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A unique role in global nephrology

The International Society of Nephrology 2011-2020

John Feehally

About the Author: Professor John Feehally

John Feehally was Consultant Nephrologist at Leicester General Hospital from 1988 to 2015, and is Honorary Professor of Renal Medicine at the University of Leicester, UK. He has been ISN Secretary General (2005-2009), ISN President (2011-2013), and ISN Programs Chair (2013-2019).

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INTRODUCTION

In 2020, the International Society of Nephrology (ISN) celebrates 60 years since its foundation and

first congress in 1960. The story of the ISN has been documented in two previous accounts

published to coincide with its 40th and 50th anniversaries respectively1,2. Presented here is an

account of the ISN in its most recent decade, between 2011 and 2020. This report describes the

increasing range and impact of ISN’s many activities around the world in this decade, and how ISN

has grown, developed, and matured to maintain and enhance its unique role as the leading

professional organisation in global nephrology.

The history of the ISN in this decade is generally one of continuing growth and success inevitably

interspersed with some challenges and vicissitudes. The ISN achieves much because of the very

many who become involved – ISN members who volunteer their time, energy and expertise to make

ISN’s whole range of activities effective and successful, and also the professional staff who make the

ISN run so smoothly. All these people are much valued, but it would not have been practical to

name them all, so those identified by name have held the most senior leadership positions in ISN,

both among its members and its professional staff.

ISN: VISION & MISSION – Commitment to global activities

What is ISN? And what does it want to become? In this decade, the vision and mission of ISN

underwent further steady development beyond its origins as a conventional professional medical

society. Since the 1980s, its leaders had begun to recognise ISN’s unique opportunity and

responsibility to be a truly global nephrology organisation, seeking to support the growth of

nephrology, not only in high income countries (HIC), which had already established substantial

nephrology services and infrastructure, but also in low and middle income countries (LMIC) in all

parts of the globe. The initiation of the ISN Fellowship program in 1985 was the first manifestation

of this commitment to supporting nephrology in LMICs. This was followed over the next two

decades by the development of the five ISN programs3, which became the bedrock of ISN’s unique

capacity building in LMIC under the umbrella known as COMGAN (Commission for Global

Advancement in Nephrology), later rebranded from 2009 as ISN GO (Global Outreach). Since the

1 Robinson RR, Richet G. International Society of Nephrology: a forty year history. 1960-2000. Kidney Int Suppl. 2001 Jun;79:S1-100. 2 Barsoum R. A mission in evolution: the International Society of Nephrology in the past 10 years – 2001-2010. Kidney Int 2011; 79: 935-943 3 Fellowships, Sister Renal Centers, Continuing Medical Education, Educational Ambassadors, Clinical Research

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beginning of the 21st century, ISN increasingly described itself as a philanthropic organisation4

largely on the basis of these programs. This is reflected in ISN’s Vision and Mission reframed in 2018

(Table 1).

Table 1: ISN Vision & Mission 2011-2020

2011-2018 2018-Present

Vision ISN aspires towards the elimination of kidney disease worldwide.

A future where all people have equitable access to sustainable kidney health

Mission ISN is dedicated to advancing the diagnosis, treatment, and prevention of kidney diseases globally through collaborations, meetings, publications, outreach, and other activities that:

• Raise public awareness

• Connection professionals

• Support research

• Provide nephrology education and training worldwide

• Reduce the frequency and impact of kidney diseases and their associated conditions

The ISN is a philanthropic organization dedicated to advancing worldwide kidney health. We do this for all our stakeholders by:

• BRIDGING THE GAPS of available care through advocacy and collaborations with our global partners

• BUILDING CAPACITY in healthcare professionals via granting programs, education and research

• CONNNECTING OUR COMMUNITY to develop a stronger understanding of the management of kidney disease

In the decade 2011-2020, there have been many opportunities to broaden ISN’s effectiveness in

LMIC. Since the ISN is the only professional society with a major commitment to support nephrology

in MIC, it seeks out as many such opportunities as possible, within the limited resources available.

On the other hand, ISN is sensitive to its responsibility also to provide valuable benefits for all its

members including those in HIC, whose continuing membership in large numbers are critical to the

inclusiveness, the financial strength, and therefore the effectiveness of the society. The ISN

Executive Committee and Council have debated the balance between LMIC and HIC member needs

throughout the decade, and although effective strategies have been agreed, there are inevitable

tensions in providing optimal membership experiences and benefits for all members in diverse

locations around the world.

4 Couser WG, Feehally J, Rodriguez-Iturbe B. The International Society of Nephrology: what does "philanthropic" mean for members? Kidney Int. 2009;76:239-42

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LEADERSHIP, ORGANISATION, GOVERNANCE

ISN members provide their time and talents on a volunteer basis. The only members receiving direct

remuneration are the editors in chief of KI and KI Reports. On ISN’s many committees, working

groups and regional boards some four hundred ISN members are voluntarily contributing. Some of

these make involvement with ISN a major element in their professional life.

Staff & Headquarters

In 2011, ISN was contracting its management requirements through the Brussels-based association

management company, Interel, having moved the contract in 2009 from its first provider of these

services, MCI, also based in Brussels. Luca Segantini had been recruited as ISN Executive Director in

2009 (Figure 1). The increasing range and complexity of ISN’s activities already required a growing

professional staff; in 2010 there were 8 FTEs.

ISN’s growth had brought it to the stage that reduced the advantages offered by working through an

association management company, and in 2011 the decision was made that ISN should become self-

managing, directly employing its own staff, and renting offices in Brussels for its headquarters. A

subsidiary office was maintained in New Jersey, USA where the financial affairs were managed,

appropriately given that ISN continued to be incorporated as a 501(c) non-profit organization in the

United States5. A Belgian legal entity, the ISN Foundation, was established to handle the

complexities of Belgian payroll and a local office in Brussels.

The expectation, based on business modelling developed by Luca Segantini that the move to self-

management would reduce costs as well as improve efficiency, was amply borne out. The transition

while time consuming for staff and some leaders, was largely seamless to the wider ISN

membership.

ISN continues to be served by a highly committed, young, multilingual staff; Brussels which hosts

many international organisations providing a fertile ground for their recruitment. Staff numbers

continued to grow throughout the decade as ISN’s activities and infrastructure relentlessly

increased; in 2019 ISN employed or contracted 36 staff.

5Section 501(c) of US federal law allows non-profit organizations to be exempt from some income taxes.

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In 2018 Luca Segantini stepped down after a decade of exemplary leadership and service for ISN,

and was succeeded by Charu Malik in 2019 (Figure 1).

Figure 1: ISN Executive Directors, 2011-2020

Luca Segantini 2008-2018 Charu Malik 2019-present

Organisational Structure

The decade has also seen an evolution in the organisational structure and governance of ISN to meet

the needs of its growing portfolio.

In 2011, the ruling ISN Council had 32 members (each councillor had a maximum 6-year term of

office) elected on a regional basis using geographical boundaries little changed for 30 years (Table

2). The number of councillors from each region broadly reflected the number of ISN members in

that region. Election of councillors took place every two years (shortly before WCN), and ISN

members were eligible to vote for councillors from all regions. The day to day leadership of the ISN

was mainly devolved to the smaller Executive Committee chaired by the ISN President; other

members being the past-President, President-elect, Secretary-General, Treasurer and Executive

Director; with two councillors and two other ISN members selected by the President (Table 3).

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Table 2: ISN Councillors 2009-2019

Region 2009-11 2011-13 2013-15 2015-17 2017-19

Africa Sarala Naicker (South Africa) Maher Ramzy (Egypt)

Boucar Diouf (Senegal) Maher Ramzy (Egypt)

Boucar Diouf (Senegal) Maher Ramzy (Egypt)

Boucar Diouf (Senegal) Felicia Eke (Nigeria)

Felicia Eke (Nigeria) Charles Swanepoel (South Africa)

Europe Jorge Cannata (Spain) Kai-Uwe Eckhardt (Germany) Dick de Zeeuw (Netherlands) Meguid El-Nahas (UK) Peter Stenvinkel (Sweden) Kamal Serdengecti (Turkey) Laszlo Rosivall (Hungary)

Jorge Cannata (Spain) Kai-Uwe Eckhardt (Germany) Dick de Zeeuw (Netherlands) Meguid El-Nahas (UK) Francesco Locatelli (Italy) Peter Stenvinkel (Sweden) Laszlo Rosivall (Hungary)

Jorge Cannata (Spain) Kai-Uwe Eckhardt (Germany) Dick de Zeeuw (Netherlands) Meguid El-Nahas (UK) Francesco Locatelli (Italy) Klaus Ølgaard (Denmark) Laszlo Rosivall (Hungary)

Sandrine Florquin (Netherlands) Paul Harden (UK) Eric Rondeau (France) Francesco Locatelli (Italy) Klaus Ølgaard (Denmark) Justin Silver (Israel) Rumeyza Kazancioglu (Turkey)

Sandrine Florquin (Netherlands) Paul Harden (UK) Eric Rondeau (France) Rosanna Coppo (Italy) Klaus Ølgaard (Denmark) Justin Silver (Israel) Rumeyza Kazancioglu (Turkey)

Middle East

Riyad Said (Jordan) Mona Al-Rukhaimi (UAE)

Mona Al-Rukhaimi (UAE)

Mona Al-Rukhaimi (UAE)

Shahrzad Ossareh (Iran)

North & East Asia

Philip Li (China) Toshio Miyata (Japan) Sungwong Kim (South Korea) Chih-Wei Yang (Taiwan)

Zhi-Hong Liu (China) Toshio Miyata (Japan) Sungwong Kim (South Korea) Chih-Wei Yang (Taiwan)

Zhi-Hong Liu (China) Sungwong Kim (South Korea) Sadayoshi Ito (Japan) Chih-Wei Yang (Taiwan)

Sadayoshi Ito (Japan) Daniel Chan (Hong Kong) Masaomi Nangaku (Japan) Fan Hou (China)

Sadayoshi Ito (Japan) Daniel Chan (Hong Kong) Masaomi Nangaku (Japan) Fan Hou (China

Oceania & SE Asia

Gavin Becker (Australia) Peter Kerr (Australia)

Somchai Eiam-Ong (Thailand) Peter Kerr (Australia) Gavin Becker (Australia)

Somchai Eiam-Ong (Thailand) Peter Kerr (Australia) David Johnson (Australia)

Somchai Eiam-Ong (Thailand) David Johnson (Australia) Robert Walker (New Zealand)

David Johnson (Australia Robert Walker (New Zealand) Adrian Liew (Singapore)

Russia & NIS*

Irma Tchokonelidze (Georgia)

Irma Tchokonelidze (Georgia)

Irma Tchokonelidze (Georgia)

Helena Zakharova (Russia)

Latin America

Ana Cusumano (Argentina) Juan Fernandez-Cean (Uruguay) Martha Franco (Mexico) Sergio Mezzano (Chile)

Ana Cusumano (Argentina) Juan Fernandez-Cean (Uruguay) Martha Franco (Mexico) Sergio Mezzano (Chile)

Sergio Mezzano (Chile) Roberto Pecoits-Filho (Brazil) Laura Sola (Uruguay) Mirian Boim (Brazil)

Roberto Pecoits-Filho (Brazil) Laura Sola (Uruguay) Mirian Boim (Brazil) Walter Douthat (Argentina)

Roberto Pecoits-Filho (Brazil) Laura Sola (Uruguay) Mirian Boim (Brazil) Walter Douthat (Argentina)

South Asia Georgi Abraham (India) Rezvi Sheriff (Sri Lanka)

Sanjay Agarwal (India) Vivek Jha (India) Rezvi Sheriff (Sri Lanka)

Sanjay Agarwal (India) Vivek Jha (India) Harun-Ur-Rashid (Bangladesh)

Sanjay Agarwal (India) Vivek Jha (India) Harun-Ur-Rashid (Bangladesh)

Harun-Ur-Rashid (Bangladesh) Manisha Sahay (India) Muhibur Rahman (Bangladesh)

North America

Richard Johnson (USA) Adeera Levin (Canada) Nathan Levin (USA) Agnes Fogo (USA) Roland Blantz (USA) Allison Eddy (Canada) Marcello Tonelli (Canada)

Roland Blantz (USA) Alfred Cheung (USA) Allison Eddy (Canada) Agnes Fogo (USA) Bertram Kasiske (USA) Susan Quaggin (Canada) Marcello Tonelli (Canada)

Roland Blantz (USA) Alfred Cheung (USA) Allison Eddy (Canada) Joseph Bonventre (USA) Bertram Kasiske (USA) Susan Quaggin (Canada) Marcello Tonelli (Canada)

Alfred Cheung (USA) Joseph Bonventre (USA) Bertram Kasiske (USA) Susan Quaggin (Canada) Sharon Andreoli (USA) Ravi Mehta (USA) Karen Yeates (Canada)

Joseph Bonventre (USA) Sharon Andreoli (USA) Ravi Mehta (USA) Karen Yeates (Canada) Kam Kalantar-Zadeh (USA) Tushar Vachharajani (USA) Myles Wolf (USA)

*NIS, New Independent States

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Table 3: Executive Committee Membership 2011-2021

2011-13 2013-15 2015-17 2017-19 2019-21

President John Feehally (UK)

Giuseppe Remuzzi (Italy)

Adeera Levin (Canada)

David Harris (Australia)

Vivekanand Jha (India)

President-Elect Giuseppe Remuzzi (Italy)

Adeera Levin (Canada)

David Harris (Australia)

Vivekanand Jha (India)

Agnes Fogo (USA)

Past-President Bernardo Rodriguez-Iturbe (Venezuela)

John Feehally (UK)

Giuseppe Remuzzi (Italy)

Adeera Levin (Canada)

David Harris (Australia)

Secretary General Adeera Levin (Canada)

Ricardo Correa-Rotter (Mexico)

Robyn Langham (Australia)

Treasurer* Victor Schuster (USA)

Thomas Coffman (USA) / Stuart Shankland (USA)

Stuart Shankland (USA)

Stuart Shankland (USA)

Stuart Shankland (USA)

Representatives of Council

Gavin Becker (Australia)

Toshio Miyata (Japan)

Susan Quaggin (Canada)

Peter Kerr (Australia)

Zhi-Hong Liu (China)

Mona Al-Rukhaimi (UAE)

Roberto Pecoits-Filho (Brazil)

Masaomi Nangaku (Japan)

Elena Zakharova (Russia)

Adrian Liew (Singapore)

Ad hoc members Vivekanand Jha (India)

William Couser (USA)

Bernardo Rodriguez-Iturbe (Venezuela)

Chih-Wei Yang (Taiwan)

Kai-Uwe Eckardt (Germany)

Masaomi Nangaku (Japan)

Valerie Luyckx (Switzerland)

Gloria Ashuntantang (Cameroon)

Fergus Caskey (UK) Sarala Naicker (South Africa) Valerie Luyckx (Switzerland)

Chairs - various ISN committees

David Harris (Australia) Publications

David Harris (Australia) Education

John Feehally (UK) Programs

John Feehally (UK) Programs

*Treasurer became Secretary/Treasurer from 2017

During the decade, the ISN was served by five presidents (Figure 2), 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 Presidents

continued to be elected by the Council; Secretary-General and Treasurer were appointed by the

Council on the recommendation of the President and Executive Committee. In 2017 it was agreed to

discontinue the longstanding role of Secretary General, since the administrative responsibilities of

that role had now been taken over by HQ staff.

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Figure 2: ISN Presidents 2011-2020

John Feehally (UK)

2011-13

Giuseppe

Remuzzi

(Italy)

2013-15

Adeera Levin

(Canada)

2015-17

David Harris

(Australia)

2017-19

Vivekanand Jha

(India)

2019-2021

Although these overall structures had served ISN well, there were some limitations. The rapidly

moving palette of ISN’s work required intensive oversight and prompt decision making by the

Executive Committee. The Council was not easily kept fully informed and its role had sometimes

been reduced to retrospective approval of plans already moving forward, especially since the

Council only met face to face once or twice a year. Councillors were not always well connected to

ISN activities and priorities in the regions they represented. While ISN also had regional committees

in eight regions in the developing world, these had been developed in the 1990’s to support

COMGAN, were focused on LMIC support giving advice on the ISN programs, but had no other

specified role.

A first step in the needed changes was the establishment of Regional Boards in each of the ten world

regions in 2016, with terms of reference which in summary required the Regional Boards to be the

‘eyes and ears’ of the ISN in the region – ensuring dissemination of key information, advising about

regional contexts for new proposals, helping to plan regional implementation. The first Chairs of the

Regional Boards were appointed by the Executive Committee. As Regional Boards began to function

effectively, the relative roles of councillor and Regional Board became increasingly less clear, not

least because the old established division into council regions did not map precisely to those of the

new Regional Boards. Logically, this then led to a major revision of the Council structure, approved

by Council in 2018, and implemented for the 2019 council elections. There are now only twenty

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councillors, the chairs and deputy chairs of the Regional Boards (Table 4). Deputy Chairs are elected

every two years, and succeeded the Chair after two years.

Table 4: ISN Councillors 2019-2021

New Council structure – there are now twenty Councillors - the chairs and deputy chairs of the ten

ISN Regional Board

Despite the increasing number and skills of the HQ staff team led by the Executive Director, the

growth in scope and complexity of ISN’s work required more intensive time commitment for the

Executive Committee. Much work could be done virtually, but the added value of face to face time

was at a premium. The previous pattern of only one or two such meetings each year (at WCN and

during ASN Kidney Week) with one Executive Committee retreat during each Presidency was clearly

insufficient. From 2011 Executive Committee retreats were held annually (2011 Oxford, 2012

Oxford, 2013 Bergamo, 2014 Bergamo, 2015 Vancouver, 2016 Vancouver, 2017, Madrid, 2018

Frankfurt, 2019 Brussels). There was also from 2016 an Executive Committee meeting annually in

Brussels giving the opportunity to strengthen working relationships between the Executive

Committee members and HQ staff.

At the beginning of the decade the only staff member regularly attending Executive Committee

meetings was the Executive Director. By the end of the decade also present at each Executive

Committee meeting (and Council) meeting were the directors and senior staff for Programs,

Region Councillors 2019-21

Africa Charles Swanepoel (South Africa) Gloria Ashuntantang (Cameroon)

Western Europe Eric Rondeau (France) Rosanna Coppo (Italy)

Central & Eastern Europe Rumeyza Kazancioglu (Turkey) Vladimir Tezar (Czech Republic)

Middle East Shahrzad Ossareh (Iran) Ali Abu-Alfa (Lebanon)

North & East Asia Fan Hou (China) Yusuke Suzuki (Japan)

Oceania & SE Asia Adrian Liew (Singapore) Muh Geot Wong (Australia)

Russia & NIS Helena Zakharova (Russia) Abduzhappar Gaipov (Kazakhstan)

Latin America Walter Douthat (Argentina) Magdalena Madero (Mexico)

South Asia Manisha Sahay (India) Dibya Singh Shah (Nepal)

North America Myles Wolf (USA) Rulan Parekh (Canada)

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Meetings, Marketing & Communications, Advocacy, Research, Membership and Operations. This

change reflected the growing importance of senior staff oversight for delivery of ISN’s work, and a

changing balance in the roles of volunteer leaders and staff.

Governance Review

In 2016, the ISN Executive Committee appointed Light Trail6 to undertake a review of the existing

ISN organisation and governance, and make recommendations for change. This review was

prompted by both external and internal concerns. It was felt that the external perception of ISN’s

unique achievements and objectives was limited by complexities of messaging, which were in part a

product of ISN’s growth and success. Internally the relentless growth in the range of ISN’s activities

had provoked incremental organisational changes which despite the best efforts of staff and

leadership were felt to have added complexity, and to be hindering effective and flexible

management of change.

ISN needed management and governance procedures able to prioritise and manage the many

external opportunities with which it was being presented, as well as the many new proposals for

action being received from its members. LightTrails worked with the ISN leadership from 2017 to

2019 to agree and then implement significant changes, which are significantly enhancing ISN’s

effectiveness.

These included

• a fresh description of ISN’s vision, mission and values (Table 1)

• broadening membership inclusivity – allied health professionals, such as nurses, dieticians or

renal technicians, holding a health-related doctoral degree being eligible for full membership

of ISN

• introduction of the new regional board and council structures, and changed election

processes

• Clarification of the respective roles of committees, working groups, and advisory groups (ISN

Committees and Working Groups, and their chairs during the decade are shown in Tables 5

& 6).

• renewed emphasis on the implementation of ISN’s policy to ensure equity, diversity and

inclusion a more transparent and disciplined approach to resource allocation

• and improved ways of working within the leadership and staff team

6 LightTrail, an organisational development consultancy based in Vancouver, Canada, which specialised in advising non-profit organisations.

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Table 5: ISN Committee Chairs 2011-2019

Committee Chairs during 2011-2019

Advocacy Adeera Levin (Canada)

Nominating Ricardo Correa-Rotter (Mexico)

Joanne Bargman (Canada)

Agnes Fogo (USA)

Sarala Naicker (South Africa)

Clinical Practice Guidelines Gavin Becker (Australia)

Education David Harris (Australia)

Vivek Jha (India)

Publications David Harris (Australia)

Bertram Kasiske (USA)

Acute Kidney Injury Ravindra Mehta (USA)

Emmanuel Burdmann (Brazil)

Dialysis Fredric Finkelstein (USA)

Simon Davies (UK)

Pathology Agnes Fogo (USA)

Ian Roberts (UK)

Interventional Nephrology

Miguel Riella (Brazil)

Tushar Vachharajani (USA)

ISN-ACT (Advancing Clinical Trials) Vlado Perkovic (Australia)

iNET-CKD (International Network of Chronic Kidney Disease Cohort Studies)

Harold Feldman (USA)

ISN-ANIO

(co-chair with ANIO)

John Feehally (UK)

Adeera Levin (Canada)

Kidney Health Professionals Marie Richards (Australia)

Kidney Health in Disadvantaged Populations

Guillermo Garcia (Mexico)

Keith Norris (USA)

Meetings Carol Pollock (Australia)

Renal Disaster Relief Task Force Raymond Vanholder (Belgium)

Wim van Biesen (Belgium)

WKD (co-chair with IFKF) William Couser (USA)

John Feehally (UK)

Philip Li (Hong Kong)

Young Nephrologists Fiona Brown (Australia)

Roberto Pecoits-Filho (Brazil)

Jeffrey Perl (Canada)

Rolando Claure-Del Granado (Bolivia)

Awards Committee President

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Table 6: ISN Committees and Working Groups 2019-Present

Type Chair

Committees

Awards Vivekanand Jha (India)

Clinical Research Giovanni Strippoli (Italy)

Continuing Medical Education Peter Blake (Canada)

Core Programs David Harris (Australia)

Educational Ambassadors Program Elena Zakharova (Russia)

Fellowship Allison Eddy (USA)

ISN-ACT (Advancing Clinical Trials) Vlado Perkovic (Australia)

Thomas Hiemstra (UK)

iNET-CKD (International Network of

Chronic Kidney Disease Cohort

Studies)

Harold Feldman (USA)

Sister Renal Centres Marcelo Orias (Argentina)

Peter Kerr (Australia)

Young Nephrologists Gavin Dreyer (UK)

Working Groups

Advocacy Donal O’Donoghue (UK)

Dialysis Simon Davies (UK)

Education Tushar Vachharajani (USA)

Interventional Nephrology Yong-Soo Kim (South Korea)

Kidney Health Professionals Michele Trask (Canada)

Paul Bennett (Australia)

Renal Disaster Preparedness Adrian Liew (Singapore)

Renal Pathology Ian Roberts (UK)

Research Adeera Levin (Canada)

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The organisational chart of ISN in 2020 is shown in Figure 3.

Figure 3. ISN Organisational Chart 2019-Present

MEMBERSHIP

At the end of 2019 there were 8,350 ISN members (Table 7). A steady increase in the number of

members, which might have been expected given the steady increase in numbers of nephrologists in

many parts of the world, did not materialise There was however a gradual shift in the distribution of

membership with more members in South and East Asia and Africa, and fewer in North America

(Figure 4). Encouragingly the age distribution shifted to a younger membership (Figure 4), not least

because of the active work and profile of the Young Nephrologists Committee.

Table 7: Patterns of ISN Membership 2011-2019

2011 2015 2019

Members paying full membership dues

5,086 3,761 6,342

Joint members* 2,404 1,229 665

Members in training** 497 1,286 830

Others 2,038 2,214 513

Total members 10,025 8,490 8,350

*Joint members are members in lower income countries – 10 members for each membership due. Until 2015 this was available to all low- and middle-income countries, then only in LIC and LMIC **Members in approved medical training programs. From 2015 no membership dues in first year of ISN membership, and reduced fee thereafter until training completed.

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Figure 4. Patterns of ISN membership

A: Regional distribution of members 2011 & 2019

Africa…Eastern and Central

Europe5%

Latin America7%Middle East

4%NIS and Russia

1%

North America and the Caribbean

23%

North and East Asia21%

Oceania and South East Asia

8%

South Asia7%

Western Europe19%

ISN MEMBER PER REGION 2011

Africa9%

Eastern and Central Europe

2%

Latin America7%

Middle East6%

NIS and Russia2%

North America and the Caribbean

20%North and East Asia

11%

Oceania and South East Asia

18%

South Asia11%

Western Europe14%

ISN MEMBER PER REGION 2019

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B: Age distribution of members 2011 & 2019

Transient surges in membership were seen in regions where WCN was being held, as a substantial

reduction in WCN registration fee was offered to members, but member retention was

disappointing. There were a variety of initiatives intended to grow membership; the goals were to

make membership benefits more attractive and communicate more effectively about them, with the

aims to increase both new members and member retention. Young 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

37-404%

41-5021%

51-6540%

66+33%

under 372%

ISN MEMBERS PER AGE GROUP 2011

37-4010%

41-5022%

51-6529%

66+13%

under 3726%

ISN MEMBERS PER AGE GROUP 2019

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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.

While the total number of ISN members (as for any other medical professional organisation) is a

yardstick for the popularity of the membership benefits it affords, from a financial perspective it is

the revenue generated (i.e. the number of full fee-paying members) which is critical to the success of

the society by fuelling both existing and intended activities. ISN member benefits were continually

reviewed to ensure they were attractive: traditional benefits like access to ISN’s journals in hard

copy had become less relevant in the era of digital access. Communications with members were

refined to ensure ISN’s wide range of activities and successes were better known. Although the ISN

Academy (see below) was at first open access, from 2019 some elements had member only access.

Although many member benefits are equally valuable to all members, some differ. For example, in

LMIC ISN membership affords access to ISN’s capacity building programs. Some members will value

the philanthropic opportunity, ISN membership being a means of providing support for

disadvantaged nephrology colleagues in LMIC.

The challenge of maintaining and growing membership numbers is not unique to ISN, and in part

reflects changing attitudes to society membership, especially among younger physicians who may

prefer to pay for particular elements of membership benefit rather than seeing the value of the

entire package.

Honorary membership of ISN, which had been granted to ISN members, judged to have played a

major role in ISN or played a wider leading role in global nephrology, was discontinued in 2013.

ISN COMMUNICATIONS

The transforming effects of the digital era provided new possibilities for wide-reaching rapid

communications which have influenced ISN’s approach to communications with members, and also

reaching out beyond the membership to increase awareness of the range and depth of ISN’s

activities and to advocate for kidney health.

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The website remained a primary source of information. The ISN’s first effective website had been

built in partnership with Nature Publishing Group as part of ISN’s publishing contract, but from 2013

a more refined and flexible digital platform was established7.

Regular ISN communications with the membership was focused into a fortnightly ‘e-blast’ known as

ISN Insight, keeping additional e-mail communications to a minimum for greater impact.

The quarterly ISN News continued as a 16-page colour high quality hard copy publication focused on

news of ISN achievements and new activities, and delivered both to ISN members and a broader

swathe of ISN supporters. ISN News is now transmitted digitally with no hard copy.

The decade was also characterised by the emergence of digital social media such as Facebook,

Twitter, and LinkedIn and their role in medical education and networking became prominent. At

first the province of a small number of enthusiasts, this rapidly became a communications norm,

especially among younger ISN members. Used first by the Young Nephrologists Committee and the

WKD team, a number of social media groups rapidly sprang up across ISN, and to ensure greater

coordination, these are now coordinated by ISN’s Social Media Task Force (Twitter:

@ISNKidneyCare, @ISNEducation and @worldkidneyday).

FINANCES

ISN continued to rely on three main income streams: membership dues, journal income, and

revenues from WCN and other ISN conferences. ISN’s reserves were maintained at a level which

allowed some of the interest generated from their investment to provide an additional income

stream.

The ISN’s reserves had been held in Vanguard, a US-based low risk investment fund, for some years

which had provided relative stability, and helped to minimise the adverse effects of the 2008 global

financial crisis. In 2016 there a switch to more active management of ISN’s investments to optimise

returns, and the Royal Bank of Canada was appointed as ISN’s investment manager.

OFAC – the US Office for Federal Asset Control

ISN has always desired to deploy its resources wherever in the world they can contribute to the

growth of nephrology, regardless of political or other external influences. However, some

7 Developed by BrightBean Solutions (led by Jordan Weinstein, ISN member from Canada) alongside technical planning for ISN Academy.

18

restrictions continued throughout the decade in a small number of countries embargoed by the

United States through OFAC. Since ISN is incorporated in the United States, it is restrained by such

federal action, even when resources are only being used for philanthropic goals such as medical

education and training. During this decade OFAC sanctions at various times prevented all ISN

activity in countries including Cuba, Iran, Sudan, Syria, North Korea, and Myanmar. ISN was however

able to obtain temporary licences from OFAC for specified activities in Iran (2015 - present),

Myanmar (2013), Cuba (2014) and Sudan (2016-2018). Restrictions in Cuba eased in 2015, and the

bans in Sudan and Myanmar were lifted in 2016 and 2017 respectively.

ISN IN ACTION

The decade has seen expansion in the range and depth of ISN global efforts, most of which can be

summarised in three elements: education, advocacy, and research. Such elements are not

necessarily completely distinct, and many ISN activities involve more than one of these elements.

For example, at the World Congress of Nephrology there is clearly activity related to education,

research and advocacy. Nevertheless, for convenience, ISN‘s work is described here under these

three headings.

EDUCATION

ISN continues to offer a broad range of educational opportunities – through journals, meetings, and

more recently its on-line presence. ISN’s educational offerings for its members and non-members

alike are varied in content and approach. Education is the driving force for the ISN capacity building

programs in LMIC

World Congress of Nephrology

The World Congress of Nephrology (WCN) was held in alternate years throughout the decade. Bids

to host WCN are invited from different regions of the world by rotation to help ensure ISN’s

commitment to the growth of nephrology across the world. The final choice of city from those

bidding is made by the Executive Committee and the Council in the light of recommendations from

the ISN’s professional events team. WCN was held in Vancouver (2011), Hong Kong (2013), Cape

Town (2015), Mexico City (2017), and Melbourne (2019) (Table 8). An increasing feature of WCN

was sustainable logistics and organisation – at Vancouver in 2011 the congress was held in an eco-

friendly ‘green’ building with electronic instead of paper signage, and all food was supplied by local

merchants making donations to needy populations. By 2019 WCN at Melbourne was completely

paper-free with on-line programs and reminders.

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Table 8: World Congresses of Nephrology 2011-2019

Date City Partner Societies

Chair, Scientific Program

Committee

Chair, Local Organising Committee

Registrations % of registrations from region where WCN

held

Abstract submissions (% accepted)

2011

Vancouver CSN Richard Johnson (USA)

Adeera Levin 4,300 North America 24%

2,013 (85%)

2013

Hong Kong APSN HKSN

Carol Pollock (Australia)

Philip Li (Hong Kong)

5,899 North & East Asia 28%

1,919 (91%)

2015 Cape Town AFRAN SARS

Pierre Ronco (France)

Charles Swanepoel (South Africa)

3,600 Africa 27% 1,861 (81%)

2017

Mexico City SLANH Kai-Uwe Eckardt (Germany)

Ricardo Correa-Rotter

(Mexico)

4,000 North & Central

America 49%

1,500 (87%)

2019 Melbourne ANZSN APSN

Masaomi Nangaku (Japan)

Peter Kerr (Australia)

3,580 Australasia & Western Pacific

61%

1,170 (97%)

AFRAN, African Association of Nephology ANZSN, Australia and New Zealand Society of Nephrology APSN, Asian Pacific Society of Nephrology CSN, Canadian Society of Nephrology HKSN, Hong Kong Society of Nephrology SARS, South African Society of Nephrology SLANH, Sociedad Latinoamericana de Nefrologia e Hipertension

Though always working in partnership with the local and regional societies of nephrology, the ISN’s

professional events team have taken increasing control over the operations of WCN, once the city

has been selected, using their experience to gain greater financial benefits by negotiation, for

example, with the chosen convention center and the local hotel bureau. Although WCNs have been

judged successful by the feedback received, registrations no longer increased and never matched

the high points which had been achieved when WCN was held in partnership with ERA-EDTA: in

Berlin in 2003 (8,600 registrations), and Milan in 2009 (10,500 registrations). 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 through invited presentations and oral and

poster presentations of original work selected from submitted abstracts. But it increasingly also

provides a focus on issues specific to the region: for example, HIV-related kidney disease and foetal-

maternal kidney health issues in Cape Town in 2015, diabetic kidney disease in Mexico City in 2017,

glomerulonephritis and dialysis-related issues in Melbourne in 2019.

The WCN educational program also offers a solid diet of core nephrology knowledge; a pathology

course is a regular and popular feature, and there are hands-on workshops for interventional

nephrology. ISN’s many other activities in education, research, and advocacy, for example the

Programs and World Kidney Day, are now showcased more clearly than they were in the past.

20

From 2020 it was agreed that WCN would become an annual meeting – the chosen cities so far being

Abu Dhabi (2020)8, Montreal (2021), and Kuala Lumpur (2022).

ISN Awards & Named Lectures

WCN, as ISN’s flagship meeting, continues to showcase the winners of ISN Awards, which are

presented during plenary sessions. The awardees are selected by a committee chaired by the ISN

President following an open call to ISN members for nominations. The winners of ISN Awards during

the decade are shown in Table 9.

Table 9: ISN Award winners 2011-2019

There is an open call to all ISN members for nominations. The Bywaters, Hamburger, Richards, and Robinson

Awards are selected by an Awards Committee chaired by the ISN President.

The Lilian Jean Kaplan Prize winners are selected by a separate committee with joint representation from ISN

and its partner for the prize, the PKD Foundation. This committee was chaired 2011-2019 by Nathan Levin

(USA)

WCN also continued to be the opportunity for a number of ISN lectures named in honour of past ISN

leaders (Table 10). In 2012, the ISN Council approved the introduction of a new named lecture at

WCN, in honour of Stewart Cameron (UK, ISN President: 1993-1995), with the invited lecturer to be

8 The Abu Dhabi WCN 2020 was unfortunately cancelled because of the coronavirus pandemic

Award Focus 2011 2013 2015 2017 2019

Jean Hamburger

Award

Research in nephrology with

a clinical emphasis

Eberhard Ritz (Germany)

David Salant (USA)

Manikkam Suthanthiran

(USA)

Stanley Jordan (USA)

Detlef Schlondorff (USA)

AN Richards Award

Basic research in fields relevant to nephrology

Terry Strom (USA)

Susan Quaggin (Canada)

Barry Brenner (USA)

Friedhelm Hildebrandt

(USA)

Melissa Little (Australia)

Roscoe R Robinson

Award

Education in nephrology

Meguid El-Nahas

(UK)

Norbert Lameire (Belgium)

Haiyan Wang

(China)

Georgi Abraham (India)

Mignon McCulloch

(South Africa)

Agnes Fogo (USA)

Bywaters Road Lifetime achievement in

the field of Acute Kidney

Injury.

Ravi Mehta (USA)

Bruce Molitoris (USA)

Kirpal Chugh (India)

Raul Lombardi (Uruguay)

Mehmet Sever (Turkey)

Ray Vanholder

(Belgium)

Lilian Jean Kaplan Prize

Advancement in the

Understanding of Polycystic

Kidney Disease

James Calvet (USA)

Gerd Walz (Germany)

Vincent Gattone (USA)

Dorien J.M.

Peters (Netherlands)

Peter Igarashi (USA)

Gregory Pazour

(YSA)

David Beier (USA)

Ronald Perrone

(USA)

York Pei (Canada)

Bradley Yoder

(USA)

21

less than 40 years old and having already made major contributions to clinical research in

nephrology. While this recognition of Cameron was warmly welcomed, the decision prompted an

update of the ISN’s policy with regard to both its named lectures and named prizes; not least to

avoid the situation that offering such recognition for other senior past ISN leaders could lead to a

continually growing list of named lectures and award which might devalue their prestige.

Table 10: Named Lecturers at WCN 2011-2019

2011 Vancouver 2013 Hong Kong 2015 Cape Town 2017 Mexico City 2019 Melbourne

Donald Seldin Lecture

David Salant Membranous nephropathy:

journey from rats to man

Nine Knoers A new era of nephrogenetics:

advances using next generation sequencing

Olivier Devuyst Continuum from rare disorders to

general population risk

Melissa Little From embryogenesis to kidney engineering

Shimon Sakaguchi Control of immune responses by

regulatory T cells

Claude Amiel Lecture

David Sachs New Approaches to renal Transplantation: Tolerance and Xenografts

Li-Sheng Liu 2010 Chinese Guideline for the Management of Hypertension

Dusko Ehrlich Intestinal microbiota in health and disease

Mark Pepys Therapeutic progress in amyloidosis

Stephen Simpson Putting the balance back in diet: the nutritional geometry of obesity, metabolic disease and ageing

Brenner-Dirks Lecture

Wendy Hoy Renal Disease in Indigenous Populations: Lessons from the Australian Aborigine

Adibul Hasan Rizvi Make the impossible possible: renal transplantation in developing countries

Shabir Madhi Role of vaccines in making the world a better place for children

Philipp Scherer Metabolism and Obesity

Sania Nishtar Global health and noncommunicable diseases

Stewart Cameron Lecture

Myles Wolf Mechanisms of cardiovascular injury induced by disordered phosphate homeostasis

Katalin Susztak Epigenetics: finding the missing heritability of complex diseases

Richard Flavell Dysbiosis – immunoregulation by the gut

Carola Vinuesa Novel insights into the molecular pathogenesis of human SLE

Hugh de Wardener Lecture

Tom Kirkwood Why and how aging makes us sick

John Stamatoyannopoulos The new genomics: implications for understanding and treating renal disease

Jonathan Himmelfarb The global epidemic of kidney disease and access to high quality dialysis care

ISN Pioneer Awards

From 2013, ISN established Pioneer Awards to recognise individuals who as ‘unsung heroes’ have

made outstanding and sustained contributions to the establishment or development of nephrology

in their own country or region. Only those born in LMIC and who have worked for the great majority

of their career in such a country are eligible. One award could be made in each developing world

region every two years; the recipients are honoured at WCN, and there is also a presentation at a

meeting in the awardees’ own region. Winners of the Pioneer Awards are shown in Table 11.

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Table 11: ISN Pioneer Awards 2013-2019

*Pioneer Awards were not made in three regions in 2019, since there were no suitable nominations

Nexus, Forefronts & Frontiers

ISN’s Forefronts meetings, a feature of ISN’s meeting portfolio since the 1990s, were highly focused

on topics typically of most interest to laboratory researchers. Seven Forefronts meetings were held

during the decade (Table 12). Through Forefronts meetings, ISN supported renal science where the

translational impact was not necessarily immediate, and with little expectation that revenue would

be generated; indeed, ISN has usually been a net investor to ensure the scientific success of each

Forefronts meeting, which typically did not draw in substantial external financial sponsorship.

ISN’s Nexus meetings, established in 2006, focused on topics with an established bench to bedside

spectrum of work, and intended 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 12). By selecting topics characterised by an active

pipeline of new therapies, the opportunities for commercial sponsorship were maximised with the

goal that Nexus would be revenue generating for ISN (a goal that was achieved with variable

success).

As time passed, the distinction between topics suitable for Nexus or Forefronts blurred, and in 2016

it was agreed to amalgamate the two into a new brand, ISN Frontiers. There have now been two ISN

Frontiers meetings (Table 12).

Region 2013 2015 2017 2019

Africa

Yackoob Seedat (South Africa)

Rashad Barsoum (Egypt)

Hasan Abu-Aisha (Sudan)

Oladipo Olujimi Akinkugbe (Nigeria)

Central & Eastern Europe

Momir Polenakovic (FYR Macedonia)

Vytautas Kuzminskis (Lithuania)

Ayla San (Turkey)

Halima Resic (Bosnia & Herzegovina)

Latin America

Nelson Mazzuchi (Uruguay)

José Luis Peña (Mexico)

Nestor Schor (Brazil)

Edgar Sanclemente (Colombia)

Middle East

Tareq Suhaimat (Jordan)

Berhooz Broumand (Iran)

Riyad Said (Jordan)

*

Russia & NIS

Natalia Tomalina (Russia)

Maya Ignatova (Russia)

Assiya Kanatbayeva (Kazakhastan)

Valery Pilotovich (Belarus)

North & East Asia

Haiyan Wang (China)

Shan-yan Lin (China)

Wu-Chang Yang (Taiwan)

*

OSEA

Visith Sitprija (Thailand)

Zaki Morad (Malaysia)

Wiguno Prodjosudjadi (Indonesia)

Supat Vanichkarn (Thailand)

South Asia

Vidya Acharya (India)

Adibul Hasan Rizvi (Pakistan)

Harun-Ur-Rashid (Bangladesh)

*

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Table 12: ISN Nexus, Forefronts and Frontiers Meetings 2010-2020

A: Nexus

Year Topic Venue Registrations

September 2012 Bone and the Kidney Copenhagen, Denmark 678

April 2014 New Era of Drug Discovery and Clinical Trials in Kidney Disease

Bergamo, Italy 316

September 2014 Hypertension and the Kidney Brisbane, Australia 143

April 2016 Translational Immunology in Kidney Disease Berlin, Germany 213

B: Forefronts

Year Topic Venue Registrations

June 2012 Systems Biology and the Kidney Ann Arbor, USA 119

October 2012 Tubulointerstitial Disease in Diabetic Nephropathy Melbourne, Australia 126

September 2013 Stem Cells and Regeneration in the Kidney Florence, Italy 92

March 2014 Intrinsic Regulation of Kidney Function Charleston, USA 78

September 2014 Genetic Basis of Renal Disease Boston, USA 106

October 2015 Immunomodulation of Cardio-Renal Function: A focus on

cardio-renal pathophysiology and immunity

Shenzhen, China 181

September 2016 The Metabolome and Microbiome in Kidney Disease San Diego, USA 99

C: Frontiers

Year Topic Venue Registrations

February 2018 Kidney Disease and Cardiovascular Disease

Tokyo, Japan 1584

October 2020 Complement related kidney diseases: classification, genetics and

treatment

Bergamo, Italy In

preparation

Journals

During this decade, ISN’s flagship journal continued to be Kidney International (KI), Nature Reviews

Nephrology ceased to be an ISN journal, and a new online, open access journal, KI Reports was

established.

Kidney International

Editors-in-chief of KI through the decade were Qais Al-Aqwati (USA) (2005-2011), Detlef Schlondorff

(USA) (2011-2018), and Pierre Ronco (France) (2018- ). Throughout this period the editorial office

24

for KI continued to be based at Washington University, St. Louis, Missouri, USA under the

indefatigable leadership of executive editor, Pat Morrissey.

Under its successive editorial teams, KI continues to be a successful, high profile journal publishing a

wide range of original research in basic and clinical science as well as reviews and other features,

including some directly related to ISN activities. KI’s impact factor grew briskly from 6.5 in 2010. In

2018 its five-year impact factor was 8.6, placing KI third among nephrology journals. KI Supplements

continued to provide a parallel opportunity for focused publications, for example KDIGO Clinical

Practice Guidelines or meeting proceedings sometimes with publication costs met by commercial

sponsorship.

KI had always provided a valuable income stream for ISN through the purchase of institutional as

well as individual subscriptions, and also print advertising revenue. However, there was now a

rapidly changing and uncertain publishing landscape with the move from print to digital having

impact on all aspects of the financial model for medical journals. A decade long contract with

Nature Publishing Group expired in 2015, and a new ten-year contract was awarded to Elsevier.

The move away from Nature Publishing Group meant, unfortunately, that Nature Reviews

Nephrology9, which had proved to be a popular ISN membership benefit, was no longer an ISN

journal.

Kidney International Reports

Reflecting the shift towards on-line rather than paper publishing, a peer-reviewed open access,

exclusively on-line journal, KI Reports, was launched in 2016 with Jai Radakrishnan (USA) as its first

editor in chief, and Radha McLean as Executive Editor. With the primary aim of contributing to

improved care of patients with kidney disease, it publishes original clinical and translational articles

and educational content related to kidney disease, including clinical trials, epidemiology, systematic

reviews and outcomes research, as well as national and regional clinical practice guidelines. KI

Reports encourages submission of original research from LMIC in its journals.

ISN Academy www.theisn.org/education-external/isn-academy

9 Nature Reviews Nephrology (NRN) had been launched by Nature Publishing Group in partnership with ISN as Nature Clinical Practice Nephrology in 2005, Robert Schrier (USA) being its first editor-in-chief. In line with its policies for this stable of journals, NPG rebranded it in 2009 as NRN, with a new editor in chief from the NPG staff, Susan Allison. NRN’s exclusive focus on review articles, mostly with a clinical focus quickly brought it success; in 2018 its Impact Factor was 15.3.

25

In this decade, as the communication power of the internet and its varying digital platforms evolved

rapidly, ISN moved forward in developing an on-line educational offering, led by the Education

Committee, chaired by David Harris The development of a ‘fit for purpose’ digital platform was the

key foundation, and challenging given the very rapidly changing technology in this arena. The new

on-line education portal was launched in 2013 as ISN Education, and from 2017 was known as ISN

Academy. An editorial team chaired by Vivek Jha, and then by Tushar Vachharajani, rapidly

generated a wide range of content including for example: talks streamed from WCN and other ISN

educational meetings, podcasts, cases and images, guidelines, and webinars. The high level of

volunteer commitment from ISN members, both in leadership and in production of content, enabled

rapid progress at remarkably low cost compared to the investments made in on-line education by

some other comparator organisations. In keeping with ISN’s vision and mission it included much

material particularly relevant to emerging nephrology in LMIC, which became one hallmark of the

ISN Academy distinguishing it from all other on-line nephrology offerings around the world10. A

significant proportion of content is developed in partnership with other organizations, including

KDIGO11, Cochrane Collaboration, DOPPS12, ISPD13, and IPNA14. Today, the ISN Academy contains

some 8,000 hours of educational resources, and selected content in seven languages, which attract

to the platform around 1,000 visitors each month.

CAPACITY BUILDING PROGRAMS IN LMIC

The ISN’s outreach education programs focused on LMIC remained through the decade a unique ISN

offering which continued to bring global recognition and respect to the society. The work continued

to be divided into five programs only available to applicants from LMIC: Fellowships, Continuing

Medical Education, Sister Renal Centers, Educational Ambassadors, and Clinical Research (including a

Scientific Writing Course).

These five ISN programs had been known from 2009 as ISN-GO15. The ISN-GO ‘brand’ had some

disadvantages, not least the implication that these five programs represented all that ISN was doing

to support LMIC nephrology, whereas ISN’s work for LMIC had now grown greatly in breadth and

depth. Therefore the ‘GO’ title was dropped in 2014, and now the five are simply known as ISN

Programs.

11 KDIGO, Kidney Disease Improving Global Outcomes 12 DOPPS. Dialysis Outcomes & Practice Patterns Study 13 ISPD, International Society for Peritoneal Dialysis 14 IPNA, International Pediatric Nephrology Association 15 GO - Global Outreach

26

The programs continued to be a major expenditure for ISN, which now commits to them on average

$1.5 million annually. At any one time about 20% of this expenditure comes from partnerships with

academic and commercial organisations, as well as individual donors (Table 13).

Table 13: External financial support for ISN Programs 2011-2020

Abbvie Amgen American Nephrologists of Indian Origin Australia & New Zealand Society of Nephrology Asia Pacific Society of Nephrology American Society of Nephrology Baxter CREED (Cross-Regional Education & Exchange in Dialysis), Australia Elsevier European Renal Association- European Dialysis & Transplant Association Heartlands Hospital, Birmingham, UK Hong Kong Society of Nephrology International Association of Chinese Nephrologists Indian Society of Nephrology International Pediatric Nephrology Association (PNA) Japanese Society of Nephrology Kidneys for Life – Manchester Institute of Nephrology & Transplantation, UK Kidney Research UK Otsuka Pontifica Universidade Catolica do Parana Renal Association, UK Roche Salmasi Family Schrier Fund Société Francophone de Néphrologie Dialyse et Transplantation Sociedad Latinoamericana de Nefrologia e Hipertension Turkish Society of Nephrology The Transplantation Society University of Michigan, USA World Kidney Fund

While the programs are widely regarded as successful, and offering a high ‘return on investment’

documentation of their impact is challenging. Although qualitative feedback is strongly positive,

considerable efforts continue to quantify the impact of the programs16. The organisation and

management of the five programs continued without major change during the decade. Each

16 For example: Feehally J et al. Improving global health: measuring the success of capacity building programs: a view from the International Society of Nephrology. Kidney Int Suppl 2016; 6: 42-51

27

program had a chair, the five chairs meeting regularly to ensure coordinated oversight of the work in

a ‘Core Programs Committee’ led by the Programs Chair (Table 14). ISN staff support was led by the

Programs Director at HQ; administration of the programs was streamlined by the incremental

introduction of an on-line application process which all five programs were using by the end of the

decade.

Table 14: Leadership of ISN Programs 2011-2020

Chair Deputy Chair

Core Programs

Committee

2007-13 Bill Couser (USA)

2013-19 John Feehally (UK)

2019- David Harris (Australia)

Fellowships 2007-13: David Harris (Australia)

2013- : Allison Eddy (Canada)

2019- : Ike Okpechi (South Africa)

Continuing Medical

Education

2007-13: Norbert Lameire (Belgium

2013-19: Fred Finkelstein (USA)

2019- : Peter Blake (Canada)

2017-19: Peter Blake

2019- : Sydney Tang (Hong Kong)

Sister Renal Centers 2009-17: Paul Harden (UK)

2017-20: Peter Kerr (Australia)

2017-20: Marcelo Orias (Argentina)

Educational

Ambassadors

2008-15: Sarala Naicker (South Africa)

2015-19: Vivek Jha (India)

2019- : Elena Zakharova (Russia)

2017-19: Elena Zakharova (Russia)

2019- Gavin Dreyer (UK)

Clinical Research* 2008-12: Giuseppe Remuzzi (Italy)

2012-18 Cello Tonelli (Canada)

2018- : Giovanni Strippoli (Italy)

2015-19 : Giovanni Strippoli (Italy)

2019- : Arpana Iyengar (India)

*known until 2014 as Clinical Research & Prevention

High demand for the Programs continued, and the selection process, especially for fellowship and

sister renal center applications has become increasingly competitive. Successful applicants are those

who convincingly demonstrate the relevance and suitability of their proposal to the circumstances of

nephrology in their institution and their country.

Fellowships http://fellowship.theisn.org/

28

The emphasis of ISN Fellowships continued to be clinical training, although some fellowships for

research training were awarded when appropriate for the home applicant. In recent years some

40% of ISN fellowships are awarded for training within their region, rather than choosing host

centers in a developed country. This helps to ensure relevant clinical experience, and minimises

any language or cultural limitations. Such in-region training also helped to reduce the risk that

fellows going to HIC would find attractive career and never returned home after the fellowship. For

example, since 2010, more than 90% of fellows from sub-Saharan Africa, who have trained in centers

in South Africa, have returned home.

Sister Renal Centers http://src.theisn.org/

The sister renal center (SRC) program has continued to be popular and successful, and this success

brought its own challenges. The structure of the program in which center pairs passed through

three levels over six years (designated C, then B, then A), increasing ISN funding being provided at

each level, had been based on the expectation that not all sister center pairs would flourish at the C

level or subsequently at the B level, so that only a minority of pairs would be sufficiently successful

to move on to B and then A. As it turned out success were higher than predicted, and the Sister

Center program budget was increasingly unable to support financially all those center pairs

deserving of promotion to the next level. The budget was further stretched by the growing success

of ‘trios’ in which centers which had ‘graduated’ in turn supported another emerging center.

Although some SRC pairs had kidney transplantation as a significant part of their shared program,

the importance of further expansion of transplantation was recognised by ISN as well as The

Transplantation Society (TTS). An agreement between ISN and TTS led to a Sister Transplant Center

(STC) program from 2013 using the SRC model with equal co-funding from the two societies, and

joint representation on a selection committee. Immediately popular and successful (for example

one STC establishing a kidney transplant program in Palestine West Bank) the STC program was soon

expanded. By 2019 the SRC was actively supporting 65 pairs and trios, the STC was supporting 15

pairs.

Continuing Medical Education https://www.theisn.org/continuing-medical-education-program

ISN continued its well-established model for CME in LMIC supporting speakers from within or

beyond the region (typically 2-3 speakers per meeting) to attend CME meetings for which the

program had been developed to meet local needs. CME programs increasingly include practical

sessions, for example providing intervention nephrology training. ISN paid travel, and the local

29

organisers met local subsistence costs (exceptionally these were also met for the speakers by ISN for

CME meetings in very low resource settings).

Local organisers were also asked whenever possible to make opportunities for visits to hospitals and

delivering teaching ward rounds. Ideally there would also be meetings with local health leaders – for

example hospital directors, deans, local or national health ministers. These were infrequent but

often fruitful opportunities for ISN to emphasise an outside international perspective on the state of

local nephrology and services for kidney care.

Review of applications and funding decisions had previously been made by the CME chair alone

working with ISN staff. The increasing number, and growing range and breadth of proposals,

required increased support provided through appointment of a deputy chair, and also by a CME

committee with regional representation.

During the decade there was an increasing emphasis on supporting CMEs in very low resource

settings. With a limited budget, this meant that ISN CME funding could no longer be available for

some CME programs which had been supported consecutively for several years, but were now well

established, and grown beyond the need for ISN support. For example, in China the CME program

no longer provided support for educational meetings in the major centers, but did provide support

for CMEs in more remote, less developed centers in partnership with ISN members from major

centers in China.

Some CME funds began to be used for more extensive support of larger regional meetings which

afforded opportunities not only for education but also for strategic discussions among nephrology

leaders in the region, who were facing similar issues. The first two of these were held in West Africa

and East Africa in 2018.

Educational Ambassadors http://ea.theisn.org/

In the Education Ambassador program, experts undertake short (1-3 weeks) visits to an emerging

center with the specific goal of supporting the development of an aspect of clinical care (for

example, renal pathology, vascular access care, interventional nephrology or kidney

transplantation). The expert can be accompanied by supporting personnel (for example a nurse or a

technician) to help with technical aspects of the services. Repeat visits are encouraged in the

interest of sustainability.

30

Clinical Research https://www.theisn.org/programs/apply#clinical-research-program

Established in 2000 to provide ‘seed’ funding for small research projects in LMIC, this was known as

the Clinical Research & Prevention program until 2014, since the majority of grants were awarded to

screening and detection studies establishing the local epidemiology of CKD. With a broadening of

the topics, the title reverted in 2015 to Clinical Research program. The program typically funded 2-3

grants each year for up to $20,000 each. These grants were generally regarded as effective and

sufficient, not least because staff and other costs are relatively low in LMIC. About 50% of funded

projects in the decade resulted in published work, and 40% of applicants went on to get additional

funding. It became clear that the research opportunity of the grant should be complemented by

offering to some promising investigators experience in critical evaluation, data analysis, and writing.

Initially this was achieved by funding some grant recipients to attend a course at the Mario Negri

Institute in Bergamo, Italy, but then ISN established its own three-day residential Scientific Writing

Course the first two held in Bangalore, India in 2018 and 201917. The Course, directed by Marcello

Tonelli (Canada), has been successful and popular, and plans are underway to take it to other

regions.

Regional Training Centers

One reason for the change in emphasis towards supporting fellowship training within region was the

increasing number of centers in LMIC with the expertise, capacity and commitment to provide such

training, several of which had graduated from the Sister Renal Center program. From 2016 ISN

recognised the best of these, nine throughout the world, as Regional Training Centers (Table 15).

The continuing success of these centers is being evaluated before deciding if this scheme will be

expanded.

As well as the five programs, there are other ISN efforts building capacity in LMIC.

17 These courses were co-funded by ISN and ANIO (American Nephrologists of Indian Origin).

31

Table 15: ISN Regional Training Centers from 2016

ISN Region Center

Africa

Red Cross Children’s Hospital, Cape Town, South Africa Groot Schuur Hospital, Cape Town, South Africa

Eastern & Central Europe

Nephrology Department, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania

Latin America

Department of Nephrology & Mineral Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Fundacion Valle de Lili, Cali, Colombia New Independent States & Russia

National Center of Nephrology & Renal Replacement Therapy, Minsk, Belarus

North & East Asia

Institute of Nephrology, Peking University, Beijing, China

Division of Nephrology, The First Affiliated Hospital of Sun Yet-sen University, Guangzhou, China

National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing, China

South Asia

Department of Pediatric Nephrology, St. John’s Medical College Hospital, Bangalore, India

Renal Disaster Relief Task Force

The role of ISN’s Renal Disaster Relief Task Force (RDRTF) was reappraised during the decade. RDRTF

had been established in the 1990s to provide urgent support for management of AKI following

earthquakes and natural disasters in disadvantaged parts of the world. In partnership with

Médecins Sans Frontières it was successful in rapid deployment of teams including physicians,

nurses, and technicians who would give advice on preventive management, and provide power,

clean water and equipment to enable acute dialysis (and increasingly to support those on chronic

dialysis whose access to routine care was destroyed by the disaster). The guidelines on such care

published by members of RDRTF became standard guidance18. The last major earthquake at which

18 Sever MS et al. Recommendation for the management of crush victims in mass disasters. Nephrol Dial Transplant. 2012;27 Suppl 1:i1-67

32

RDRTF deployment had a substantial impact was in Port au Prince, Haiti in 2011. Thereafter the

growth of nephrology services has meant that practical help from RDRTF was becoming less

necessary as resources within the affected country or its regional neighbours were sufficient it

handle the crisis. Reappraisal of the role of RDRTF (led by chair, Wim van Biesen (Belgium) has led to

a new assignment providing templates to support local and national disaster preparedness plans.

Renal Registry Development

Recognizing the lack of data on patients with kidney disease in LMIC, ISN SharE-RR (SHARing

Expertise to support the set-up of Renal Registries) has worked since 2017 to develop

resources supporting the establishment or development of renal registries in LMIC.

MAJOR NEW ISN INITIATIVES

During the decade, three major new initiatives took shape, reflecting in part the interests and drive

of the ISN Presidents during this period, as well as reacting to opportunities that emerged within and

beyond the kidney community. These initiatives have focused respectively on acute kidney injury

(AKI), chronic kidney disease (CKD), and end-stage kidney disease (ESKD) respectively.

Acute Kidney Injury

Although improving detection and outcome of AKI are recognised as global challenge, there are

limited data from LMIC about differing patterns of AKI aetiology (including for example

communicable disease, especially in children, and maternal health catastrophes) compared to HIC.

And the lack of expertise and resources (including acute dialysis) in LMIC has been presumed to be

contributing too many avoidable deaths.

In 2013, ISN President Giuseppe Remuzzi launched the 0by25 initiative with the goal of reducing to

zero avoidable deaths from AKI by 2025. The concept and challenge of 0by25, with particular focus

on AKI in LMIC, were widely promulgated, and 0by25 was energetically embraced by many ISN

members, and also more widely in the global nephrology community. A Lancet paper laid out the

scale of the challenge and recommended some strategies19.

19 Mehta R et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015; 385:2616-43

33

Ravi Mehta (USA) was appointed director of the 0by25 initiative, and the existing ISN AKI Committee

was subsumed into the effort. Several initiatives were planned under three broad themes of

increasing knowledge about AKI (especially in LMIC), increasing awareness of AKI, and developing

practical interventions for AKI relevant to low resource settings.

To improve knowledge about AKI ISN undertook a ‘Global Snapshot’ in 2014, for which physicians

from 72 countries (including a substantial number of LMIC) reported on cases of AKI under their care

on a single day20. From 2014 ISN has entered discussions with the Institute for Health Metrics and

Evaluation (IHME) in Seattle, USA seeking to have AKI presented separately as a cause of death in

their annual Global Burden of Disease (GBD) reports21.

Across the nephrology community and other health professionals, ISN has driven AKI awareness

through education and communications. Messaging about AKI is also a consistent feature of ISN’s

advocacy efforts to impact on global health policy. However, the World Health Organisation (WHO)

does not identify AKI as a distinct health priority, and there were elements relevant to AKI in many

WHO programs (for example in child and maternal health, communicable disease, and clean water

strategies) making it harder to develop an incisive approach.

Developing practical interventions for AKI in LMIC

ISNs first practical effort to impact AKI in LMIC came through the Saving Young Lives (SYL) program.

SYL was founded in 2012 to establish “proof of principle” that sustainable acute PD programs

treating adults and children with AKI could be developed and maintained in very low resource

settings, to measure their success, and to provide a template for the extension of such programs

across the many parts of the world where they will save lives. SYL is a partnership between four

international nephrology organisations – ISN, IPNA, ISPD, and EuroPD. Initially supported for five

years by the Recanati-Kaplan Foundation it is now funded by equal contributions from its four

partner organisations. SYL focused on education, training, and mentorship. Hands-on workshops in

Cape Town provided training in PD catheter placement and the practical management of AKI for

teams of doctors and nurses. The clinical approach was based on the ISPD clinical practice guideline

20 Mehta R et al. Recognition and management of acute kidney injury in the International Society of Nephrology 0by25

Global Snapshot: a multinational cross-sectional study. Lancet 2016;387:2017-25.

21 Reporting in GBD on the growing impact of CKD on death and disability was already proving influential in increasing the profile of CKD in health policy discussions

34

for acute PD22 , which emphasised when necessary the utility of locally produced low cost PD fluid

and improvised PD catheters. By 2016 SYL had helped establish twelve acute PD centers in sub-

Saharan Africa where previously there was no dialysis available, with demonstrable success23. SYL is

now working to increase the number of centers in Africa, and to apply the lessons learnt in low

resource settings in Asia and Latin America.

ISN 0by25 has evaluated the feasibility of improving AKI detection and management of AKI in the

community in LMIC using point-of-care serum creatinine and urine dipstick testing with a symptom-

based risk score, supported by an education and training program to optimize the identification and

management of AKI. From 2017 this was tested in three low resource countries (Bolivia, Nepal and

Malawi) with demonstrable benefits on AKI care24, and its generalisability into routine practice is

now being tested since 2019 in five LMIC centers25.

ISN committed substantial revenue to fund the first three years of the 0by25 initiative. Initial

optimism that 0by25 could then be sustained and expanded through external fundraising was not

borne out. 0by25 continues with more limited funding and increased efforts to ensure wherever

possible the goals of 0by25 are integrated into other existing ISN programs. As the year 2025

approaches, ISN is understandably focused on showing measurable progress towards the original

0by25 challenge of zero avoidable deaths, even if accepting that this will not be fully achieved by

2025.

Chronic Kidney Disease & Global Health Policy

During the presidency of Adeera Levin (2015-17) work on the 0by25 initiative continued to be driven

forward, but she led development of an additional emphasis on the growing challenge of CKD, in

recognition of its importance as a non-communicable disease (NCD) with increasing prevalence and

the marked variation in awareness among health policy makers and strategies for effective care at

local and national levels.

22 Cullis B et al. Peritoneal dialysis for acute kidney injury. PD Int 2014; 34: 494-517.

23 Smoyer WE et al. "Saving Young Lives" with acute kidney injury: the challenge of acute dialysis in low-resource settings. Kidney Int. 2016;89:254-6

24 Macedo E et al. Risk factors and definition of kidney dysfunction in the community setting: the ISN 0by25 initiative. KI

Reports 2019; 4: S79

25 As part of the ISN Kidney Care Networks project, funded by the Stavros Niarchos Foundation.

35

Up to date information was needed country by country about the availability of expertise and access

to care, as well as relevant health policy. ISN through its membership and networks was uniquely

placed to collect such data, which it has now made available in the Global Kidney Health Atlas

(GKHA) – directed by David Johnson (Australia) and Aminu Bello (Canada). The first edition of GKHA

was published in 2017. A second edition in 2019 increased the granularity of the data, and added

some specifics, notably in documenting care for children26. The GKHA was enthusiastically

supported by ISN members, achieving returns for the first edition from 125 countries (representing

93% of the world’s population) rising to 160 countries (99 % of the population) for the second

edition. Sequential information can now be used to monitor progress, and where necessary provide

challenge to health systems which lack behind in care.

The ISN’s first global health summit to review these issues was held by ISN in Vancouver in 2016

drawing together one hundred experts from all world regions, and leading to the publication of a

‘road map’ providing recommendations on closing gaps in care, research , and policy27.

End-Stage Kidney Disease

During the presidency of David Harris (2017-19), the work on ‘0by25’ and CKD continued, and there

was an additional emphasis on the worldwide challenges of ESKD care. The huge disparities in care

between countries and even within HIC were increasingly well documented. In few places was

integrated care for ESKD truly available - including availability of renal replacement therapy through

dialysis and transplantation, and also conservative care. These disparities raise many issues to be

addressed: including the need to educate and train sufficient workforce, as well as the effectiveness

of various funding models, and a number of ethical considerations. The ethical issues were initially

addressed by an ISN Task Force28. ISN then held its second global health summit in Sharjah in 2018

to addresses the whole range of ESKD issues which produced an action plan for progress29.

26 www.theisn.org/all-articles/665-global-kidney-health-atlas

27 Levin A et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390:1888-1917.

28 Jha V et al. International Society of Nephrology Ethical Dialysis Task Force. Ethical issues in dialysis therapy. Lancet. 2017; 389:1851-1856.

29 Harris D et al. Increasing access to integrated ESKD care as part of universal health coverage. Kidney 2019; 95(4S):S1-S33.

36

RESEARCH

ISN has always held research as critical to the growth of nephrology and progress in patient care. It

has supported research through its journals and congresses, as well as the Fellowship program, the

Clinical Research program and Scientific Writing Course. ISN does not have the resources to be a

major research funder, but in this decade developed a number of new projects through which ISN’s

global networks and influence can best be used to support renal research worldwide.

ISN-Advancing Clinical Trials (ACT)

The ISN-ACT works to improve the capacity of the global nephrology community to lead and

participate in clinical trial research, through networking and training, and by standardising high-

quality trial conduct through working groups focussed on capacity building and networking, trial

design, trial toolkit development, and patient engagement. Since December 2017, the ISN-ACT

brings out an inventory of important clinical trials every month which are published on the ISN

Academy and distributed through social media.

ISN- International Network of CKD cohort studies (iNET-CKD)

ISN iNET-CKD has built a network of existing CKD cohort studies from across the world, to promote

research opportunities using patient-level data and bio-samples to understand CKD progression and

outcomes; the network currently contains more than 20 cohorts from six continents. It also provides

leadership and training for those wishing to establish cohorts. There are already two published

studies: one based on 17 cohorts in the network (34,000 subjects), the other on 8 cohorts in the

network (23,000 subjects)30.

ISN- Hydration for Kidney Health Research (H4KH)

The ISN and Danone Nutricia Research have collaborated to create the Hydration for Kidney Health

research initiative which supports established and new researchers investigating the role of

hydration in kidney health, and provides grants and fellowships in this field of work.

30 Alencar de Pinho N et al. Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease. Kidney Int. 2019;96:983 - 994. Orlandi PF et al. A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts. Kidney Int. 2019;96:1217-1233.

37

CKDu

During the decade there was growing attention paid to the emerging epidemics of chronic kidney

disease of uncertain origin (CKDu) occurring typically in poor agricultural communities in equatorial

LMIC, most notably in Central America and Sri Lanka. There have been intensive efforts country by

country to identify causes and develop strategies for prevention and care of this major public health

issue. In 2016 ISN was invited by the Sri Lankan government to give advice on the approach being

taken there, and has since developed an international facilitating role, developing the International

Consortium of CKDu Collaborators (i3C) bringing together the many voices in the nephrology

community with the aim to develop a framework and accountability structure to promote better

understanding of this issue.

ADVOCACY

During this decade ISN has placed increasing emphasis on its responsibilities and opportunities to

advocate globally for kidney health. ISN has significantly increased its investment in advocacy,

recruiting dedicated staff, and building a volunteer leadership team to seek out and take

opportunities. WHO had not been explicitly prioritising kidney disease, but a new emphasis on non-

communicable diseases (NCD) as a global health challenge led to a United Nations (UN) and WHO

High Level Meeting on NCDs in 2011. The original draft of the 2011 political declaration on NCDs

which emerged from that meeting did not mention kidney disease. ISN led intensive advocacy which

resulted in an additional statement in the declaration recognising the importance of kidney disease

as an NCD which confers worsens health outcomes; a small but important change.

ISN’s advocacy opportunities advanced further in 2012 when ISN was declared to be in ‘official

relations’ with WHO, meaning that ISN is the organisation to which WHO turns for advice on kidney

disease and health. Since then, ISN has had an increasingly prominent role at the annual WHO

World Health Assembly and at UN General Assembly High level meetings, for example the 2018 High

Level Meeting on NCDs, and the 2019 High Level Meeting on Universal Health Coverage.

ISN provides regular input into the WHO policy discussions and consultations about kidney disease

and kidney health, and has developed targeted position papers highlighting evidence-based

solutions on how to improve the prevention and management of kidney disease31.

31 Some examples of ISN contributions are available at: https://www.theisn.org/advocacy#policy-papers-publications.

38

ISN and WHO have an agreed Collaboration Plan. As part of this Plan, ISN has been commissioned

by WHO to produce guidance on establishing chronic dialysis programs in low resource settings as

well as an observatory highlighting current research activities in CKDu.

Opportunities to influence have mainly emerged from the NCD agenda, focused on CKD

identification and care, as well as RRT for ESKD, including kidney transplantation. ISN has continued

also to advocate for the importance of AKI and the many opportunities to improve outcomes for

those with reversible AKI.

ISN has also become a full member of the Non-Communicable Disease Alliance thus working closely

with organisations such as the World Heart Federation, International Diabetes Federation, World

Stroke Organization, and World Hypertension League in joint advocacy initiatives.

Regional Policy Forums

Using the opportunity of WCN rotating through different region of the world, ISN established a

series of regional policy forums, the first held during the WCN in Mexico City in 2017, the second in

Melbourne in 2019. The goal was to draw together representatives of health professionals, patients,

and policy makers to address specific issues related to kidney health in the region and to seek

agreement from health ministers and other leaders that governments committed to substantial

change in policy and investment to address gaps in care. ISN has a unique role in facilitating such

forums calling on its ‘official relations’ with WHO, and bringing to the discussions its local expert

members, and the data available from GKHA. Both for a so far have been very successful with

substantial output32. They have led to a significant statement of intent, the Twelve

Recommendations on Global Kidney Health, which aims to guide future efforts to reduce the burden

of kidney disease worldwide33.

32 Global kidney policy Forum Focus on Latin

America. https://www.theisn.org/images/GKPF_event_brochure_FINAL._August2017.pdf.

ISN Global Kidney Policy Forum Focus on Oceania. https://www.theisn.org/advocacy#policy-papers-publications

33 https://www.theisn.org/advocacy#12-recommendations-to-global-kidney-health

39

Declaration of Istanbul

ISN played a key role, in partnership with TTS, in the summit which had led in 2008 to the

Declaration of Istanbul against organ trafficking and transplant tourism. The Declaration of itself

would not have been effective in improving the situation unless there was a sustained effort by the

transplant community to observe and challenge, through local professional societies and

governments, the continuation or re-emergence of unacceptable transplant practices. A Declaration

of Istanbul Custodian Group was therefore established jointly by ISN and TTS with membership from

both societies, and this Group working through regional networks remains active and vigilant, since

pockets of organ trafficking and transplant tourism continue to emerge.

World Kidney Day

World Kidney Day (WKD) was throughout the decade a successful and improving advocacy

opportunity being used by many in the nephrology community. It continued to be a partnership

between ISN and IFKF (International Federation of Kidney Foundations) with a joint steering

committee. ISN co-chairs during the decade were William Couser (-2011), John Feehally (2011-17),

and Philip Li (2017- ). Various aspects of kidney health were chosen as themes year by year (Table

16) to be the focus of WKD and promotional materials provided, which many countries made use. A

scientific editorial on the WKD theme is published annual (Table 16). From 2019 a broader WKD

theme was agreed to be used year on year: ‘Kidney Health for Everyone Everywhere’. The web and

social media visibility of WKD has continued to increase, and ISN members were identified as WKD

‘ambassadors’ to help its promotion. In 2020, 99 countries reported a total of 1270 WKD activities.

There are now WKD events now in more than 150 countries worldwide. The web and social media

visibility of WKD has continued to increase, on WKD 2020 reaching 327 million people.

40

Table 16: World Kidney Day Themes 2011-2020

Theme Scientific editorial

2011 Protect your kidneys: Save your

heart World Kidney Day 2011: Protect your kidneys, save your heart William G. Couser, Miguel C. Riella

2012 Donate – Kidneys for Life – Receive

The global role of kidney transplantation Guillermo Garcia, Paul N. Harden, Jeremy R. Chapman

2013 Kidneys for Life – Stop Kidney Attack!

Acute kidney injury: global health alert

Philip KT Li, Emmanuel A. Burdmann, Ravindra L. Mehta

2014 Chronic Kidney Disease (CKD) and aging

Chronic kidney disease and the aging population

Marcello Tonelli, Miguel C. Riella Published in 45 journals

2015 Kidney Health for All CKD in disadvantaged populations

Guillermo Garcia-Garcia, Vivekanand Jha Published in 50 journals

2016 Kidney Disease & Children – Act Early to Prevent It!

Averting the legacy of kidney disease – focus on childhood Julie R. Ingelfinger, Kamyar Kalantar-Zadeh, Franz Schaefer Published in 70 journals

2017 Kidney Disease & Obesity – Healthy Lifestyle for Healthy Kidneys

Obesity and kidney disease: hidden consequences of the epidemic

Csaba P. Kovesdy, Susan Furth, Carmine Zoccali Published in: 60 journals

2018 Kidneys & Women’s Health. Include, Value, Empower

Women and kidney disease: reflections on World Kidney Day 2018

Giorgina B Piccoli, Mona Alrukhaimi, Zhi-Hong Liu, Elena Zakharova, Adeera Levin Published in 57 journals

2019 Kidney Health for Everyone, Everywhere

Title; Burden, Access and Disparities in Kidney Disease Deidra C. Crews, Aminu K. Bello, Gamal Saadi Published in 51 journals

2020 Kidney health for everyone everywhere—from prevention to detection and equitable access to care

Kidney health for everyone everywhere—from prevention to detection and equitable access to care

Philip KT Li, Kamyar Kalantar-Zadeh Published in 43 journals

41

ISN PARTNERSHIPS

A consistent mantra for ISN throughout the decade has been the need for partnership working in the

many projects to which it is committed. ISN is uniquely placed to make global impacts in education,

research, and advocacy. But does this more effectively when sharing complementary expertise and

resources. A unique strength of ISN is its network of more than one hundred affiliated national and

regional nephrology societies.

ISN has partnered closely with ISPD in Saving Young Lives, and ISPD’s management is now provided

from ISN’s office. ISN’s programs have given substantial support to paediatric nephrology though

fellowships and sister centers; three of ISN’s nine Regional Training Centers are paediatric centers.

As well as SYL, both IPNA and ISPD have fellowship programs which have regularly been deployed

alongside ISN to support individuals needing longer fellowship training than could be provided by

either scheme alone. APSN is an active funding partner in ISN programs. IFKF remains a founding

partner for World Kidney Day.

Since 2010 ISN has forged a partnership with ANIO (American Nephrologists of Indian Origin) which

has raised significant funds from its membership to support novel research and care improvement

projects in India.

ISN has committed to a series of joint activities with ASN and ERA-EDTA, the two other nephrology

societies with global reach. This has made possible some important common statements and unified

communications for example about the global burden of kidney disease.

42

CONCLUSION

ISN’s range and depth of work has grown remarkably in this decade. ISN’s unique position in global

nephrology is clearer, and this is reflected in the many ways in which ISN is contributing to the

growth and strength of nephrology worldwide. The ISN has maintained its relevance for kidney

professionals worldwide, and a key reason for this may be its unique focus on philanthropic

activities. The ISN should now have the mature organisational structure, finances, and governance

to select the right priorities, and make the most of these opportunities, anchored by its vision,

mission, and values.

‘Unsung heroes’

A number of people without whom the ISN would never have succeeded in this recent decade have

been named – particularly those who have held senior leadership or staff positions.

But there are many, many more unnamed without whom the ISN would not be flourishing. They

include

• The many staff who has worked for the ISN based in either its Brussels or North American

offices, some throughout this decade. All are highly professional and committed.

• The many ISN members from all regions, numbering several hundred, who have shown their

commitment to ISN by their work on ISN Committee, Task Forces, and other groups,. All

have given freely of their time because they embrace the goals of ISN; many have made ISN

work a main priority of their professional lives.

ISN is absolutely reliant on the professionalism, expertise, and commitment of all these people, and

owes them, whatever the scale of their contribution, a debt of gratitude. They and their successors

will be at the heart of ISN’s future progress.

43

AUTHOR’S COMMENT

I have been a close direct observer of the ISN for most of the decade 2011-2020, as a member of the

Executive Committee until 2019. I hope this has given me useful insights into the workings of ISN,

but I recognise that this account may lack the objectivity of an outside observer, since throughout

these years ISN has been at the heart of my professional life as a nephrologist, and I remain

passionately committed to its vision, mission, and values.

I have chosen to steer a middle course between two possible approaches. On the one hand

providing a short ‘journalistic’ piece likely to provide an account too superficial to allow a proper

exposition of the complexities, challenges, and opportunities with which ISN has dealt during this

last decade. On the other hand, I also chose to avoid a heavily referenced forensic historical account

of events which for most readers would be beyond their time and interest34.

I have had access to all the documentation in paper and digital files in the ISN’s office. This includes

minutes of the ISN Executive Committee, Council, and committees, boards, and task forces; as well

as papers describing changes in governance, and all new initiatives considered by ISN leadership

during this decade.

I have had advice from many who have had lead roles in ISN during this decade. Nevertheless, this

account is my responsibility, and I apologise for any inaccuracies, omissions and solecisms it may

contain.

34 The source documents are held by ISN and are for a considerable part in the public domain for the interested historian.