Argentina, 26.8 pmp) (50). The causes of this shortage are multiple. Potential contributors to this variation include the increasing burden of CKD, erosion of nephrology practice scope by other specialists, lack of workforce planning in some countries relative to others, and the development of new care delivery models (48). A novel strategy has been the successful ISN Fellowship program. Since its implementation in 1985, over 600 fellows from 483 LMIC have been trained. A significant number of fellowships were undertaken in selected developed centers within the fellow’s own region. In a recent survey, 85% of responding fellows were re-employed by their home institutions (51,52). Interdisciplinary prevention approach Since 1994, a National Institutes of Health consensus advocated for early medical intervention in predialysis patients. Owing to the complexity of care of CKD, it was recommended that patients should be referred to a multidisciplinary team consisting of nephrologist, dietitian, nurse, social worker, and health psychologist with the aim to reduce predialysis and dialysis morbidity and mortality (53). In Mexico, a nurse-led, protocol driven, multidisciplinary program reported better preservation in eGFR and a trend of improvement of quality of care of CKD patients similar to those reported by other Multidisciplinary Clinic programs in the developed world. Additionally, more patients started dialysis non-emergently, and some obtained a pre-emptive kidney transplant. For those unable to obtain dialysis or who choose not to, a palliative care program is now being implemented (54). Care models supporting primary care providers or allied health workers achieved better effectiveness in slowing kidney function decline when compared to those providing specialty care. Future models should address region-specific causes of CKD, increase the quality of diagnostic capabilities, establish referral pathways, and provide better assessments of clinical effectiveness and cost-effectiveness (55). Online educational programs for CKD prevention and treatment Whereas it is important to enhance the promotion and implementation of ‘‘Prevention’’ of kidney disease and kidney failure amongst healthcare professionals, it is equally important to promote ‘‘Prevention’’ with education programs for those at risk of kidney disease and kidney failure, and for the general population at large. It is a stepwise process, from awareness, engagement, participation, empowerment, and partnership. As highlighted above, in general, the health literacy of the general population is low. Awareness and understanding of kidney disease are inadequate. Education is key to engaging patients with kidney disease. It is the path to self-management and patient-centered care. Narva et al. found patient education is associated with better patient outcomes (56). Obstacles include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. New education approaches should be developed through research and quality improvement efforts. Schatell found web-based kidney education is helpful in supporting patient self-management (57). The internet offers a wealth of resources on education. Understanding the types of internet sources that CKD patients use today can help renal professionals to point patients in the right direction. It is important that reputable healthcare organizations, preferably at a national level, facilitate easier access to health information on their websites (Supplementary Table S1). The mode of communication currently used by patients and the population at large is through the internet - websites, portals, and other social media, such as Facebook and Twitter. There are also free apps on popular mobile devices providing education on kidney disease. There is no shortage of information on the internet. The challenge is how to effectively ‘‘push’’ important healthcare information in a targeted manner, and to facilitate users seeking information in their efforts to ‘‘pull’’ relevant and reliable information from the Braz J Med Biol Res | doi: 10.1590/1414-431X20209614 Prevention of kidney diseases 7/10 internet. It is important the ‘‘pushing’’ of health information is targeted and specific, relevant for the condition (primary, secondary, or tertiary prevention), and is offered at the right time to the right recipient. It is possible with the use of information technology and informatics to provide relevant and targeted information for patients at high risk, coupling the information based on diagnosis and drugs prescribed. Engagement of professional society resources and patient groups is a crucial step to promote community partnership and patient empowerment on prevention. Additional resources may be available from charitable and philanthropic organizations. Renewed focus on prevention, raising awareness, and education Given the pressing urgency pertaining to the need for increasing education and awareness on the importance of the preventive measures, we suggest the following goals to redirect the focus on plans and actions: 1. Empowerment through health literacy in order to develop and support national campaigns that bring public awareness to prevention of kidney disease. 2. Population-based approaches to manage key known risks for kidney disease, such as blood pressure