12^th Global Nephrologists Annual Meeting June 26-28, 2017 London, UK

Biography:

Edwin Rodríguez-Cruz has completed Doctorate degree from the San Juan Bautista School of Medicine, PR. He specializes in Internal Medicine & Pediatrics. He completed Pediatric Cardiology fellowship and sub-fellowship in Interventional Cardiology from the Children's Hospital of Michigan. Currently, he is the Director of Cardiology of the San Jorge Children's Hospital, and Associate Professor of Medicine and Pediatrics at the San Juan Bautista School of Medicine, PR, USA. He has published over 20 articles in peer review journals and many specialty opinions by editors' request. His interests are in the areas of heart failure, structural heart diseases, and difficult venous accesses. He has special interest in chronic total venous occlusions (CTVO).

Abstract:

Chronic Total Venous Occlusions (CTVO) are one of the many challenges physicians have to confront in the daily treatment of patients with End Stage Renal Disease (ESRD). Even in cases where an arteriovenous fistula is present, central venous occlusions may occur and be a hassle for the culmination of therapy by hemodialysis. A total of 79 patients with CTVO has undergone re-opening of the vessels in our institution, of those 29 had ESRD. The 29 patients comprised: 17 females and 12 males. The mean age was 17 years (8- 76 years). One female patient was lost to follow up. The time at presentation was a mean of 4 months (3-9 months). The majority of patients had swelling of one extremity or face, and difficulty with dialysis upon presentation. A total of 48 percutaneous interventions were carried out. In all the patients, we were able to open the anomalous vessel. Twelve (12) patients required more than 1 intervention to maintain patency of their diseased vessel. The shortest time to need another procedure was 1 month, and the longest 25 months. Stents were implanted in 11 patients with 2 requiring more than 1 stent in different occasions. Of the patients with only 1 procedure, the range without re-interventions is from 1 month to 5 years. The most commonly intervened vessels were central thoracic veins. With the application of simple methods of reopening the CTVO percutaneously, we have achieved a good medium term patency in patients with ESRD. With newer technologies however, possibly adapted from arterial interventions, the longevity of these accesses may be prolonged.

Biography:

B Balaji Kirushnan has completed his medical training in the year 2012. He has won the Apollo gold medal award in Internal Medicine during his post-graduation. He has been trained in various fields of Nephrology like acute renal failure, continuous renal replacement therapy, peritoneal dialysis and renal transplant. He has also been trained in renal histopathology and across the blood group renal transplantation. He has given various lectures to physicians to highlight the importance of referral to a Nephrologist. He is a member of Indian Society of Nephrology and Indian Society of Nephrology southern chapter. He has been certified by Royal College of Physicians, UK in Nephrology. He has a number of case reports to his publications. He has won accolades and is prized for poster presentations in various international and national conferences. A special interest in research has made him a part of the ongoing research in clinical trials in nutrition in haemodialysis and novel therapies of hepatitis C.

Abstract:

Chronic hepatitis C remains an important health problem in chronic kidney disease and is associated with reduced graft survival after renal transplantation. It is more common in developing countries and in haemodialysis centers, where there is a break in universal precautions during reuse of haemodialyzers.  Hepatitis C is also associated with increased rates of rejection, new onset diabetes mellitus and occurrence of de-novo glomerulonephritis after renal transplant. It is associated with fibrosing cholestatic hepatitis and extra hepatic complications like vasculitis. The recommended treatment in the post-transplant setting with interferon is only when the benefits of the treatment outweigh the risks.  Conventional interferon therapy in the post renal transplant scenario has been associated with increased rates of allograft rejection. Directly acting antivirals (DAA) could offer a new therapeutic armamentarium in post renal transplant recipients without precipitating rejection. Newer drugs like sofosbuvir, ledipasvir and daclatasvir have been used in hemodialysis and peritoneal dialysis patients to achieve a sustained virological response before renal transplant. The above strategy has shown better outcome in terms of patient tolerability of drugs and sustained remission rates of virological response after transplant.    

Biography:

Zaher Armaly, Clinical Lecturer in the Faculty of Medicine, Bar Ilan University has been a member of the faculty since 2009. He received his MD degree from Padua, Italy in 1989. After one-year Medical Training in Nahariya Medical Center, he moved to Rambam Medical Center for Residency & Specialization in Internal Medicine and subsequently sub-specialization in Nephrology and Hypertension. Since 2003, he serves as Director of the Department of Nephrology and Hypertension at Nazareth Hospital, Nazareth, Israel. He has received several awards for his research and clinical activity including Dangur Family Award from Bar Ilan University. He has over 30 original publications in peer review journals and text books. Besides his recent and past achievements in research, he had excellent achievements as a Lecturer, expressed by a wide variety of prizes that he received for (constantly) excellence in teaching including the best Bar Ilan Lecturer Award. He has extensive experience in Nephrology research. His main interest is anemia and the impact of carnitine on iron-induced oxidative stress in CKD patients. Over the last 10 years his group has been studying the pathophysiology of inflammation and oxidative stress following IV iron administration. In addition, his research focuses on contrast-induced nephropathy and novel therapeutic approaches to this common disease state. Finally, he studies the incidence of depression in ESRD patients on hemodialysis and peritoneal dialysis and the factors underlying this phenomenon. 

Abstract:

Background: Anemia is a common problem in CKD patients. It is attributed to decreased erythropoietin (EPO) production, low iron stores, and the chronic inflammatory milieu. Therefore, therapy includes not only recombinant EPO, but also irons replenishment. However, the latter induces oxidative stress as well as inflammation. Randomized, controlled studies suggested that L-carnitine supplementation might have positive effects on the response to EPO in long term hemodialysis patients. However, there is no evidence whether this approach is also beneficial in earlier-stage CKD patients. Thus, the present study examined whether L-carnitine prevents IVIR-induced oxidative stress and whether it improves response to EPO.

Aims: Our hypothesis is that: 1. Intravenous administration of iron (IVIR) to CKD patients at early stages of the diseases (Stage 2-4) provokes oxidative stress and inflammation; 2. Prophylactic L-carnitine supplementation could prevent the IVIR-induced oxidative stress and inflammatory responses in these patients.

Methods: The current study included 32 anemic CKD patients (stages 2-4) that were divided into 2 subgroups: Group of 16 patients was given a weekly IVIR (Sodium ferric gluconate, [125 mg/100 ml] for 12 weeks. Group 2: Sixteen patients received the same IVIR regimen but also carnitine (20 mg/kg, IV) was administered weekly 30 min prior to IVIR administration through the whole treatment period. Weekly blood samples were drawn before and after each IVIR for Hb, C-reactive protein (CRP), advanced oxidative protein products (AOPP), TBARS and neutrophil gelatinase-associated lipocalin (NGAL), in addition to routine complete blood count and biochemical analyses.

Results: Combined administration of IVIR and carnitine increased Hb more profoundly (+8%) than those treated with IVIR alone (+13%). While IVIR alone induced oxidative and inflammatory responses, patients who received carnitine did not exhibit these adverse effects, as was evident by abolishing IVIR-induced elevation in CRP, NGAL, AOPP, and TBARS.

Conclusion: Our finding demonstrated that co-administration of carnitine with IVIR preferentially attenuates the adverse consequences of IVIR, suggests a role for Carnitine therapy in these patients. 

Biography:

Anita Saxena is currently working as an Additional Professor in the Department of Nephrology in Sanjay Gandhi Post Graduate institute of Medical Sciences, Lucknow.  Her qualifications include MD and PhD. She completed her Post-Doctoral fellowships during 1995-96, Addenbrook’s Hospital, Cambridge University, England. She is a member of American Society of Nephrology (ASN), International Society of Nephrology (ISN), International Society of Renal Nutrition and Metabolism (ISRNM), Asia Pacific Society of Nephrology (APSN), Indian Society of Nephrology (ISN), Peritonial dialysis Society of India, Indian Society of Organ Transplantation (ISOT), Indian Association of Nephrology (IAN), Member Research Board of Advisors American Biographical Institute, USA, Advisory Council, International Biographical Centre, Cambridge, England and Philosophical Society, Cambridge, England. She has more than 60 published papers. 

Abstract:

Protein energy wasting (PEW) affects morbidity and survival of patients on maintenance dialysis. Primary end point was to evaluate efficacy of proseventy on hypoalbuminemia over a period of 6 months (increase in serum albumin). Inclusion criteria: i) Serum albumin is <3.8 g/100 mL ii) patients on maintenance dialysis for at least 3 months. Exclusion criteria: No clinical PEW as per ISRNM criteria. Multicentric oral nutritional intervention study was performed on maintenance dialysis patients with established hypoalbuminemia (serum albumin <3.8 g/100 mL) and PEW as per ISRNM criteria. 36 patients were on peritoneal dialysis and 144 on hemodialysis. The study was approved by ethics committee. 180 patients (90 supplemented and 90 control) were randomly assigned 1:1 to standard treatment (control group) or standard treatment plus nutritional supplement (supplemented group) for 6 months. The renal specific protein powder supplement contained 70% soya protein. Control group were kept on 1.2 g/kg/d protein and 35 kcal/kg/d. Supplemented group received protein supplement daily in three divided doses of 10 g/dose. Patients were evaluated on 3 visits at months 0, 3 and 6. At each visit, nutritional status was assessed by SGA, 24 hour dietary recall and anthropometry, routine biochemical parameters. SF36 Quality of Life questionnaire pre/post intervention was used for assessment of efficacy of nutritional supplement. Three days dietary recall was maintained in food diaries. At inclusion, no difference in age, sex, SGA and routine biochemistry was observed. Control group, however, had significantly higher serum albumin (3.37±0.36 vs. 3.2±0.41 g/dL; p=0.013) and subscapular skinfold thickness (14±6.0 vs. 12.1 ±5.0 mm; p=0.032) than supplemented group. Out of 180 patients, 128 (89 in control and 39 in supplemented) completed the study. Compliance was assessed by counting empty tins returned by the patient. At visit 1, 2 and 3, there was significant difference in protein intake in supplemented and control groups (48.35±14.2 and 51.93±16.4; 65.15±21.86 and 63.49±19.4; and 67.05±20.7 and 65.36±19.1 g/day respectively). At visit 1, 2 and 3 in supplemented and control groups, there was significant difference in energy intake (1546.06±397.24 and 1607.41±396.72; 1774.73±535.9 and 1730.49±408.15; and 1891.31±490.65 and 1813.26±464.82 kcals/day). Though CRP levels were above normal in both the groups, they were significantly higher in controls compared to supplemented group (visit one 8.7±8.1 vs. 4.2±6.01 visit 3, 5.2±0.9 vs. 4.7±0.8 (p=0.016). At 3^rd month, the serum albumin (3.4±0.43 vs. 3.3±0.48 g/dL) and illiac SFT (18.1±8.6 vs. 15.5±8.5 mm; p=0.043), increased significantly in the supplemented group. At six months in supplemented group serum albumin increased significantly (p=0.000) to 3.9±0.49 versus 3.3 ±0.51 in control group. Nutritional status as per SGA score improved in supplemented compared to controls. At 6 months, the biceps (13.0±7.1 vs. 9.1±6.0 mm), triceps (16.1±5.1 vs. 12.1±5.1 mm), subscapular skinfold (17.0±7.2 vs. 16.4±6.9 mm) and suprailliac skinfolds (18.1±8.7 vs. 16.8±8.7 mm) were significantly higher in supplemented group (p=0.000) compared to controls. Additional protein-rich renal specific nutritional supplement to standard nutritional counseling raised serum albumin and increased skinfold thickness in PEW patients undergoing dialysis. 

Biography:

M Karavetian earned her PhD in “Health Promotion” from Maastricht University, Netherlands and her Dietetics degree from American University of Beirut, Lebanon. She has extensive experience in nutrition management of the chronically and critically ill patients. She shares her experience in conferences and workshops locally and regionally in the aim of training health care professionals for better health care. She also is trained and specialized in health care quality (setting policies and procedures and training staff on the new set of rules in health care settings). Her research is focused on identifying effective strategies to change dietary behavior in chronically ill patients. Her publications focus on dietary management of hemodialysis patients and finding the optimal dietitian-to-patient ratio needed in the hemodialysis unit in the Arab world for optimal clinical outcomes. She has shared her experience in national and international conferences. She currently is an Assistant Professor in the Department of Natural Sciences in Public Health, College of Sustainable Sciences and Humanities, Zayed University, Dubai.

Abstract:

Background: Osteodystrophy management includes a dietary phosphorus restriction, which limits protein intake, exacerbating the malnutrition-inflammation syndrome and mortality among hemodialysis patients.

Methods: A multi-center randomized controlled trial was conducted to test the hypothesis that intensive nutrition education focused on phosphorus-to-protein balance will improve patient outcomes. Six hemodialysis units were randomly assigned to the Trained Hospital Dietitian (THD) protocol (210 patients). Six others (184 patients) were divided equally according to the patients' dialysis shifts and were assigned to Dedicated Dietitian (DD) and Control protocols. Patients in the THD group received nutrition education from hospital dietitians who were trained by the study team on renal dietetics, but who had limited time for hemodialysis patients. Patients in the DD group received individualized nutritional education on dietary phosphorus and protein management for 6 months (2-hour/patient/month) from study renal dietitians. Patients in the control group continued receiving routine care from hospital dietitians who had limited time for these patients and were blinded to the study. Serum phosphorus (mmol/L), malnutrition-inflammation score (MIS), 8-domain health-related quality of life (HRQOL) index and length of hospital stay (LOS) were assessed at T0 (baseline), T1 (post-intervention) and T2 (post-6 month follow up).

Results: Only the DD protocol significantly improved serum phosphorus (T0:1.78±0.5, T1:1.63±0.46, T2:1.69±0.53) and 3 domains of the HRQOL index and maintained MIS at T1, but this protective effect resolved at T2. The LOS significantly dropped for all groups by T2.

Conclusion: The presence of competent renal dietitians fully dedicated to hemodialysis units was superior over the other protocols in improving patient outcomes.

Biography:

Nikolai A Bazaev has completed his PhD and currently works as a Senior Scientist in National Research University of Electronic Technology, Department of Biomedical Systems. He has published more than 10 papers in reputed journals. He is an actual member of ESAO since 2016, member of ERA-EDTA since 2017. He works on two scientific projects: Development of a wearable artificial kidney, and development of a noninvasive glucometer. 

Abstract:

The work is devoted to results of dialysis regeneration methods investigation. The aim of the work is to construct a wearable artificial kidney that carries out prolonged continuous peritoneal dialysis. The dialysis fluid is recirculated through an extracorporeal circuit, which undergoes regeneration. Several activated carbons and hemosorbents were evaluated as potential sorpiton material. Three methods of urea elimination were aprobated: Immobilized urease, electrooxidation and thermal degradation. As a result, a prototype of a wearable artificial kidney was assembled. Its regeneration unit is based on electrolysis and gives opportunity to reach the urea elimination rate up to 1.2 g/h; creatine and uric acid elimination rates both equals to 0.3 mg/h (in vitro experinents). Along with that it is possible to keep concentration of sodium, chlorine and calcium ions in the range of 10% deviation from the starting value. The prototype of WAK is designed as a backpack and weights about 3.5 kg. In vivo experiment showed that the prototype carries out its functions, gives opportunity to eliminate exeeded fluid from peritoneal cavity and doesn’t affect blood pH during dialysis. 

Biography:

Dwijen Das completed MBBS from Gauhati Medical College and MD (General Medicine) from Assam Medical College, Dibrugarh, Assam, India. He is currently working as an Associate Professor of Medicine and In-charge of Dialysis Unit, Silchar Medical College. He was immediate past Honorary General Secretary of API, Assam Chapter and a fellow of American College of Physicians. He has 20 publications to his credit in reputed indexed journals. He has contributed many chapters in Medicine updates published during Assam APICON and all India APICON. He is also an Assistant Editor of Assam Journal of Internal Medicine and peer reviewer of two journals of national repute and one international journal. He is the Editorial Board Member of the book, “Progress in Medicine” published in 2017.

Abstract:

Acute kidney injury is defined by an abrupt decrease in kidney function that includes, but is not limited to acute renal failure. It is a broad clinical syndrome encompassing various etiologies, including specific kidney diseases like acute interstitial, glomerular or vasculitic renal diseases; non-specific conditions like ischemia, toxic injury or extra-renal pathology as pre-renal azotemia, or post-renal obstructive nephropathy. Acute kidney injury is common, harmful and potentially treatable. Even a minor acute reduction in kidney function has an adverse prognosis. Kidney failure is defined as a GFR of 15 ml/min per 1.73 m² body surface area, or requirement for renal replacement therapy. Acute kidney injury complicates 5-7% of acute care hospital admissions and upto 30% of admissions at intensive care unit, particularly in the setting of diarrheal illness, infectious diseases like malaria, leptospirosis and natural disasters such as earth quakes. Mortality due to AKI may exceed 50% in cases admitted in intensive care unit. It also increases the risk for development or worsening of chronic kidney disease. Acute kidney injury may be community acquired or hospital acquired. Common causes of community acquired syndrome includes volume depletion, adverse effects of medication and obstruction of the urinary tract and those in hospital acquired AKI are sepsis, major surgical procedures, critical illness involving heart and liver failure, administrations of intravenous contrast and nephrotoxic medications. Pre-renal azotemia is the most common cause of acute kidney injury and usually a result of renal hypoperfusion. It accounts for approximately 60 to 70% of the community acquired and 40% of the hospital acquired cases. The most common clinical conditions associated with pre-renal azotemia are hypovolemia, decreased cardiac output, advanced cirrhosis and medications that interfere with renal autoregulatory responses such as NSAIDS and inhibitors of angiotensin II. Early in the course of pre-renal acute kidney injury, the renal parenchyma remains intact because kidney hypoperfusion initiates a neurohormonal cascade that results in afferent arteriolar dilatation like myogenic reflex, prostaglandin mediated and efferent arteriolar constriction, angiotensin II mediated thereby maintaining glomerular filtration pressure closer to normal and thus prevents marked reduction in GFR if renal blood flow reduction is not excessive. Intrinsic azotemia is classified according to the primary histologic site of injury. Renal tubular epithelial cell injury, commonly termed acute tubular necrosis, occurs more commonly in the setting of ischemia, although renal tubules can also be affected by sepsis and toxins both endogenous and exogenous.

Biography:

Can Hüzmeli completed his MD at Çukurova University in 2002. In 2010, he completed his residency training internal Medicine at Mustafa Kemal University. After completion of the Nephrology fellowship at the Cumhuriyet University in 2014, he has been working as a Nephrology Specialist at Necip Fazil City Hospital, since 2015.

Abstract:

The reason of anaemia during chronic renal insufficiency is deficiency of erythropoietin (ESA). Risk factors for ESA resistance are absolute or functional iron deficiency, gastrointestinal blood loss, haemolysis, inflammation, infection, malignancy, folic acid and vitamin B12 deficiency, inadequate haemodialysis, hyperparathyroidisim, Angiotensin converting enzyme inhibitor, Angiotensin II receptor blocker, Anti-erythropoietin antibody and genetic polymorphism. We describe a case of 52 year old man who had a history of renal allograft failure. Three moons later he presented to the hospital with symptoms of severe anemia, hematuria, fever, exhaustion and fatigue. Due to deep anaemia, 5 times in 2 months (2U each time) erythrocyte replacement (ES) was performed. There was sensitivity in the graft site. Laboratory examinations were: Hb 5.4 gr/dl (13-17), albumin 2.2 gr/dl (3.5-5.2), ferritin >2000 ng/ml (30-100), transferrin saturate was calculated as 40%, vitamin B12 402 pg/ml (191-663), parathormon 630 pg/ml (15-65), C-reactive protein 117 mg/L (0-5), sedimentation 70 mm/hour. In the conducted peripheral spread, normochromic was compatible with normocytic anaemia. The patient was taking epoetin beta 150 Ü/kg vitamin D in treatment, upon no detection of reproduction in sent blood, urine and sputum cultures. Methylprednisolone (10 mg) was started with Graft intolerance syndrome (GIS) diagnosis. Patient did not have fever and did not need ES in his medical follow-ups. GIS was successfully treated with low dose steroids despite the suggestion of high dose steroids. After treatment, Hb level exceeded 12 gr/dl and he did not need erythropoetin.   

Biography:

Surapon Nochaiwong completed his Doctor of Pharmacy (PharmD) from Chiang Mai  University (CMU), Thailand in 2011. After that, he has held the position of Instructor in Department of Pharmaceutical Care, Faculty of Pharmacy, CMU. His research focuses on clinical areas of pharmacoepidemiologic studies in nephrology including drug safety and effectiveness. He and colleagues formed “The Thai Renal Outcomes Research (THOR) Investigators” in 2015 and received funding from CMU, Health Systems Research Institute of Thailand (HSRI), and National Research Council of Thailand (NRCT). He has published several papers in well-known journals and presented his work in both national and international conferences. 

Abstract:

Dialysis patients with uremic pruritus (UP) have a significantly higher risk of mortality and a poor quality of life. This study aimed to develop and validate a multidimensional scale assessing the UP: Uremic Pruritus in Dialysis Patients (UP-Dial). The development and validation of the UP-Dial instrument was conducted in four phases: (1) Item generation, (2) development of pilot questionnaire, (3) refinement with patient recruitment, and (4) psychometric validation. Participants completed the UP-Dial, the visual analogue scale (VAS) of UP, the Dermatology Life Quality Index (DLQI), the Kidney Disease Quality of Life-36 (KDQOL-36), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI) during May 15, 2012 to November 30, 2015.  The 27-item pilot UP-Dial was generated with 168 participants. After factor analyses, the final 14-item UP-Dial encompassed three domains: Signs and symptoms, psychosocial, and sleep. Face and content validity were satisfied through the item generation process and review of experts. The psychometric analysis demonstrated that the UP-Dial had good convergent and discriminant validity. The UP-Dial was significantly correlated (Spearman rank correlation, [95% CI]) with the VAS-UP (0.76 [0.69 to 0.83]), DLQI (0.78 [0.71 to 0.85]), KDQOL-36 (-0.86 [-0.91 to -0.81]), PSQI (0.85 [0.80 to 0.89]), and BDI (0.70 [0.61 to 0.79]). The UP-Dial revealed excellent internal consistency (Cronbach’s α 0.90 [0.87 to 0.92]) and reproducibility (intraclass correlation 0.95 [0.90 to 0.98]). The UP-Dial is valid and reliable for assessing UP among dialysis patients. This questionnaire can be used to standardize the effects of intervention in comparative-effectiveness research.