“Presentation of Sister Renal Center (SRC) program „Sheffield - Sarajevo” Fahrudin Masnic Clinic for Hemodialysis University Clinical Centre Sarajevo Bosnia and Herzegovina

Sarajevo & Sheffield 2013 - 2016

Talk Outline

ISN Sister Renal Center Program purpose Why Sheffield Kidney Institute ? Sarajevo – Sheffield Partnership Education eGFR and AKI

ISN Sister Renal Center Program purpose

ISN SRC LEVELS Level C is the first stage within the program. Sister center partnerships jointly enter the program at Level C for a period of two years. They receive basic annual funds from ISN to help develop and support training links. These centers are eligible for an upgrade to a level B position if the progress reports are satisfactory. Level B is the second stage within the program. Sister center partnerships which have shown significant progress in Level C can move to Level B after two years and receive further funding and benefits. Level A is the final stage. Level B centers can apply competitively for an upgrade to Level A after two years. These upgrades are reserved for those few partnerships whose emerging sister centers show the most promising development towards centers of excellence in their region. Honorary C or B Levels are failed upgrades from C to B and from B to A which have one additional chance to apply for an upgrade.

Why Sheffield ?

Academic nephrology in Sheffield has an international reputation for research excellence in basic and clinical science and has made a significant contribution to world renal research for more than 25 years. This is achieved through research and educational activities at the Sheffield Kidney Institute and the Academic Unit of Nephrology. The Sheffield Kidney Institute is the main renal unit based at the Northern General Hospital in Sheffield, providing acute and chronic kidney disease services in the areas of South Yorkshire and North Derbyshire. It has outpatient department, two inpatient wards and two dialysis wards, as well as satellite dialysis units.

The Sheffield Kidney Institute provides Acute nephrology, CKD patients, transplantation/access surgery and elective nephrology/PD. Over 800 transplant recipients are followed up in the transplant clinic. Approx. 60 renal transplants are performed annually, and there is an active live donor programme. Laparoscopic donor kidney retrieval is established. Non heart beating deceased donor transplantation and an ABOi living donor programme have commenced during 2008. Specialist joint Renal-Rheumatology clinic aimed at providing care for patients with systemic lupus erythematosus (SLE). Low clearance clinic which provides multi-disciplinary care for people with advanced chronic kidney disease (CKD) who may need dialysis or a kidney transplant in the near future. Conservative Care Clinic for those patients who have chosen non-dialysis (conservative) management of their CKD.

Sarajevo – Sheffield Partnership

To help Sarajevo become a Centre of clinical excellence. This is through nephrology update with focus on AKI and GFR reporting, as well as active transplant and dialysis program update. Give other Nephrology Centers in Bosnia and Herzegovina support along ISN SRC Program. To develop culture of audit and clinical governance in Sarajevo. Develop leadership.

To drive forward transplant program in Sarajevo. To help improve CKD diagnostics and management not only at Clinical but also and Primary Care Levels and introduce eGFR reporting – guidelines for non-nephrologists. Broaden professional friendships and learn from each other.

Education

Meetings with clinical chemistry lab in primary care and UCCS to discuss the roll out of automated eGFR in primary care and UCCS in Sarajevo. Several educational workshops/Courses for non- nephrologists – (primary care, diabetes, cardiologists etc.) with teachings from the SRC Mentor Center (Dr. Arif Khwaja, Dr. Simms-Williams). Workshops organized in Primary Care settings as well as in-hospital teaching sessions.

Workshops provided strong educational support, with emphasis on eGFR reporting, AKI and CKD staging, AKI prevention and care, Impact of newly set-up low clearance clinic, Future of CKD Introduction of a program of Clinical Audit and governance. Active audit program now takes place based around UK Renal Association Standards for dialysis.

eGFR and AKI

eGFR at UCSC and Canton Sarajevo…milestones eGFR reporting + staging (with the use of MDRD if eGFR <60mls/min) started in University Clinical Center Sarajevo and Primary Care laboratories. Laboratories started printing GFR reports + staging, which prompted new level of AKI-CKD recognition awareness.

Risks of eGFR reporting Limitations in certain groups Inappropriate disease labeling of the elderly Not valid for hospital inpatients/acutely unwell Only worthwhile if linked to primary care education program

The patients with different stages of CKD in Sarajevo Canton (data from 01.01.2015. to 20.06.2016.) CKD Stage Total Patients Gender Male Female Stage 1 154 54 100 Stage 2 607 221 386 Stage 3A 268 139 129 Stage 3B 169 64 105 Stage 4 40 17 23 Stage 5 7 3 4 Total: 1245 498 747

The patients with different stages of CKD in Sarajevo Canton

AKI AKI prevalence amongst hospitalised patients in the US is 4.9% (1), therefore contributes as a major morbidity and mortality cause. Therefore, several important Workshops on AKI were held, with the support of the Mentor Centre and their valuable experience. Providing comprehensive overlook on all aspects of AKI. Naikar SS, Liu KD, Chertow GM. The incidence and prognostic signifi cance of acute kidney injury. Cherow 2007. Curr Opin Nep Nephrol Hypertens; 16:227-236.

AKI Sheffield-Sarajevo recommendations Laboratory reporting of acute kidney injury AKI care bundle and nursing care guidelines Focus on prevention Multi-disciplinary education programme Improved coding of AKI episodes

From the perspective of a trainee doctor in Nephrology and Dialysis wards…what can he/she do ? Train in CKD and AKI – Global Kidney Academy Nephrology Online Course. Develop clinical guidelines (Sheffield guidance). Develop audits which can influence better patient management and clinical governance.