In nephrology, as in much of medicine, geography determines destiny. A patient with end-stage renal disease in Tokyo or Osaka has access to world-class dialysis, transplantation, and specialist care. An equivalent patient in rural Bangladesh, sub-Saharan Africa, or lowland Bolivia may simply die — not because treatment is medically impossible, but because the trained specialists, equipment, and infrastructure needed to deliver it do not exist within reach.
Bridging this gulf requires investment at multiple levels — and one of the most efficient investments available is the well-designed international fellowship: an individual physician from a resource-limited setting, trained at a center of excellence, returning home transformed into a clinical leader, educator, and force multiplier for their entire regional healthcare system.
The International Society of Nephrology’s Fellowship Program — communicated to Japanese nephrologists through the JSN newsletter in 2006 — represents exactly this model. Japan’s role as a host nation for ISN fellows places it at the heart of a global mission to eliminate preventable deaths from kidney disease.
Japan’s Position in Global Nephrology
A World Leader With Global Responsibilities
Japan’s nephrology program is among the most sophisticated in the world:
- Japan has the highest dialysis prevalence rate of any country — approximately 340,000 patients on maintenance dialysis, or roughly 270 per million population
- Japanese nephrologists developed online hemodiafiltration and refined dialysis membrane technology that is now used globally
- Japan has world-leading expertise in IgA nephropathy — the most common primary glomerulonephritis worldwide, first described by Berger and Hinglais but extensively characterized by Japanese researchers
- The Japanese Society of Nephrology (JSN), founded in 1959, is one of Asia’s oldest and most productive nephrology societies, with over 6,000 members
This depth of clinical and research expertise positions Japan uniquely in the Asia-Pacific region — not just as a center of excellence for Japanese patients, but as a potential training hub for nephrologists from neighboring developing countries where renal care capacity is far more limited.
The Asia-Pacific Nephrology Landscape
The diversity of nephrology capacity across the Asia-Pacific region is stark:
| Country/Region | Nephrologists per Million | Dialysis Access | Transplant Program |
| Japan | ~60 per million | Universal | Established (living donor dominant) |
| Australia/New Zealand | ~40–50 per million | Universal | Established |
| South Korea | ~30–40 per million | Universal | Established |
| China | ~5–10 per million | Major urban centers | Growing rapidly |
| India | ~2–3 per million | Urban centers only | Limited living donor |
| Vietnam | ~1–2 per million | Major cities | Emerging |
| Bangladesh | < 1 per million | Severely limited | Minimal |
| Myanmar | < 0.5 per million | Extremely limited | Absent |
| Pacific Island Nations | Near zero | Absent or NGO-provided | Absent |
APSN’s partnership with the ISN global outreach program is functioning well, with successful applicants in fellowship, sister renal centre, educational ambassador, CME, and clinical research programs. Japan, as a founding member and major contributor to the Asia-Pacific Society of Nephrology (APSN), participates in this partnership both as a financial contributor and as a host nation for trainees from the region’s lower-resource settings.
The ISN Fellowship Program: 2006 and Beyond
The 2006 Milestone
In 2006, the Fellowship Program had a US$1 million budget, funded by the ISN with generous support from regional and national nephrology societies and corporate partners. Since the program was launched in 1982, nearly 400 nephrologists from 70 countries had received training in 19 host countries — a quarter of these fellowships granted in the just the four prior years as the program grew rapidly.
The 2006 JSN newsletter communication — linking to the ISN Gateway Fellowship page — was part of a deliberate strategy to expand Asian-Pacific host center participation. ISN Fellowship Program Chair John Feehally explicitly invited Japanese nephrologists to:
- Host fellows from developing countries at their institutions
- Communicate the opportunity to international colleagues in lower-resource settings
- Support the program financially through national society contributions
This invitation reflected a strategic evolution in the program’s design: an increasing proportion of short-term fellows would be placed in centers of excellence in their own region, where culture and language are more familiar — working with regional and national nephrology societies to expand these intra-regional opportunities.
How Japan Fits the Intra-Regional Training Model
The intra-regional training model has specific advantages for Asian-Pacific fellows:
- Cultural proximity: fellows from Vietnam, Thailand, Indonesia, or Myanmar training in Japan encounter fewer cultural barriers than in North America or Europe
- Language accessibility: many Asian fellows have stronger Japanese language skills or find the learning environment more accessible
- Disease pattern similarity: Japan’s expertise in IgA nephropathy, diabetic nephropathy, and hypertensive nephrosclerosis directly addresses the dominant CKD etiologies across Asia
- Practical transferability: Japanese dialysis techniques, nursing protocols, and quality systems are often more directly applicable to Asian emerging centers than Western systems
- Geographic accessibility: travel costs and visa requirements are lower for intra-regional training
The Host Center Experience: What Japanese Institutions Gain
The Bidirectional Benefit
A common misconception about international fellowship hosting is that it is purely charitable — that host centers invest time and resources for global good without institutional return. The evidence consistently refutes this:
There is increasing appreciation of the benefit international fellows bring to host institutions, particularly when close contact is maintained between the fellow and the host center after training is completed, thus enhancing global health initiatives in many developed centers.
Specific benefits to Japanese host centers include:
Clinical diversity: ISN fellows from developing countries often present their host centers with disease patterns rarely seen domestically — severe tropical glomerulonephritis, advanced CKD from endemic infections, malnutrition-related nephropathy — that enrich the clinical education of Japanese trainees and staff
Research collaboration: The program has had the unanticipated effect of identifying and training individuals who have later become leaders in nephrology in their own institutions, countries, and regions — and these leaders often maintain productive research collaborations with their former host centers for decades.
Global perspective: Japanese nephrologists who mentor ISN fellows develop a direct understanding of global kidney disease burden that enriches their academic perspective and positions their institution as a global leader
Reciprocal learning: exposure to resource-constrained nephrology practice often inspires Japanese clinicians to reconsider resource utilization and clinical prioritization in their own practice
Requirements for ISN Host Centers
Japanese centers interested in hosting ISN fellows must meet specific criteria:
- Demonstrated expertise in the subspecialty area proposed for training
- A designated mentor with time and commitment for individual supervision
- Institutional support for the fellowship arrangement
- Willingness to submit post-fellowship progress reports
- Alignment between the fellow’s training needs and the center’s specific expertise
ISN Fellows receive hands-on training in advanced host institutions, allowing them to acquire state-of-the-art knowledge in basic and clinical nephrology, dialysis, transplantation, and epidemiology. The training focuses on providing the exact skills and knowledge specifically required by the home institution.
The Fellow’s Journey: From Application to Impact
Eligibility and Selection
ISN fellows undertake short-term (2–6 months) or long-term (6–12 months) training. Applicants typically have at least a year’s experience in nephrology in their home institution and are aged 30–40 years. They can apply in one of two rounds annually, and an international panel of nephrologists assesses their applications competitively. Approximately 70% of applications are successful.
The selection criteria prioritize:
- Quality of the individual candidate’s clinical background and potential
- Specificity of the training objectives — what precise skills will be acquired and how will they be applied at home?
- Support from both the home institution (guarantee of re-employment) and the proposed host center
- National relevance — is this fellow’s training aligned with their country’s nephrology development priorities?
The Modern Application Process
Applicants interested in 12-month clinical training are required to complete the Fellowship Foundation Course on the ISN Academy and obtain certificates of completion BEFORE they apply to the ISN Fellowship Program. All selected ISN Fellows are also required to participate in ISN Academy courses during their hands-on training at the host center, complementing their learning with a curriculum tailored to their area of interest — clinical nephrology, hemodialysis, peritoneal dialysis, transplantation, pediatric nephrology, or renal pathology.
This blended learning model — combining online foundation courses with hands-on host center training — represents a significant evolution from the 2006 program and substantially improves fellowship impact.
Return and Impact: The Evidence Base
By 2004, 370 nephrologists had received fellowships in 19 host countries. An estimated 80% returned home. Of these, 61% are involved in teaching, 47% in research, and 67% in patient care.
The return and impact data — sustained across four decades — confirm that the ISN Fellowship model works:
- Fellows return to their home institutions as clinical leaders
- They teach the next generation of nephrologists locally
- They establish or expand renal services that serve thousands of patients
- They maintain productive academic relationships with their former host centers
Japan-ISN Partnership: Specific Collaborative Opportunities
APSN-ISN Coordination
APSN continues to have good partnership with ISN on various collaborative projects including fellowships, sister centre initiatives, CME, educational ambassadors, research projects, and ongoing support for the region including the 0by25 initiatives. These APSN-ISN activities are very important and welcomed by nephrologists in the Asia-Pacific region and have trained up quite a large number of renal doctors.
Japan’s JSN works within this APSN-ISN framework to:
- Identify and endorse strong Japanese candidates proposing to host ISN fellows
- Communicate fellowship opportunities in JSN newsletters (as the 2006 issue demonstrates)
- Contribute financially to the ISN Fellowship Program’s regional budget
- Provide Japanese-speaking mentors for fellows from Japanese-influenced Asian centers
Intra-Asian Fellowship Pathways
ISN and TTS (The Transplantation Society) have joined forces to support the training of young physicians from low-resource areas, providing hands-on training in advanced host institutions to acquire state-of-the-art knowledge in transplantation — with the ultimate goal of improving transplantation standards in their home countries.
Japan’s living donor transplantation expertise — among the most refined in Asia — makes Japanese transplant centers particularly valuable hosts for fellows from countries where deceased donor programs are absent and living donor programs are being established.
Conclusion
The Japanese Society of Nephrology’s 2006 communication linking to the ISN Fellowship Program gateway page represents more than an administrative newsletter item — it represents Japan’s explicit acceptance of its role as a global nephrology leader with responsibilities beyond its own patient population. By inviting Japanese nephrologists to host ISN fellows and by communicating the opportunity to developing-country colleagues, the JSN participated in one of global health’s most evidence-effective capacity-building programs.
The ISN Fellowship Program is expanding and evolving — working more closely with the Sister Renal Center Program under COMGAN — to promote development of individual nephrology leaders through fellowships and facilities of excellence through sister centers. Japan’s participation in both dimensions of this strategy positions it as an irreplaceable pillar of Asia-Pacific nephrology development.
Your next steps as a Japanese nephrologist or institutional leader:
- Contact the JSN International Committee to express interest in hosting ISN fellows — your subspecialty expertise in IgA nephropathy, dialysis technology, or transplantation may be exactly what an emerging Asian center needs
- Explore the ISN Fellowship portal at fellowship.theisn.org — review the host center criteria and assess whether your institution meets the requirements for formal registration
- Consider the ISN Sister Renal Center program as a complement to hosting — formalizing an institutional partnership with an emerging Asian center creates a lasting relationship that extends far beyond any single fellow’s training period
- Communicate ISN fellowship opportunities through institutional channels to international colleagues in developing countries — the 2006 JSN newsletter model remains effective today
- Engage with APSN-ISN collaborative initiatives including the 0by25 AKI prevention program — Japan’s clinical expertise in AKI management is directly relevant to reducing preventable kidney disease deaths across the Asia-Pacific region
- Document the impact of fellows you host — systematic outcome tracking strengthens the evidence base that justifies continued investment in the program and helps future fellows secure funding