Sophie Dupuis

Obesity and kidney disease: hidden consequences of the epidemic

Obesity is a growing worldwide epidemic. Obesity is one of the strongest risk factors for new-onset chronic kidney disease, and also for nephrolithiasis and for kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.

Nephrology in developing countries: the ISN's story

What could you do to support medical care in developing countries? This question should be compelling to many physicians in developed regions of the world, particularly those working in nephrology—a subspecialty often associated with expensive and technologically advanced therapies. In many low-income and middle-income countries (LMICs), long-term dialysis or transplantation for end-stage kidney disease are not available, but other ways to reduce the burden of kidney disease do exist— eg, management of reversible acute kidney injury by early detection, and the use of peritoneal dialysis, which is feasible, eff ective, and aff ordable. Another example is to address non-communicable diseases—for which chronic kidney disease is a powerful risk multiplier— by use of low-cost community-based detection and treatment strategies for chronic kidney disease that are eff ective and aff ordable in most settings. However, the most important thing that can be done is to build capacity for sustainable self-suffi ciency in nephrology. Since the 1980s, the International Society of Nephrology (ISN) has used its resources for education and training and, in doing so, advanced nephrology in LMICs worldwide through a portfolio of fi ve outreach programmes. These programmes, delivered at very low cost, are a model for what can be achieved by volunteers in a specialist society or other group committed to helping patients and colleagues in developing countries. In the past 25 years, the ISN’s fellowship programme has sponsored more than 600 nephrology trainees from more than 80 LMICs, who are required to sign an agreement stipulating that they will return to their home country after training; 35% are now training within their own region of the world. Survey data show that the trainees go on to become leaders in their own hospitals and universities, showing that ISN’s strategy of selecting individuals with the greatest potential is working. The ISN also helps to establish sister renal centres in LMICs, which develop nephrological expertise through relationships with established centres in developed countries, with notable successes. A typical sister centre graduates after 6–8 years and in turn supports another emerging centre in its own country or region. This approach is a two-way process, with staff in the supporting centre often having to learn as much as those in the emerging centre. Furthermore, there is the option for experienced nephrologists to join our educational ambassador scheme and to visit a nephrology centre in an LMIC for several weeks to help to establish new programmes that will benefi t patient care. ISN has more than 100 volunteers covering every aspect of clinical nephrology who are available to travel and teach anywhere in developing regions of the world. Additionally, the clinical research and prevention programme builds research capacity in LMICs by providing seed funding for small clinical research projects, and by assigning research mentors. It supports chronic kidney disease surveillance programmes, helping LMICs to generate their own epidemiological data—crucial for infl uencing health policy. These data are generated independently, and also in partnership with WHO and the Global Burden of Diseases project.

Obesity and Kidney Disease: Hidden Consequences of the Epidemic

Obesity is a growing worldwide epidemic. Obesity is one of the strongest risk factors for new-onset chronic kidney disease, and also for nephrolithiasis and for kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.