Introduction ( Jan J. Weening) Public health in the emerging world ( Dan Kaseje)

1. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world • Introduction (Jan J. Weening) • Public health in the emerging world (Dan Kaseje) • Strengthening health research capacity in developing countries: a critical element for achieving health equity (Chitr Shitthi-amorn) • International aid and medical practice in the less-developed world: doing it right (Ivor Katz)

2. 1. NKF and NIDDK practice guidelines for the US 3. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world 2. The InterAcademy Council in its January 2004 Report to the United Nations

3. NKF and NIDDK practice guidelines for the US-1. Clinical Guidelines- • Define chronic kidney disease (CKD), classify stages • Evaluate kidney function • Association level of kidney function with systemic complications • Stratify the risk for loss of kidney function and development of cardiovascular disease

4. NKF and NIDDK practice guidelines for the US-2. Clinical Guidelines- • Assess those who have increased risk on CKD based on sociodemographic factors • Test in these individuals markers of kidney damage, specifically proteinuria • Estimate in these individuals the level of GFR from prediction equations that take into account serum creatinine, and some or all of the following factors: age, gender, race and body size.

5. NKF and NIDDK practice guidelines for the US-3. GFR estimates- • Standardization of GFR estimates (creatinine calibration; reporting; MDRD equation – serum creat, age, sex, Afr-Am or not) • Instruction of physicians • Education of care providers to undergraduate, graduate and postgraduate levels • Education of public • Research recommendations: improve and develop new prediction equations using better filtration markers; continue to evaluate the burden of CKD; evaluate alternative definitions of CKD.

6. NKF and NIDDK practice guidelines for the US-4. Albuminuria measurement- • Albumin is preferred over total protein in age>puberty • Ratio of albumin over urine creatinin on a spot untimed urine specimen should be determined and reported • Use PARADE recommendations: repeat assays; no vigorous exercise; refrigerate samples; one freeze is acceptable; no need to acidify; need for standardization; adjust creatinine for gender • Definitions: • normal <30 mg albumin/g creatinine • Microalbuminuria >30 to 300 mg alb/g creatinine • Macroalbuminuria >300 mg alb/g creatinine

7. NKF and NIDDK practice guidelines for the US-5. Albuminuria as a clinical marker of kidney damage- • Populations at increased risk for CKD (DM, HT, family) should be screened annually for microalbuminuria • Test for therapy effect within 6 months • Children should be screened with standard dipstick twice: prior to starting school and in early adolescence • Research recommendations: value of testing for albuminuria; value of titration of anti-HT based on changes in albuminuria; guidelines for expected reductions in albuminuria; new markers (urinary cells and mediators of injury) • Albuminuria as a surrogate marker for clinical trials

8. NKF and NIDDK practice guidelines for the USWhat is desirable and feasible globally?

9. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • The InterAcademy Council in its January 2004 Report to the United Nations states that • …inadequate attention has been given by the international community to the needs of capacity building in science and technology (S&T) as the engine that drives knowledge-based development. • …local S&T capacity is essential for using and contributing to the world’s valuable store of knowledge. • …current structures of higher-education systems in many countries are inadequate to meet the challenges of the 21st century. • …the culture and values of science are critical for building a global community. • …building capacity in agriculture, engineering, health, and the social sciences is essential for national development.

10. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • The InterAcademy Council in its January 2004 Report to the United Nations states: • In addition to national and regional funding programs for the support of S&T through networks and centers of excellence, two global funds should be established: • A Global Institutional Fund for 10 to 20 centers of excellence over a period of 5 to 10 years • A Global Program Fund to support research proposals

11. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • The InterAcademy Council in its January 2004 Report to the United Nations states: • Human resources should be expanded by a number of actions including the support of industrialized-country governments for S&T professionals and doctoral programs in developing nations’ best universities by offering long-term fellowships to deserving young people from industrialized countries who wish to do their training in world-class research programs in developing nations • Visiting professors from foreign countries should participate • Industrialized nations should provide incentives for outstanding young researchers from developing countries to apply their skills in the service of their native lands thus enhancing future leadership • Digital libraries of science have to be established

12. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • The InterAcademy Council in its January 2004 Report to the United Nations states: • Strengthen national societies of science, engineering and medicine • Mobilize the international S&T community • Raise the level of public awareness • Protect public goods and define the boundaries of the public/private interface SEE ADDENDUM Report p. 1-15

13. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • Establish epidemiology and biostatistics of renal disease, its associated risk factors, preclinical signs • Perform exemplary screening and intervention programs in confined groups (e.g. taxi drivers; school teachers) • Link the local, regional, national screening program to World Kidney Day • Develop a network of participating health care centers of primary, secondary and tertiary level • Place the program under auspices of National Government • Raise Public and Press Awareness

14. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • Implementation requires • Increased Public Health capacity • Establishment of centres of excellence for public health research • Enhancement of information infrastructure • Establishment of awareness-raising programs

15. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • Centers of excellence for public health to be established as an integral part of medical research centers • Can such centers be at the interphase of public/private? • ISN can provide sister center relations with exchange of senior staff, health care workers, nurses, students from high-income countries • ISN organizes regional and local conferences where the outcome of local experience is disseminated

16. Implementation of strategies for prevention relevant to national health care systems and specific centres in the emerging world – Jan J. Weening • ISN provides a • Fellowship Program • Senior Scholar Program • Library Enhancement Program • Local Visit and Update Program • Science Journal • Clinical Therapeutic and Management Journal? • International Guidelines (in collaboration with NKF-US) • Prevention Programs • Epidemiology and biostatistics • Intervention strategies