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In the early nineties, ISN leadership began discussions on active collaboration between established kidney care centers and emerging centers from low-resources areas. By 1996, 17 active partnerships were established and a further 16 were in a formative stage. These paired centers would become known as the Sister Renal Centers . Today, 63 partnerships are active within the Sister Renal Centers Program.

The overall impact of the ISN SRC Program on emerging centers is highlighted here by describing the successes of three SRC partnerships who graduated in 2019, having completed the six-year process involving a gradual progression through three possible upgrades from level C to level A.

Emerging Institution: Colonial War Memorial Hospital, Fiji; Supporting Institution: Concord Repatriation General Hospital, Australia.

When the partnership was formed in 2014, the goal was to establish the first Nephrology service in Fiji, acting as a hub for the development of Nephrology in the Pacific Islands.

Supported by the program, the hospital published a paper demonstrating that Fiji has one of the highest rates of end-stage kidney disease worldwide. The conclusions of this analysis were pivotal in the Fijian government’s decision to provide funding to set up a National Kidney Research and treatment center to improve access to kidney care for all.

The SRC program has been directly responsible for establishing organized renal care in Fiji. The Colonial War Museum hospital now has a dedicated renal clinic team and has established and maintained a renal biopsy program as well as a hemodialysis for acute kidney injury program that has treated hundreds of patients. The Fiji Nephrology Symposium has been run annually for five years and is now aligned with the Fiji Medical Association conference.

An electronic dialysis registry has been established to support improved data collection on the characteristics and outcomes of chronic dialysis in Fiji. A nascent culture of research has emerged with one peer-reviewed publication and seven abstracts accepted and presented, ensuring an improved scorecard on the Global Kidney Health Atlas between 2017 and 2019.

Fiji now has a Nephrology workforce comprising one nephrologist, one ISN Fellow, general physicians supporting Nephrology, and a network of motivated and increasingly experienced renal nurses able to benefit the next generation of clinicians.

Emerging Institution: National Medical Research Center for Children´s Health, Institute of Pediatrics NCZD Moscow, Russia; Supporting Institution: Department of Pediatric Nephrology and Transplantation, New Children´s Hospital, University of Helsinki, Finland.

The main goal was to begin pediatric renal r-transplantations (KT) in the emerging center in Moscow. The first KT was performed on November 1, 2017. Since then, 25 KT’s have been performed with great success at the emerging center.

Nephrologists, surgeons, and anesthesiologists were trained in intensive care, fluid and electrolyte management, surgical techniques, induction, and continuous immunosuppression at the supporting center in Helsinki in 2018 and 2019. Supporting center personnel visited Moscow twice with educational programs and activities addressing CKD care and the complications of pediatric kidney transplantation.

Secondary goals were also attained: general principles and approach in psychosocial issues of pediatric CKD and transplantation were shared between specialists at the centers. The clinical practice of congenital nephrotic syndrome was explored and conveyed to the emerging center. Indications and principles of molecular genetics in pediatric kidney diseases were discussed at length and a program of care for children with hereditary kidney disease was developed collaboratively and implemented at the emerging center.

The success of the program secured the employment of two experienced doctors at the center.

Emerging Institution: Viet Duc Hospital, Vietnam; Supporting Institution: Juntendo University, Japan.

The focus was on improving the knowledge of local nephrologists in renal care and training local pathologists.

From 2014 to 2019, six Continuing Medical Education (CME) courses in Renal Pathology were held from basic to advanced levels. Further courses took place in nephrology, dialysis, and transplantation covering all aspects of kidney diseases.

Staff from the Pathology and Kidney Diseases and Dialysis departments of the Viet Duc Hospital attended short-term training courses in Japan, and the Japanese Society of Nephrology (JSN) and the Asian Pacific Society of Nephrology (APSN) held scientific meetings in Tokyo.

Prior to the SRC Program, only two basic staining techniques were available for kidney biopsy samples for optic microscopy. Now five basic staining techniques are carried out routinely. The number of kidney biopsies carried out per year has increased from 50 cases in 2014 to 300 cases in 2019.

In order to promote the early detection and prevention of kidney disease and provide more evidence for policy making within the Vietnamese health care system, an epidemiology survey and urinalysis were conducted in 2695 Vietnamese subjects to detect risk factors for CKD and urine abnormalities.

The Viet Duc Pathology department has become a center of reference for seven other hospitals. Collaborative relationships between nephrologists and other relevant specialists in Hanoi and Northern Vietnam have been established as well as between local and international specialists creating the potential for future research projects and motivating young professionals to work in the field.

Emerging Institution: Moi Teaching and Referral Hospital (MTRH), Kenya Supporting Institution: Amsterdam UMC (VUme), The Netherlands

Building on an existing partnership between the Vrije Universiteit medical center in Amsterdam and the Moi Teaching and Referral Hospital in Kenya, the ISN Sister Renal Centers Program supported the development of a renal unit, including dialysis and renal transplantation, at MTRH.

Vascular surgeons from VUme visited MTRH to teach local surgeons how to create an AV fistula. The unit was eventually able to establish a training program for dialysis nurses and now performs over 1600 dialysis treatments per month.

Training was given to all nephrologists, surgeons, and operating room nurses by their VUme counterparts so that renal transplants could be performed at MTRH. The first three living-related renal transplant procedures were successfully performed by collaborating physicians from VUme and MTRH, and repeated several times a year until 2018 when MTRH carried out their first fully independent transplant procedure. In 2019, 43 living-related renal transplant procedures were performed and at least one procedure every other week is scheduled in 2020.