTIES OF DEFINING THE INCIDENCE OF ARF
IN EMERGING COUNTRIES
No nationwide collection systems, data from isolated centers
Severe fluid depletion (gastrointestinal or other infectious
illness), hemolysis secondary to malaria, HUS, snakebite
Complications of pregnancy due to limited care during
pregnancy and delivery
Incidence
Hospital: 2 – 8 per admission/year
Community: 12 – 41 pmp
In children:
In young women:
Cerda et al., Nat Rev Nephrol, 2008
ACUTE KIDNEY INJURY CONTRIBUTES TO THE
MORTALITY RATE WORLDWIDE
1.7 million death/year
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High-income countries:
Low- and middle-income countries:
300 thousands/year
1.4 million/year*
*Calculations made assuming a similar death rate as in high-income countries
Lewington et al., Kidney Int, 2013
ACUTE RENAL FAILURE: A DISEASE OF THE YOUNG
Nigeria Average age < 40 years
Arije et al., Afr J Med Sci, 2000
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India Average age = 34 years
Chugh et al., Kidney Int, 1998
THE IMPORTANCE OF DIFFERENT CAUSES OF ARF
VARIES FROM REGION TO REGION
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Tropical areas:
South Asia:
Africa:
Latin America:
Diarrhoeal and infectious disease,
malaria
Leptospirosis, typhus, envenomation
Malaria and indigenous herbal
remedies
Leptospirosis, dengue fever,
envenomation, obstetric complications
Jha et al., Nat Rev Nephrol, 2013
Jha et al., Nat Rev Nephrol, 2013
Seedat et al., Nephron, 1993
Lombardi et al., Sem Nephrol, 2008
ARF in the dehydration/infection-associated
cases or gyneco-obstetric complications can be
prevented in the home or in local healthcare
facility, often by simple treatments, such as
fluid administration and/or prompt treatment
of infections
With such treatments mortality is low and full
recovery can be expected in the majority of
patients
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Lewington et al., Kidney Int, 2013
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For those who require
hospital and dialysis,
gravity-driven peritoneal
dialysis is ideal for its
technical simplicity and
results are comparable
to hemodialysis
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Saving Young Lives in Africa and Asia
A collaborative project (2012-2016) between :
- ISN (J. Feehally)
- International Pediatric Nephrology Association (IPNA) (B. Smoyer)
- International Society for Peritoneal Dialysis (ISPD) (F. Finkelstein)
- Sustainable Kidney Care Foundation (SKCF) (M. Carter)
The project:
Development of specialized hospital centers for care of AKI including
facilities for acute PD (in Africa and Asia)
Development of models for delivery of early preventive care in local
healthcare settings in the catchment area of these specialist centers
Development of triage mechanisms to allow identification of those
needing specialized care with transport enabling rapid transfer
Funded by Recanati-Kaplan Foundation
CENTERS WHERE THE PROGRAM HAS BEEN
ESTABLISHED OR UNDER CONSIDERATION (2013)
Etiopia
(Addis Abeba)
Benin (Cotonou)
Ghana
(Kumasi,
Accra)
Nigeria
(Lagos)
J Feehally, personal communication
Established
Under consideration
Malawi
(Blantyre)
Uganda
(Kampala)
Tanzania
(Moshi)
Cambodia
Laos
(Vientiane)
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Why is it ok that a young girl dies of renal
failure in a poor country?
What we are going to do for this girl?
Nothing, is not even included on the agenda
of WHO
Treatment of acute renal failure has to
become part of human right
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ANTIRETROVIRAL TREATMENT FOR AIDS
3 by 5
(3 million people on antiretroviral by 2005)
In 2011, more than 8 million people living with
AIDS in low- and middle-income countries
received antiretroviral treatment UNAIDS, Global report, 2012
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THE HUMAN RIGHT CASE BY ISN FOR ACUTE
RENAL FAILURE
0 by 25
(No one should die of untreated acute renal
failure in poorest part of Africa, Asia and
South America by 2025)
1. Epidemiology
2. Information technology
3. Training model
4. Intervention
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4 GOALS ( just to start with…) 20,000 60,000
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This initiative requires leadership by
ministries of health, as well as robust
governance system to implement any
decision
We can also build on the ground of the
collaboration with the World Health
Organization that ISN has developed
during the last years
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One cannot accomplish all of the
above within two years of presidential
term, but I would be happy to devote
any time and energy to get at least
some of them off the ground and to
pave the way for possible
implementation of these measures in
ISN strategy in years to come
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J. Dirks
A. Levin
Canada
B. Brenner
B. Freedman
J. Burkart
M. Rocco
R, Glassock
D. Warnock
N. Levin
F. Finkelstein
USA
R. Plata
Bolivia
M. Riella
R. Pecoits-Filho
Brazil
R. Lombardi
L. Solà
Uruguay
C. Swanepoel
Y. Seedat
South Africa
G. Brunori
G. Capasso Italy
J.P. Grunfeld
France
J. Feehally
UK
B. Rodriguez-Iturbe
Venezuela
R. Correa-Rotter
Mexico