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ISN Initiatives related to CKD: COMGAN AND KDCC.
William G. Couser, MD
Past-president, ISN
ISN COMGAN Chair
The focus of nephrology world wide has changed from an emphasis on renal
replacement therapy for ESRD to an increased focus on the early detection
and prevention of kidney disease and its cardiovascular consequences.
Data from several countries indicate that about 10% of the adult population
has some form of CKD. People with CKD have a greatly increased risk of
premature death from cardiovascular disease (CVD) - indeed they are up
to 100 fold more likely to die of CVD, now the most prevalent cause of
premature death worldwide, than to reach ESRD. Studies have demonstrated
that early detection and treatment of CKD not only reduces progression
to ESRD but more importantly reduces by up to 50% the risk of CV death.
The ISN has adapted to this "new nephrology" with changes in
the face of many of its core outreach programs encompassed under the Commission
for the Global Advancement of Nephrology (COMGAN). The ISN fellowship
training program has increased the emphasis on training in clinical epidemiology
and outcomes research and is utilizing programs that specialize in such
training. The ISN Continuing Nephrology Education (CNE) program, which
supports over 50 educational events that reach over 10,000 health care
providers in the developing world each year, has increased the emphasis
on education in early detection and treatment. The ISN
Sister Renal Centers program has been restructured and supports 40 centers
worldwide that facilitate early detection initiatives and progress from
level C to level A with a goal of creating a major independent renal center
in each region of the developing world to promote all aspects of renal
health. The ISN Research and Prevention Committee provides funding for
early detection and treatment programs designed to demonstrate both the
feasibility and cost effectiveness of such efforts in developing countries
with challenged health care systems. This committee has developed the
Program for Detection and Management of Chronic Kidney Disease, Hypertension,
Diabetes and Cardiovascular Disease in Developing Countries (KHDC program)
as a global template designed to help doctors, health care workers, and
governments to establish local prevention programs for CKD, hypertension,
diabetes and CVD with screening, management and data assessment components.
The template for establishing such a program is available on-line and
applications for support of these programs are considered twice each year.
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