"A Lasting Legacy of Improved Nephrology Services in the Southern Philippines": An ISN-APSN Sister Renal Centers Pair Graduates the Program

Staff from the SPMC visit the SGH Transplant Center

The ISN and the Asian Pacific Society of Nephrology (APSN) collaborated to support a Sister Renal Centers (SRC) partnership between the Southern Philippines Medical Center (SPMC) in Davao City, Philippines, and the Singapore General Hospital (SGH) in Singapore over seven years.

From modest beginnings to a flourishing center of reference

According to ISN SRC liaison officers Dr. Franklin Guillano and Dr. Jason Choo, the SRC Program has significantly impacted the SPMC. At the outset of the collaboration, the SPMC did not have a renal pathology laboratory, and no kidney biopsies were conducted. Since then, a renal pathology lab has been established with support from the SGH, leading to an increase in kidney biopsies to an average of 25 per month.

Staff from the SPMC receive hands-on nephrology training at the SGH

Ongoing staff training accommodates this increase. Previously, the Mindanao region lacked qualified nephrologists, leaving many areas without essential kidney care services. The SPMC now runs a nephrology fellowship training program that produces ten graduates annually, improving access and outcomes in underserved areas. Since 2022, two fellows-in-training have attended the center in Singapore every month, a practice that is planned to continue.

The first Interventional Nephrology Center in Mindanao is nearing completion with support from the SRC Program. It performs an average of 80 interventional procedures each month, dramatically improving access for dialysis patients in the region and reducing travel and other expenses for patients requiring specialized kidney care.

In addition, the program has fostered collaboration and knowledge-sharing among healthcare professionals in the region, driving continuous improvement and development in local kidney care services.

Building on Success: Expanding kidney care capacity in the regionv

The SPMC has met and exceeded the objectives set out at the program’s start. Dr. Guillano comments, "The program has laid a foundation for enhanced patient care and professional development in Mindanao, leaving a lasting legacy of improved nephrology services in the Southern Philippines."

The two centers plan to form a collaborative trio with the Davao Regional Medical Center (DRMC), 60 km north of the SPMC in Tagum City. The DRMC is an 800-bed hospital offering internal medicine training but no specialized kidney care services.

An SPMC Nephrology Fellow receives one-to-one training at the
SGH from Dr. Manish Kaushik

The collaboration intends to enhance the DRMC’s hemodialysis and peritoneal dialysis programs, fortify kidney transplant and deceased organ donation initiatives, and upgrade general nephrology services, introducing new renal pathology and interventional nephrology services.

Dr. Guillano concluded, "The ISN's support in funding, program structure, administration, and finance has been exemplary. This support has enabled the successful implementation of our projects and contributed to the overall improvement and development of nephrology services in our institution and the broader community we serve."

With input from APSN, ISN matches institutions in low- and middle-income countries with centers of excellence, guiding and lending vital educational support to teams of doctors across Asia Pacific.

Offering a sustainable and competitive training scheme, the program prides itself on creating self-sufficient teams of experts. Graduated centers can use their new experience and knowledge and their cultural and linguistic know-how to train staff at other centers in their region, helping them set up vital treatment or care services.

‘We are the biggest kidney transplantation and peritoneal dialysis center in Vietnam.'

Westmead Hospital (Australia) supported Cho Ray Hospital (Vietnam) in becoming a renal center of excellence. The center deals with many difficult referral cases from different hospitals from southern Vietnam and is considered as the most effective Organ Allocation Unit.

It is proud to achieve 60% patient remission rates thanks to a strong collaboration between the nephrology, pathology and HD departments.

Each year, ISN and APSN co-fund up to two specially-selected research study projects in low- and middle-income countries. These focus on acute kidney injury, chronic kidney disease, screening and intervention as well as specific local needs.

Between 2014 and 2018, it has poured 47,000 USD into the upcoming and ongoing studies:

• 2018: Nepal (Dharan) – CKD & TBC in Nepal, led by Ananda Chapagain
• 2017: Sri Lanka (Saliyapura) – Screening of CINAC among adolescents, led by Channa Jayasumana
• 2015: Thailand (Bangkok) – AKI epidemiology in Southeast Asia, led by Nattachai Srisawat
• 2014: China (Beijing) – The incidence and mortality of acute kidney injury in China: A nationwide multi-center retrospective survey, led by Li Yang
• 2014: India (Pondicherry) – Comparison of clinical characteristics etiology and the clinical outcomes between the patients' community acquired and hospital acquired AKI, led by Sreejith Parameswaran.
   

By assigning international faculty to share specific hands-on skills at regional courses and give lecture at local meetings, ISN and APSN support essential teaching and training across medical communities.

This partnership co-founded the 11th International Congress of the International Society for Hemodialysis and organized by The Nephrology Society of Thailand.

Thailand's Minister of Public opened the meeting to some one thousand guests. Lectures focused on hemodialysis, vascular access, CKD-MBD, infection, cardiovascular complications, and renal replacement therapy.

APSN lends its support to Nepal's pilot training center, helping local doctors provide better services to detect the signs of acute kidney injury in patients affected by the disease. Based on the results of the 0by25 pilot feasibility study, the Kidney Care Network implements sustainable and integrated kidney care services in low-resource settings.

Pilot training sites are now located in Bolivia, Brazil, Malawi, South Africa and Nepal.