Evolution ,Outcomes and the impact of an ISN- SRC collaboration on a Dedicated Onconephrology Service : 3 year Experience from India

 

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Evolution ,Outcomes and the impact of an ISN- SRC collaboration on a Dedicated Onconephrology Service : 3 year Experience from India

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Rajeevalochana
Parthasarathy
Rajeevalochana Parthasarathy jeevssri@gmail.com Chennai Kidney Associates Nephrology Chennai India *
Sanjeev Nair docsvn@gmail.com Chennai Kidney Associates Nephrology Chennai India -
Veenaa Manjari veenaa3218@gmail.com Chennai Kidney Associates Nephrology Chennai India -
Sukanya Govindan sukanyagovindan@gmail.com Chennai kIdney associates Pediatric Nephrology Chennai India -
Kenar Jhaveri kjhaveri@northwell.edu Northwell Health, Zucker School of Medicine Nephrology New York United States -
Subashri Mohanasundaram subashri.mohan@gmail.com Chennai Kidney Associates Nephrology Chennai India -
Syeda Hurmath drsyedahurmath@gmail.com Trustwell hospitals Nephrology Bengaluru India -
Madhusri Babu madhusrisribabu2903@gmail.com Medway Hospitals Nephrology Chennai India -
Shyam Bansal drshyambansal@gmail.com Medanta Hospitals Nephrology New Delhi India -
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Onconephrology bridges nephrology and oncology, addressing kidney complications arising from cancer and its therapies.e established exclusive onconephrology clinic at Cancer Institute, WIA, Adyar Chennai, a quarternary not for profit cancer center in June of 2022. In January 2023 we collaborated wit Northwell, USA to enhance onconephrology services to improve protocols and patient care . This study outlines the evolution of the onconephrology clinic and clinical outcomes over 3 years

Prospective cohort analysis of oncology patients referred for kidney problems patients seen over 3 years from  June 2022 to July 2025 in Cancer Institute , WIA. . Primary outcomes were referral volume, diagnostic categories, requirement for renal replacement therapy (RRT) and creatinine at presentation. Continuous data are median (IQR) or mean (SD). Categorical data are n (%). Group comparisons used Mann-Whitney U for continuous variables and two-sample proportion z-tests for proportions. Differences in the primary outcomes pre and post ISN ISN SRC Category C established with Northwell USA in January 2023  was done 

3,598 referrals were included (pre SRC n=106; post SRC n=3,492). Median age was 57 years pre and 58 years post (p=0.24). Male sex comprised 62% pre and 57% post. AKI accounted for 41% of pre referrals (43/106) and 35% of post referrals (1,233/3,492) (p=0.27). Mean creatinine at presentation increased from 1.50 mg/dL pre to 1.88 mg/dL post (p=0.000057). Eighteen patients ( 20% ) came for a follow up ( 2 or more visits) pre SRC when compared to 1577 ( 43.8%) post SRC. From june 2022 to Jan 2023 one clinic per week was done. From Feb 2023 onwards 2 clinics per week was established till date . Total number of clinics done so far are 1742. In February 2024 exclusive pediatric onconephrology subspecialised clinic was set up once a month. The commonest cancer in patients who were referred was urological cancers( 40%) followed by gynaecological cancers( 22%). 38 biopsies were perfomed in the period studied( 3 pre SRC and 36 post SRC) . The commonest pathology identified was ATI( 22 patients) followed by AIN ( 70% of the biospies perfomed was suspected drug related AKI). The number of patients requring RRT was 5 pre SRC and 28 post SRC. Hemodialysis was the commonest modality used followed by PD. CRRT in the center was started in June 2024. A national CME  on onconephrology and an exclusive SAARC Onconephrology teaching course was started in May 2025.

The establishment of the International-Indian Society of nephrology SRC( C) in January 2023 led to a marked rise in referrals, improved patient retention, and broader clinical and academic activity in a first of a kind dedicated  onconephrology clinic in India. The post-SRC period demonstrated higher disease acuity, increased biopsy and RRT utilization, and service diversification including pediatric and critical care onconephrology. This  highlights the feasibility and impact of structured onconephrology services in a developing country, emphasizing the need for continued capacity building and collaborative research.

Kewords