Time: 09:40-10:20 am
Dr. P. Ravi Kumar is currently Senior Consultant Nephrologist and Head of the Nephrology Department at The Sri Manakula Vinayagar Medical College and Hospital, India. After completing his MB, MD, & DNB he worked in an exclusive cancer institute for a year. Then he proceeded to University of Toronto and did a three year Clinical Fellowship in Nephrology where he rotated at all the three major hospitals under the university network, Toronto General, Toronto Western & Sunnybrook Health Sciences Centre in Toronto, Canada. He then served as WHO Consultant in Nephrology in East Africa for 4 years and was Consultant Nephrologist for the Ministry of Health, Republic of Seychelles, Africa. He then returned to Canada as a Returning Fellow / Physician, Nephrology Ward services, at The University of Toronto/Sunny brook Health Sciences Centre, Canada for 8 years. He served as the Executive director/Medical Advisor of Nursing & Home health care services in Canada for 12 years. He has over 30 research articles and over 40 scientific presentations to his credit. He also actively practices meditation and medical hypnosis. He is also a certified Life coach.
The burden of CKD is on the rise globally and in India. There are scarce population based studies based in rural industrialized settings in India and elsewhere. The study was done to find out the prevalence and determinants of chronic kidney disease (CKD) among adults in rural Pondicherry, India. It was a community-based cross sectional study in 13 villages of a Primary Health Centre in rural Pondicherry. A representative sample of 422 adults more than or equal to 50 years of both genders was selected by population proportional to size methods. All the participants were screened by SCORED questionnaire to get the potential cases of CKD. We did serum creatinine, urine examination, blood pressure and anthropometric measurement for the potential cases. CKD was diagnosed by estimation of glomerular filtration rate and presence ofprotienuria. The data was analyzed using Statistical Package for Social Science version 24. The study was approved by the Institutional Ethics Committee of SMCMCH, Pondicherry. The prevalence of CKD was found to be 24.2% in the study sample of respondents 50 years or more. Most (73.5%) of the CKD cases were at stage 2, Stage 3a had 15 % and stage 3b had 2% of the cases. The determinants of CKD were Rising age (60-69 years, PR: 2.36,CI:1.36-4.07), Poor Nutritional status (underweight: PR: 2.26,CI:1.05-4.89), (overweight: PR: 2.19,CI:1.06-4.52), (obese:PR: 2.13 CI: 1.13-4.01)and presence of at least one chronic co-morbidity(PR:5.85,CI:1.38-24.78). Majority of the patients in the CKD group had minimal proteinuria -87.25%. In the CKD group 42.15% had no hypertension or diabetes mellitus. Considering the higher prevalence of CKD in the study area, targeted screening of adult population should be undertaken as means of early detection, diagnosis, treatment and follow up of at risk individuals to prevent further progression of CKD.Further research is required to look at the etiology of CKD in such industrialized, coastal settings
He graduated from the Medical School of the Aristotle University of Thessaloniki, on May 1988. PhD of the Department of Medicine of the Democritus University of Thrace (2001 - 22 June 2005 Cert. no: 278). From April 2008 until June 2010 He was member of the Scientific Council of the “G PAPANIKOLAOU” Hospital. From March 2010 until March 2012 hewas elected a member of the Board of the Greek Society of Nephrology. On 18/12/2103 he was elected as a representative of the doctors on the Board of interconnected Hospital "G.PAPANIKOLAOU" and the Psychiatric Hospital of Thessaloniki. From March 2016 he is the secretary of the Board of the Greek Society of Nephrology. He is member of the European Renal Association and of the International Society of Nephrology. His special interest is interventional nephrology, the placement of tunneled dialysis catheters by nephrologists.
Tunneled catheters became available in the late 1970s. In recent years, nephrologists in many countries have taken the initiative to perform nephrology related procedures. I think that nephrologists are ideally suited for this activity because of their unique clinical relation with renal patients and of course the better understanding of the problems related to renal replacement therapy. We all know that the dialysis access remains the “weakest link” in the management of ESRD patients. Also, we all know that nephrologists know the dialysis patients’ needs better.
Presentation of our experience on placement of tunneled catheters with retrograde technique. In recent years many nephrologists participated in the conversion, from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. On the other hand, many clinicians believe that de novo access is required when converting temporary hemodialysis (HD) to TCC. Leading focus of this presentation was to raise interest and awareness of the scope of interventional nephrology and especially the insertion of tunneled catheters by nephrologists.
Board certified in Internal Medicine and Nephrology. Managing partner at Nephrology Associates, Chattanooga, for the past 5 years and has been with the organization since 1995. Manages an organization that includes 15 Nephrologists, with up to 23 physician extenders. Covers a 50 mile radius in the Southeast area of Tennessee with over 1,200 dialysis patients and 15,000 CKD patients. Has an MBA from the University of Tennessee at Chattanooga and actively participates in Clinical/Pharmaceutical Research at our research Organization: SERRI (Southeast Renal Research Institute). Medical Director for Network 8 (covers Mississippi, Alabama and Tennessee) as part of the Medicare Network Distribution.
The discussion will focus on highlighting the burden of Chronic Kidney Disease (CKD) and include the general principles for the management of patients with CKD. Identify ways to help delay progression of CKD. Will include the review of clinical trials focused on this and reducing proteinuria. Review recent data, particularly looking at trials involving SGLT-2 Inhibitors used in treatment of Type 2 Diabetes and their effect on CKD. Look at data on optimizing Blood Pressure control and the role of Ace-inhibitors and Angiotensin Blockers in patients with proteinuria. The second part of the discussion will attempt to initiate a discussion on the lack of quality clinical/therapeutic trials in Nephrology. Help bring about awareness of the need for not just more, but also the need for quality clinical and therapeutic interventions involving all aspects of Nephrology.
Dr. Aldriwesh is an Assistant Professor of Molecular Biology and Microbiology at King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia. She was awarded Master’s and Ph.D. degrees from Leicester University, United Kingdom. Dr. Aldriwesh is a Middle East representative at the International Studies Committee of the ISPD. Her research interest is about identifying the contributory factors in the development of infectious peritonitis in peritoneal dialysis patients.
Background: Infectious peritonitis is a clinically important condition contributing to the significant mortality and morbidity rates observed in peritoneal dialysis (PD) patients. Although some of the socioeconomic risk factors for PD-associated peritonitis have been identified, it is still unclear why certain patients are more susceptible than others to infection.
Methods: We examined the molecular components of human peritoneal dialysate (HPD) in an attempt to identify factors that might increase patient susceptibility to infection. Characterization studies were performed on initial and follow-up dialysate samples collected from 9 renal failure patients on PD.
Results: Our in vitro data showed that peritonitis-causing bacteria grew differently in the patient dialysates. Proteomic analysis identified an association between transferrin presence and infection risk, as peritoneal transferrin was discovered to be iron-saturated, which was in marked contrast to transferrin in blood. Further, use of radioactive iron-labeled transferrin showed peritoneal transferrin could act as a direct iron source for the growth of peritonitis-causing bacteria. We also found catecholamine stress hormones noradrenaline and adrenaline were present in the dialysates and were apparently involved in enhancing the growth of the bacteria via transferrin iron provision. This suggests the iron biology status of the PD patient may be a risk factor for development of infectious peritonitis.
Conclusions: Collectively, our study suggests transferrin and catecholamines within peritoneal dialysate may be indicators of the potential for bacterial growth in HPD and, as infection risk factors, represent possible future targets for therapeutic manipulation.
Haichang Huang is a nephrologist at the Kidney Disease Research Center, Jingdong Yumei Kidney Disease Hospital, Beijing, China. He has published several articles in international and national journals
Background: Patients with chronic kidney disease (CKD) often have CD4+ regulatory T cells (Tregs) deficiency or/and dysfunction, leading to chronic inflammation. We aim to investigate the effect, function, and related mechanism of low-dose IL-2 on peripheral blood CD4+ regulatory T cells expansion in vitro from patients with CKD.
Methods: A total of 148 newly diagnosed patients with CKD at stage III and 35 healthy volunteer subjects were recruited into our studies. The number of peripheral Tregs in peripheral blood mononuclear cells isolated from CKD patients, which were characterized by FACS as CD4+CD25hi and CD4+CD25+FoxP3+. The effect of low-dose IL-2 on expansion of Tregs, and the suppressive function of expanded Tregs were also analysized by FACS. The levels of FoxP3 mRNA were detected by qRT-PCR. The activation of IL-2 induced Stat5 and blocking experiments were assessed by Western Blotting and FACS.
Results: We found that the frequency of peripheral Tregs from CKD patients was significantly lower than that in healthy volunteer subjects. We also showed that IL-2 selectively expanded CD4+CD25hi and CD4+CD25+FoxP3+ regulatory T cells, and also upregulated the expression of FoxP3 mRNA. Our in vitro studies demonstrated that expanded CD4+ regulatory T cells from CKD patients suppressed proinflammatory Th1 and Th17 cell response. Furthermore, STAT5 activation is required for IL-2-induced expansion of regulatory T cells and expression of FoxP3 mRNA from CKD patients.
Conclusions: Our findings support the clinical Treg defects in CKD patients, and the rationale of evaluating low-dose IL-2 treatment for selectively modulating CD4+ Tregs to suppress chronic inflammation.
Dr. Ignacio Villanueva Bendek is a leading specialist with more than 15 years of experience in various prestigious institutions He is a graduate of the Colombian National University with a specialty in Gastroenterology and the New Granada Military University with the subspecialty in Nephrology. The doctor is a member of the Colombian Association of Gastroenterology and the Colombian Association of Nephrology.
Vascular access in hemodialysis constitutes one of the pillars of the success of a program. Efforts should therefore be aimed at achieving, in the first instance, the greatest number of arteriovenous fistula vascular accesses, and secondly at decreasing the complications related to the cannulation of access to preserve the functionally thereof in the long term. Several strategies have been described to improve this last aspect; we describe case reports of the use of ultrasound to improve the probability of successful cannulation in situations considered difficult by the nursing team.
Prof. Annette D. Wagnern is a Senior Physician of the Department of Nephrology / MHH, Hannover Medical School, Germany. She is a specialist of internal medicine and nephrology. She served as head of the department for Clinical Continuing Education in the Center for Internal Medicine / Department Rheumatology of the Hannover Medical School.
Background: Diagnosis in rare disease cases is often delayed by years . The main factor for delayed diagnosis is believed to be the lack of knowledge about rare diseases. Probabilistic diagnostic decision support systems (DDSS) have the potential to accelerate rare disease diagnosis by highlighting differential diagnoses to physicians based on case input and incorporated medical knowledge . We examine a probabilistic DDSS prototype in terms of its potential to provide correct rare disease suggestion early in the course of rare disease cases.
Methods: Retrospectively, information from medical records of 93 patients with confirmed rare inflammatory systemic disease was transferred to the DDSS. Correctness of the DDSS disease suggestions was assessed for all documented visits over time. Time to correct top fit (TF) and top five fit (T5F) disease suggestion was assessed, as was the original time to clinical diagnosis (TD). TF/TD as well as T5F/TD were calculated to allow for comparison of TF respective T5F normalised to TD. Wilcoxon signed-rank test was conducted for TD-TF and TD-T5F.
Results: The DDSS suggested the correct disease at a time earlier than the time of clinical diagnosis among the top five fit disease suggestions in 53.8% of cases (50 of 93), and as the top fit disease suggestion in 37.6% of cases (35 of 93). Median advantage of correct disease suggestions compared to the time point of clinical diagnosis was 3 months or 50% for top five fit respective 1 month or 21% for top fit. The correct diagnosis was suggested at the first documented patient visit among the top five fit disease suggestions in 33.3% (top five fit), respective 16.1% of cases (top fit). Wilcoxon signed-rank test shows a significant difference between the time to clinical diagnosis and the time to correct disease suggestion for both top five fit and top fit (z-score -6.68, respective -5.71, ?=0.05, p-value <0.001). The DDSS suggested the correct rare disease at the time of diagnosis in 89% of cases (83 of 93 cases; 95% CI: 82.92% to 95.58%).
Conclusions: The DDSS was capable of providing accurate rare disease suggestions in most of the rare disease cases. In many cases it provided correct rare disease suggestions early in the course of disease, sometimes in the very beginning of a patient journey. The interpretation of these results suggests that DDSS have the potential to highlight the possibility of a rare disease to physicians early in the course of a case. Limitations of this study derive from its retrospective and unblinded design, data input by a single user and the optimisation of the knowledge base during the course of the study. Whether the use of this DDSS leads to a reduced time to rare disease diagnosis in a clinical setting should be validated in prospective studies.
Lyudmila Ivanovna Anikonova is working at Department of Internal Diseases and Nephrology, State Institute of higher education “Mechnikov North-Western State Medical University”, Saint-Petersburg, Russian Federation
Porphyria cutanea tarda (PCT) and pseudoporphyria are the most common photosensitive vesiculobullous cutaneous entities in hemodialysis patients. PCT is a disorder in the heme biosynthesis that results from a reduction in the activity of enzyme uroporphyrinogen decarboxylase (URO-D) in the liver. The abnormal heme biosynthesis produces a pathogenic accumulation of intermediary metabolites (porphyrins) in the liver, plasma and skin. The symptoms of PCT occur because of the accumulation of photosensitizing porphyrins in the skin. In patients receiving dialysis, PCT has several linked pathogenic mechanisms. The most relevant factors are viral hepatitis C, hepatic iron overload and impaired clearance of porphyrins. Diagnosis of PCT is established by identification of characteristic clinical features and finding a substantial elevation in the level of porphyrins in urine, plasma and feces. Primary management of PCT involves removing susceptibility factors, depletion of iron stores, and reducing porphyrin levels in the liver. We report a case of PCT that developed in a patient on maintenance HD for 8.5 years; 2 more exacerbations were observed in the next 7.5 years. The diagnosis of PCT was confirmed by the detection of a substantial elevation of porphyrins in plasma. The differential diagnosis for PCT included cutaneous erythropoietic porphyrias, two subtypes of acute porphyrias (variegate porphyria, and hereditary coproporphyria), pseudoporphyria, other bullous skin disorders. The relationship between exacerbations with viral hepatitis C activity, iron levels was not always observed. Because of comorbidity, therapeutic phlebotomy was problematic and treatment modality was combination of hydroxychloroquine and haemodiafiltration.
Dr Nasrulla Abutaleb is a Consultant Nephrologist, Diaverum Hemodialysis centers, Jeddah. He served as a Head of Nephrology section at KFSHD, Dammam from 2013-2016. He was a Senior Consultant Nephrologist, King Abdulaziz Military Hospital, Tabuk, K.S.A; Head of renal unit in the period between first of Aug 1999 and June 2005.
The reasons for freeing our hemodialysis therapy (HD) from the thrice weekly schedule with its obligatory long weekend interval are overwhelming. Shifting toward every other day schedule (EOD) is the most simple, practical, logical and rewarding step to improve the outcomes of hemodialysis therapy. Eliminating the odd weekly long inter-dialysis interval would mean eliminating significant related morbidities and mortalities (M&M). Such M&M are related to the effects of the biochemical and hemodynamic stresses that occur over the weekend intervals on both acute and chronic cumulative basis. In fact, the reported rise in M&M after the weekend intervals just reflect the adverse effects of these pathological processes on the acute basis alone. The reported figures for the rise in all-cause mortality ranged from 23% (R. N. Foley et al (1)) to 41% (Zhang H et al (2)). Higher figures up to 260% were even reported for the rise in the rates of cardiac mortality and hospitalization after the weekend interval (3, 4, 5). Such M & M peaks are not seen on abolishing the long weekend HD intervals (5, 6). The mechanisms accounting for such rises in the M &M seems mostly related to the peaks in serum K level and volume status after the long weekend intervals. The effects of the weekend peaks in the levels of the other pathological parameters as BP, serum phosphate & calcium, metabolic acidosis, other ‘uremic toxins’ and repeated subclinical volume overload states with secondary need for high ultrafiltration rates are chronic and cumulative. The potential harms related to these latter abnormalities are obviously accelerated during their peaks with higher overall exposure or the AUC (area under the curve) within the third day of the weekly long inter-dialysis interval. It is impossible to estimate the contribution of such latter abnormalities to the already high M & M of the HD population. It is then, obvious that the benefits from eliminating the long weekly inter-dialysis would not be limited to the elimination of above reported weekend rises in M & M. We can speculate that the bulk of the benefits associated with quotidian HD can still be reaped with the more efficient EOD hemodialysis.
Time: 16:15 -16:45
Mr Yuichiro Kondo is a Project Leader at Nephrology R&D Management Office, Nephrology Unit, R&D Division Kyowa Kirin Co., Ltd. Japan. He is Responsible for the management of the R&D project of evocalcet and in charge of many CKD-MBD projects.
In end stage kidney disease, parathyroid hormone (PTH) is increased and promotes proliferation of parathyroid cells and finally causes secondary hyperparathyroidism (SHPT). In SHPT, extremely high PTH induces high-turnover bone disease and accelerates elution of Ca and P from bone which is associated with vascular calcification, fracture and increased risk of cardiovascular diseases and mortality. The secretion of PTH from the parathyroid gland is controlled through the calcium receptor (CaR) which senses slight changes of serum Ca concentration. A compound that acts on CaR as mimic the action of Ca is called calcimimetic. Cinacalcet, the first launched calcimimetic drug for SHPT patients adequately controlled serum PTH and Ca levels and drastically reduced parathyroidectomy (PTx). Additionally, cinacalcet also reduced the progression of cardiovascular calcification and the risk of mortality in hemodialysis patients with SHPT. However, cinacalcet caused gastrointestinal (GI) side effects such as nausea and vomiting, making difficult either continuous use or increase dosage. Such GI intolerability thereby limited the dosage of cinacalcet, resulting in poor compliance or discontinuation. Evocalcet (MT-4580/KHK7580) was a novel oral calcimimetic compound created in Japan and developed for patients with SHPT and was expected to improve upon several issues associated with cinacalcet. It was shown that the non-inferiority of evocalcet to cinacalcet in suppressing intact PTH with significantly fewer GI-related adverse events in Japanese CKD-5D patients with SHPT.Then evocalcet was launched in Japan in 2018. In this presentation, I would like to outline the history R&D of evocalcet.
Time: 17:15 -17:45
Dr Kambiz Ghasemi is working as Assistant Professor, Department of Pediatric Nephrology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Introduction: Urinary tract infection (UTI) is the most prevalent infection of genitourinary system, especially in children. The most important type of UTI is acute pyelonephritis (APN) which in case of late diagnosis and treatment, can result in severe complications such as renal scarring. The aim of this study was to evaluate the effect of Vitamin E on renal scars in children aged 3 months to 14 years.
Materials and Methods: In this single-blinded randomized clinical trial all children aged 3 months to 14 years admitted to Bandar Abbas Pediatric Hospital in 2017-2018 due to APN (based on urine culture and clinical findings such as abdominal pain and fever diagnosed by a pediatrician) were consecutively enrolled. Dimercaptosuccinic acid (DMSA) scan was performed at baseline and 78 patients with renal scars were alternately randomized into two groups; 41 controls who received 50-75 mg/kg/day intravenous ceftriaxone during hospital stay plus 8 mg/kg/day oral cefixime after discharge for a total duration of 4 months, and 37 cases who received 20 U/kg/day Vitamin E tablets in addition to the previous treatments. Another DMSA scan was performed at the end of 4 months and the evaluation was done blinded to the grouping of patients. In addition to baseline and final DMSA results, demographic data were entered into the SPSS software for statistical analysis.
Results: From the 78 patients included in the study 34 (43.6%) were boys and 44 (56.4%) were girls. Patients were equally distributed across different age groups, both genders, and both study groups. Median of decrease in photopenic areas was insignificantly higher in boys in Vitamin E group compared to their counterparts in the control group (1.27 vs 1.18 areas, P=0.607). Furthermore, regardless of gender, decrease in photopenic areas was insignificantly higher in patients older than 3 years in Vitamin E group (1.19 vs 1.12, P=0.626).
Conclusion: The results of this study demonstrate that treatment with Vitamin E for at least four months can slightly reduce renal scarring in children older than 3 years and boys with acute pyelonephritis; however, further studies and probably longer duration of treatment are required to obtain significant results.
Time: 17:45 -18:15
Dr Bonnie Richardson is a nephrologist at 5Section of Nephrology, Department of Medicine, Saskatchewan Health Authority, Regina, Canada
Background: Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease burden than non-First Nations people.
Objective: We aimed to identify the severity of chronic kidney disease and quantify the geographical challenges of obtaining kidney care by Saskatchewan's First Nations people.
Setting: The setting involved patients followed by the Saskatchewan provincial chronic kidney care program, run out of two clinics, one in Regina, SK, and one in Saskatoon, SK.
Patients: The patients included 2478 individuals (379 First Nations and 2099 non-First Nations) who were older than 18 years old, resident in Saskatchewan, and followed by the provincial chronic kidney care program. First Nations individuals were identified by their Indigenous and Northern Affairs Canada (INAC) Number.
Measurements: The demographics, prevalence, cause of end-stage renal disease, severity of chronic kidney disease, use of home-based therapies, and distance traveled for care among patients are reported.
Methods: Data were extracted from the clinical database used for direct patient care (the provincial electronic medical record database for the chronic kidney care program), which is prospectively managed by the health care staff. Actual distance traveled by road for each patient was estimated by a Geographic Information System Analyst in the First Nations and Inuit Health Branch of Health Canada.
Results: Compared with non-First Nations, First Nations demonstrate a higher proportion of end-stage renal disease (First Nations = 33.0% vs non-First Nations = 21.4%, P < .001), earlier onset of chronic kidney disease (MFN = 56.4 years, SD = 15.1; MNFN = 70.6 years, SD = 14.7, P < .001), and higher rates of end-stage renal disease secondary to type 2 diabetes (First Nations = 66.1% vs non-First Nations = 39.0%, P < .001). First Nations people are also more likely to be on dialysis (First Nations = 69.7% vs non-First Nations = 40.2%, P < .001), use home-based therapies less frequently (First Nations = 16.2% vs non-First Nations = 25.7%; P = 003), and must travel farther for treatment (P < .001), with First Nations being more likely than non-First Nations to have to travel greater than 200 km.
Limitations: Patients who are followed by their primary care provider or solely through their nephrologist's office for their chronic kidney disease would not be included in this study. Patients who self-identify as Aboriginal or Indigenous without an INAC number would not be captured in the First Nations cohort002E
Conclusions: In Saskatchewan, First Nations' burden of chronic kidney disease reveals higher severity, utilization of fewer home-based therapies, and longer travel distances than their non-First Nations counterparts. More research is required to identify innovative solutions within First Nations partnering communities.
Prof. Dr. Md. Nazmul Islam has completed his MBBS at the age of 26 years from Shahjalal University Of Science & Technology and MSC from The Imperial College School of Medicine, University of London. He is the Project Director of North East Nursing College, and Professor & Head of the Department of Nephrology in North East Medical College Hospital. Many of his papers were submitted in reputed journals. He is a member of “Chronic kidney disease and cardiovascular risk in six world sub-regions: The ISN-KDDC cross-sectional study” research programme.
Acute Kidney Injury is a clinicopathologic entity characterized by acute deterioration of renal function and often morphologic evidence of tubular injury. The main goal of our study is to find out the incidence, etiology, diagnostic approach, clinical course and finally outcome of the patients with AKI in this single centre of sylhet region, Bangladesh. The majority of studies in this area are retrospective and many only focus on specific patient groups. So, we also performed retrospective analysis. 35 patients were included with a mean age 45.97 20.78 years. 51% were male and rests of the patients were female. Quantitative variables are expressed as Mean SD and qualitative variables expressed as percentage, the calculated percentage are based on multiple responses. Age group 60-above was found as most vulnerable group. By analyzing, we have found several clinical features like fever, abdominal pain, nausea, profound weakness, oliguria and vomiting were 42.86%, 28.57%, 22.86%, 20.01%, 20.01% and 14.29% respectively. The three most frequent risk factors HTN, DM and UTI at around 45.71%, 25.72% and 14.29% respectively were reported. In our analysis, we found 5.71% mortality rate which is significantly less in comparison with other parts of Bangladesh even in the whole world.
Prof Do Tat Cuong graduated from Hanoi Medical University in 1973. He is one of the first experts in kidney and organ transplantation in Vietnam in 1992. Throughout his career, he has been in charge of a number of important positions such as Vice Director of 103 Military Hospital; Director of Vinmec International Hospital. He has published nearly 100 studies on the international and domestic journals. He is also the author of medical textbooks. He reported at 30 International Science Conferences and being the chairman of 20 state and ministerial-level projects. By his dedicated and delightful contributions to the medical practices and research, he has been honored many prestige awards conferred by the Vietnam government like Ho Chi Minh Award in Organ Transplantation; State Award; People’s Physician; Merit of the Ministry of Health; Merit from the Prime Minister of Vietnam; The Exclusive Patent on the Emergency Tracheostomy Percutaneous set.
Backgrounds: Tacrolimus is one of the basic immunosuppressive drugs for treating post-transplant renal patients. Two main challenges associated with the tacrolimus are choosing the correct starting dose and making adequate dose adjustments to compensate for changing the time of pharmacokinetics after transplantation. Herein, we study on individualized tacrolimus in patients with kidney transplantation based on the determination of CYP3A5 genotypes.
Methods: In this study, 40 patients with kidney transplantation and 200 healthy persons were selected. The CYP3A5 sequence was determined to find rs6986 polymorphism (A> G) region.
Results: We recognized that at least one allele CYP3A5*1 existing in 23 patients and 120 heathy people occupying to 57.5% and 60%, respectively. This ratio is quite high in Vietnamese. Furthermore, our finding indicated that the patients with one allele CYP3A5*1 require 1.3 to 2 times higher initial tacrolimus dose to reduce the time of reaching the trough concentration compared to usual therapeutic dose (0.2 to 0.3mg/kg/day).
Conclusions: Frequency of allele CYP3A5*1 was determined in both healthy people and patients. Initial tacrolimus dose was determined for patients with each genotype. CYP3A5 gene testing should be performed on patients with kidney transplantation to individualize the tacrolimus dose and reduce the time of reaching the trough concentration after transplantation.
Sultan Al Dalbhi is a Head of Educational Program and Academic Activities of Adult Nephrology Department at Prince Sultan Military Medical City. He served as Consultant Nephrologist at University of Toronto & McMaster University. He was a Clinical Research Associate in Systematic Review and Meta-Analysis in area of Diabetic Nephropathy Prevention and Outcomes and Critical Care Nephrology (McMaster University & Harvard Medical School)
Context: Mitochondria play a vital role in producing the energy needed for different cellular activities. The role of mitochondria in different diseases and the aging process is gradually becoming elucidated. Different studies have suggested that mitochondrial dysfunction due to mutations in genes that maintain the integrity of mitochondrial DNA (mtDNA), mitophagy, and apoptosis can lead to many neurological and muscular phenotypes as well as diseases in other organ systems including the liver, gastrointestinal tract, heart, and kidneys. We examined the current knowledge of mitochondrial dysfunction and its role in renal pathophysiology. Additionally, we examined how chronic kidney diseases can lead to mitochondrial dysfunction through oxidative stress accumulation, which can subsequently lead to other pathological complications.
Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar,
PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched.
Results: The renal pathological manifestation of mitochondrial dysfunction includes tubular defects, focal segmental glomerular sclerosis (FSGS), glomerular dysfunction, interstitial nephritis, and cystic kidney disease or renal tumors. These conditions can be caused by mutations in the nuclear genes that are involved in mtDNA replication and transcription or due to mtDNA mutations in the genes involved in the respiratory chain.
Conclusions: Clearly, mtDNA plays an important role in renal pathology, and mitochondria may serve as a potential therapeutic target to treat different renal pathologies.
Ana de Alba is a Sport and Exercise Science Professional, who coordinates the Exercise Department in Fundación Renal Iñigo Álvarez de Toledo (F.R.I.A.T.) and helps to improve the physical performance in patients with end-stage renal disease in hemodialysis treatment. Before starting in healthcare environment, Ana worked six years as a Fitness Coach, specialized in people with special needs and back pathologies and giving sports training courses as a teacher in Dirección General de Deportes (D.G.D) of Madrid Council.
Purpose: The number of patients with end-stage renal disease is rapidly growing, and hemodialysis remains the most frequent treatment for this condition. Hemodialysis patients commonly suffer from a worrying loss of physical function and mental deterioration. We aimed to determine the effects of an intradialytic exercise program on patients’ physical performance and mental status.
Methods: 27 patients (33% women; age, 68±13 years) were enrolled in a 14-week intradialytic endurance-resistance training program (‘exercise’ group), performing a total of 40 training sessions; 40 hemodialysis patients (28% women; 68±11 years) performing no exercise during the same time length were used as controls. Endpoints included physical performance (6-minute walk test [6MWT], 10-repetition sit to stand test [STS-10], handgrip strength), mental health (Beck’s depression inventory and State-Trait Anxiety Inventory), and mental and physical component scores of the short-from (SF)-12 Health Survey.
Results: There were no differences (p>0.05) between groups at baseline for sex distribution, mean age or BMI. Beneficial effects of the exercise program were observed on 6MWT distance (11 and -3% for the exercise and control groups, respectively; p<0.001), STS-10 time (-22 and 6%; p<0.001) and handgrip strength (4 and -4%; p<0.02). No significant benefits (p>0.05) were observed for mental status endpoints nor for SF-12 component scores.Despite significant benefits on physical performance, the rate of clinically meaningful responders was low (<50%). Responsiveness was dependent on baseline physical performance(p<0.05) but not on age or sex (p>0.05).
Conclusion: A 14-week intradialytic training program fields significant improvements on physical performance. However, the rate of clinically meaningful responders observed in the present study was low, being the level of responsiveness dependent on baseline physical status. Efforts to individualize exercise prescription are needed in clinical practice to enhance responsiveness, which may involve prescribing a higher training stimulus in some subjects.
Dr Dominik Tacuri-Strasser is working at consultant internal medicine, nephrology and diabetology at Ortenau-Klinikum Offenburg, Germany since 2008. He is a Member of Nephrologisches Zentrum Offenburg, Germany since 2012. He did Medical specialist training at Ortenau-Klinikum Offenburg and Freiburg University-hospital, Germany
Arterial hypertension is common in pregnant women with impact on both, mother and child. Classification of arterial hypertension in pregnancy, the pathophysiological background and overlap with preeclampsia and HELLP-syndrome are reviewed. Moreover, differential diagnosis especially in the context of acute kidney injury important diagnostic tools and therapeutical concepts are presented.
Ákos Peth? was born in year of 1971. He finished the Medical University of Debrecen in year 1999. Before the medical studies he had studied at the Technical University of Budapest, Hungary. He became the specialist in internal medicine and nephrology. He had learned multiple practical skills, e.g.: central vein catheter insertion (temporary, permanent), kidney biopsy, per cutaneous peritoneal dialysis catheter insertion and extracorporeal treatments (e.g. hemodialysis, hemoperfusion, plasma exchange, peritoneal dialysis). He is working now at Semmelweis University of Budapest, Hungary 1st Department of Internal Medicine as assistant professor.
Background: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients’ survival. The insertion of the PD catheter performed in Hungary historically only with a surgical procedure. The PD treatment used not only in end-stage renal failure. Several clinical studies have demonstrated, that PD is supportive treatment in severe heart failure.
Methods: We started the per cutaneous catheter insertion in Hungary in the spring of 2014. We modified the previously described PDC insertion, the insertion point for PDC was the left lower quadrant for subsequent intraabdominal placements of the catheter. We utilized the straight silicone Tenckhoff catheter with two Dacron rings manufactured by Fresenius Medical Care GmbH (Bad Homburg, Germany) in all cases. We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDC).
Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ±18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in 7 patients (47%) and end-stage renal disease in 8 (53%) patients. Acute technical complications within the first month were infrequent: 1 catheter (6%) had drainage problems and 1 (6%) was lost the due to extrusion. There were no serious complications (e.g. organ damage, peritonitis, etc.). We observed that PD-related improvement in left ventricular ejection fraction (LEVF) was associated with better quality of life and reduced hospitalization.
Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PD catheter placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.
Dr Eduard Tilkiyan Associate professor in Clinic of Nephrology, University Hospital "Kaspela"Plovdiv, II Department Internal Diseases, Medical University Plovdiv. He was born on 13 Aug 1964, he graduated Medical University Plovdiv in 1989. He did Speciality Internal diseases in 1994, Speciality Nephrology in 1998 and PhD doctor of medicine in 2018. He worked as an assistant professor in Clinic of Nephrology, Medical University Plovdiv from 1990 to 2009. He served as Head of Nephrology ward, Kaspela Hospital Plovdiv 2009 to 2013 and Clinic of Nephrology, University Hospital "Kaspela"Plovdiv from 2013.
The elderly population in the modern world is growing, and as life expectancy increases, more elderly patients are surviving longer with acute and chronic diseases. Most publications consider elderly patients to be those aged over 60 years. This age limit has gradually increased, leading to a broad spectrum of cut-offs that make it difficult to compare data between series.
Kidney disease is highly prevalent among elderly persons. Many studies have proved that glomerular diseases either primary or secondary are not a rare finding in the elderly. Renal biopsy occupies a prominent place in the diagnosis of renal diseases and though it remains the gold standard for diagnosis, therapeutic management and outcome prediction in patients with renal parenchymal diseases, there is currently poor consensus about proper indications and clinical usefulness of this procedure in the elderly group.
Histology and clinical findings in 219 patients aged over 60 undergone renal biopsy in the Nephrology clinic of University hospital “Kaspela”Plovdiv, Bulgaria between 2010 and 2019 are presented. The elderly patients account for 31.88% of all renal biopsies /687/ performed in our clinic for that period. Data are compared to results in younger patients aged 18 to 59. I also present a comparison among different age groups of the elderly i.e. patients aged 60-69, 70-79 and over 80 years.
Crescentic GN is the most common histologic type in patients >60years – 34 patients /15,52%/. Membranous nephropathy is the result in 32 patients /14,61%/, amyloidosis in 24 /10,95%/ and Minimal change disease in 21 patients /9,59%/ are next in order in the elderly group.
Acute kidney injury and nephrotic syndrome are the most common indications for performing renal biopsy. We pay special attention to the role of positive immunologic tests for antineutrophil cytoplasmic antibodies, anti-glomerular basement membrane antibodies, antinuclear, anti-double stranded DNA, anti-phospholipase A2 receptor antibodies in favor of performing the biopsy and following treatment. Clinical course and results of therapy are presented.
Jin-Lan Liao is working as a nephrologist at Peking University Shenzhen Hospital. She has 15 years of experience in clinical work in nephrology, including peritoneal dialysis, hemodialysis, and other blood purification techniques. Independently completed B-ultrasound guided renal biopsy and deep vein catheterization and she is also good at the diagnosis and treatment of kidney diseases
Aim: Poor sleep quality is common in haemodialysis patients and associated with worse outcomes. In this pre?specified analysis, we examined the impact of extended hours haemodialysis on sleep quality.
Methods: The ACTIVE Dialysis trial randomized 200 participants to extended (?24 h/week) or standard (target 12–15 h) hours haemodialysis over 12 months. Sleep quality was measured in the Kidney Disease Quality of Life Short Form 1.3 (KDQOL?SF) by overall sleep quality score (0–10, 10 = ‘very good’) and the sleep subscale (0–100, 100 = ‘best possible sleep’) every 3 months via blinded telephone interview. The average intervention effect was calculated by mixed linear regression adjusted by time point and baseline score. Factors predicting sleep quality were assessed by multivariate regression analysis.
Results: Overall sleep quality score and sleep subscale at baseline were similar in both groups (5.9 [95%CI 5.4–6.4] vs. 6.3 [5.9–6.8]; 65.0 [60.9–69.1] vs. 63.2 [59.1–67.3]; extended and standard hours, respectively). Extended hours haemodialysis led to a non?significant improvement in overall sleep quality score (average intervention effect 0.44 (?0.01 to 0.89), P = 0.053) and sleep subscale (average intervention effect 3.58 (?0.02 to 7.18), P = 0.051). Poor sleep quality was associated with being female and with current smoking. Sleep quality was positively associated with EuroQol?5D (EQ5D) and the SF?36 Physical Component and Mental Component Summary Scores but not with hospitalizations.
Conclusion: Sleep quality was not significantly improved by extended hours dialysis in this study. Sleep quality is positively correlated with quality of life in haemodialysis patients and is poorer in women and current smokers.
Dr Rakesh Madhyastha, MD, is a Clinical Associate in the Nephrology Department of the Medical Subspecialties Institute at Cleveland Clinic Abu Dhabi. Prior to joining Cleveland Clinic Abu Dhabi, Dr. Madhyastha was a Specialist Nephrologist for Dorset County Hospital NHS in Dorchester, United Kingdom. Dr. Madhyastha received his medical degree from Ramiah Memorial Hospital in Bangalore, India. Upon graduation, he completed his residency in Internal Medicine followed by further specialization in Nephrology at Ramiah Memorial Hospital. After completion, Dr. Madhyastha relocated to the United Kingdom where he obtained additional Nephrology training in Dorset County Hospital NHS in Dorchester. Overall, Dr. Madhyastha has extensive training in all aspects of Nephrology including renal transplant, acute kidney injury, dialysis and nephrotic/nephritic syndromes.
Introduction: Acute kidney injury (AKI) often occurs in patients supported with Extracorporeal Membrane Oxygenation (ECMO). It frequently evolves into chronic kidney damage or end-stage renal disease and is associated with a reported 4-fold increase in mortality rate. ECMO itself may contribute to maintaining kidney dysfunction through several mechanisms The reported incidence of new-onset AKI after ECMO in adults is 70.3%–84.4%, and approximately 60% of patients who receive ECMO require renal replacement therapy (RRT) (2-5)
Methods: We conducted a retrospective analysis of 47 adult patients receiving all forms ECMO between March 2015 and April 2018. The study was designed to look into the renal outcomes in these patients. We analyzed data for adult patients undergoing all forms of ECMO between March 2015 to April 2019 in our institute. We looked at the post -ECMO renal outcomes for the development of Chronic Kidney Disease (CKD), persistent requirement of Renal replacement therapy (RRT), full renal recovery at the time of discharge and death. Development of AKI was based on KDIGO 2012 definition
Results: The study cohort included 47 adult patients (32 Males and 15 Females). Nine patients (19.1 %) were above 65 years old. Nephrology opinion was sought in 31 out of 47 patients. 97.8% (n=46) developed AKI and 59.5% (n=28) needed RRT. Continuous veno-venous hemofiltration (CVVH) was the modality of RRT used in all patients. The renal outcome was measured based on renal function at the time of discharge. The average length of stay in the hospital was 31.6 days. Nine patients (19.1% ) became dialysis dependent and 6.3% developed CKD at the time of discharge. The total mortality in patients undergoing ECMO was 63.8% (n=30). Interestingly, mortality in patients with VA ECMO was higher at 72% compared to patients on VV ECMO at 20%. Only 3 patients (6.3% ) had normal baseline kidney function at the time of discharge. The most common cause of AKI was cardiogenic shock in 70% (n= 33) followed by sepsis 19.1% (n=9). Types of ECMO performed were : VA ECMO 76.5%, VV 17%, Va-V 2.1% and another 4.2% were converted from VA to VV.
Conclusion: In this study, we conclude that ECMO poses a serious risk for AKI and being on ECMO is an independent risk factor for not only developing CKD but mortality as well. Bigger and prospective studies are needed in this field to identify risk factors and preventive strategies to improve morbidity and mortality in patients on ECMO
Dr. Murkamilov Ilkhom Torobekovich is the chairman Board "Society of specialists in chronic kidney disease Kyrgyzstan". Candidate of Medical Sciences, acting Associate Professor of department faculty therapy Kyrgyz State Medical Academy named after I.K. Ahunbaev. Creator of over 100 scientific publications in clinical nephrology, cardiology and internal diseases. Co-author of monograph on intestinal human microbiota. Currently studying prevalence, progression mechanisms of diabetic and non-diabetic etiology of chronic kidney disease (CKD) among residents of the Kyrgyz Republic, cardiovascular and cerebral complications in patients with CKD, epigenetic mechanisms of human aging, gender and age features of kidney function in habitants of the Kyrgyz Republic. Dr. Murkamilov I.T. is vice chairman of the community young doctors and healthcare providers. Since 2017 included the composition of the editorial board of leading peer-reviewed journals.
Aims of the study. Studying the prevalence of risk factors for progression chronic kidney disease according to a survey of a representative sample of habitants in the Kyrgyz Republic.
Materials and methods. Surveyed 1403 people with established diagnosis of chronic kidney disease (CKD): 871 (62.1%) men and 532 (37.9%) women, the average age is 42.2±14.8 years. The present study included clinical and laboratory information of patients examined by nephrologists in the city Bishkek. At the first stage, the address of the patient’s, anamnesis, information about taken drugs, clinical examination data at the time of examination, double measurement of blood pressure and heart rate reduced body weight. All examined individuals analyzed the hemoglobin content, the number of red blood cells in the peripheral blood and the value of protein excretion in solitary urine. Biochemical analysis included evaluation concentrations of creatinin, total cholesterol, uric acid and blood glucose. Glomerular filtration rate (GFR) was calculated using the formula CKD-EPI (Chronic Epidemiological collaboration for kidney disease). CKD was diagnosed according to K/DOQI (Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification, 2002).
Results. Prevalence of signs of nephropathy with safe (optimal) GFR in a representative sample of the Kyrgyz Republic population made up 23.8% (334). Signs of nephropathy and a slight decrease in GFR were noted in 244 patients (17.3%), a moderate decrease in GFR - in 309 (22.0%) examined patients. Hard degree of GFR was found in 172 patients (12.2%), and 344 (24.5%) individuals had signs of end-stage renal failure. Risk factors for the progression of CKD were considered body mass deficiency, obesity, arterial hypertension (AH), hyperglycemia, hyperuricemia, anemia, proteinuria of the nephrotic level. Underweight was detected in 54 (3.8%) patients, obesity in 409 (29.1%), AH in 748 (53.3%), hyperglycemia in 613 (43.6%), hyperuricemia in 571 (40.6%), anemiain 490 (34.9%), and cases - nephrotic proteinuria 403 (28.7%).
Conclusion. Most common risk factor for CKD progression in Kyrgyz Republic habitants was obesity, hypertension and hyperglycemia.
Sarat Mallipeddi is a Consultant Neurophysician in Kims ongole, Andhra Pradesh, India. He has lot of interest in cases of uremic neuropathy and stroke. He has published articles for the national and international journals.
Objective: The objective was to study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in chronic kidney disease (CKD) patients on peritoneal dialysis (PD) and effect of the presence of diabetes mellitus (DM). Method: This study was a hospital based comparative study conducted among patients hospitalized in a dialysis wards, nephrology OPD in Sri Venkateswara Institute of Medical Sciences, Tirupati, India. The data were collected and tabulated using Microsoft Excel 2010 version. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0. All the continuous variables were expressed as mean ± standard deviation or median with interquartile range as appropriate. All categorical variables were expressed as frequencies (percentage).Result: Between May 2015 and December 2016, 100 CKD patients on PD were assessed. The prevalence of peripheral neuropathy was 65% based on clinical symptoms and 92% based on electrophysiological parameters. The mean age was 55.7 ± 10.9 years. About 64% were male. Twelve patients (12%) had motor weakness, 64 patients (64%) had positive symptoms and 60 patients (60%) had negative symptoms. Autonomic symptoms were seen in 14 patients (14%). Definite damage was seen in 68 patients (68%), early damage was seen in 16 patients (16%). In PD patients with DM (n = 50), 50 patients (100%) had definite damage. In PD patients without DM (n = 50), 18 patients (36%) had definite damage, 16 patients (32%) had early damage. In CKD patients on PD, patients aged >50 years (definite damage in 75.7%) showed more severe peripheral neuropathy when compared to patients aged ?50 years (definite damage in 53%). Conclusion and recommendation: Most common nerves involved in the present study were median motor nerve, sural nerve, ulnar sensory nerve, common peroneal nerve, posterior tibial nerve followed by the median sensory nerve. Peripheral neuropathy is common in CKD patients on PD, with higher prevalence and severity in elderly females and diabetics. Rationale management of diabetes in CKD patients on PD probably lowers the prevalence and severity of peripheral neuropathy.
Time: 16:45 -17:15
Dr. Yu Peng has been practicing integrated Chinese and western medicine for 15 years, majoring in the field of kidney failure and dialysis technique. She is the deputy director of the peritoneal dialysis (PD) center of Guangdong Provincial Hospital of Chinese Medicine. The novel device named “modified trocar” along with the new PD catheterization technique was first introduced by Dr. Peng in Guangdong province. By 2018, over 1000 cases of PD patients were operated by Dr. Peng, including 200 cases using modified trocar. Currently, over 600 PD patients are under regular follow-up and management in her PD center.
Peritoneal dialysis (PD) catheter implantation is necessary for patients with end-stage renal disease (ESRD) to maintain continuous ambulatory PD (CAPD). We developed a half-percutaneous technique based on a modified trocar device for the placement of a PD catheter. The retrospectively evaluation of efficacy and safety of 84 cases using this technique will be presented.
All these patients received this new PD catheter implantation technique between September 2016 and October 2017 in the Guangdong Provincial Hospital of Chinese Medicine. All ESRD patients underwent successful PD catheterization with our novel technique. Neither conversion from this method to traditional open surgery nor major intraoperative complications were observed. The mean operative time was 20.8?±?4.5 min, and the incision length was 2.28?±?0.53 cm. The operative cost was CN ¥ 1762.45 (US $261), and the length of hospital stay was 7.5?±?0.58 days. One patient (1.19%) showed leakage, and one patient (1.19%) experienced bleeding 2 weeks after the surgery. Catheter dysfunction due to catheter tip migration occurred in nine patients (10.7%) 2 weeks after the procedure, and the placement of the catheter was corrected with conservative treatment. No visceral injuries or PD-related infections were observed up to 4 weeks after the catheters were implanted.
Based on the preliminary evaluation, we consider that this half-percutaneous technique for PD catheter implantation appears to be a safe, effective and feasible procedure. This technique has the advantages of reduced surgical trauma, a shorter operative time and faster postsurgical recovery. In particular, this novel technique is easy for nephrologists to perform and therefore may help to promote and popularize PD treatment.