Day 2 :
Oslo University Hospital, Norway
Time : 09:40-10:20
Käthe B Meyer completed her Master’s and is currently completing her PhD at Oslo University. She is a Transplant Coordinator at Oslo University Hospital. She has been a member of several international committees such as the Executive Committee of the Board of Transplant Coordinators within the division of Transplantation of the UEMS, Chair of Nordic Transplant Coordinator Group and scientific committee member at EDTCO congresses. She has published 8 articles in reputed journals.
The wide use of healthy persons as kidney donors calls for awareness of risks associated with donation. Few studies have investigated associations between clinical variables and donors’ self-reported health outcomes in a long-term perspective. The aim of this study was to investigate associations between clinical variables and self-reported health outcomes long-term. The study had a mixed-methods design using a cross-sectional survey and a prospective follow-up study. Self-reported health outcomes (Short-Form 36v2 (SF-36v2™), multidimensional fatigue inventory and donor specific questions) were collected from 217 donors who donated a kidney at Oslo University hospital in 2001-2004. Pre and post donation data was collected from 202 of these donors. Linear regression analysis was used to investigate potential associations. Approximately ten years post-donation donors scored high on QOL with mean scores between 63.9 and 91.4 (scale 1-100) for the 8 subscales, highest for role emotional and lowest for vitality. Females scored higher than males on fatigue. Mean systolic BP was 129.2 mmHg (SD=14.7) and diastolic BT 78.5 mmHg (SD=7.8). Mean increase in plasma creatinine was 16.6 µmol/l (SD=16.3). Hypertension were identified in 67 donors, and 54 donors had eGFR <60 ml/min/1.73 m2. None of the clinical parameters were significant predictors for self-reported health. However, we found a significant relationship between hypertension and donor specific questions. Recipient health, worries about own health and worsened relationship with the recipient influenced willingness to donate in retrospect. Regretting donors scored higher than average on all domains of fatigue. Identifying and following donors who are at risk for fatigue is important.
Via Medis Dialysis center, Germany
Time : 10:20-11:00
Thomas Ryzlewicz has completed his PhD from Free University in Berlin (West). He started dialysis treatment in 1974. In between 2 years in the Physiologic Institute (Berlin-West, theme acid-base status). In1978, he published two papers in Kidney International (co-working with H Hampl) concerning the cardio-vascular behavior during dialysis monitored by left-heart catheter. In 1978, he worked on the development of a rough protoype for bicarbonate dialysis in order to study the amount of acidification. In 1985, he was a Consultant at the Nephrologic Clinic in Regensburg (Bavaria, Germany). He was a Senior Consultant in 1992 (dialysis centre in Ebersberg, near Munich, Germany). He is responsible for handling of many prototypes of dialysis supply systems, e.g., prototypes of hemofiltration (1978) and of the real (2-step) online-hemofiltration (1983-85). He worked on the development of an own bloodline with minimal contact between blood & air in order to reduce the sheer-stress in single fibre capillary (big EPO dosage reduction, product “Oxyless-Line”) which obtained EU patent, US patent, PEMA audit from London, and was published by Ian Macdougal (King’s College, London).
There does exist several points in dialysis technology for improvement. First point is the systemic pressure (blood pressure entry of the dialyzer). This equipment does detect kinking of the bloodline (by wrong handling) as well as to detect a totally thrombosis of the dialyzer. By this, the critical haemolysis will be prevented from the patient. The 3 online-HDF studies will be discussed (treatment-time was too short, no use of predilution, bloodflow for postdilution was too low). The advantage of the dBV-measurement should be used in order to prevent the vascular under-filling by ultrafiltration of the patient. The continous reduction of the diameter of the single fibre capillary (> in order to elevate the KUF will be discussed critically. The new design of a dialyzer (mit-cut-off membrane) will also be discussed critically. The VAM (Vascular Access Monitor) should be important for every new monitor in order to prevent the disconnection. The ISO norm 11663 will be discussed especially for the production of sterile fluid for online-therapies. The acidification of bicarbonate dialysis fluid with citrate finally is necessary in order to prevent the calcification even in the prescription of the classical dialysis fluid (with acidification of acetate). In this context, there will be a follow up word concerning not-handling of medical authorities in case of problems with a medical product.
Sanjay Gandhi Post Graduate Institute of Medical Sciences, India
Time : 11:20-12:00
Amit Gupta is currently working as a Professor of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. He is a Senior Resident in AIIMS New Delhi, India and fellow in Nephrology Guys Hospital, London, UK and Toronto Hospital, Toronto, Canada. He had qualifications of MBBS, MD (Medicine), DNB (Nephrology) and FRCP (London). He has 40 years of experience as a Faculty Member in Department of Nephrology, SGPGIMS, Lucknow, India joined in the year 1987. His main research and interest areas are Peritoneal Dialysis and Renal Transplantation. He held various positions in various societies, such as Past President of Indian Society of Nephrology, 2009 and Past President Peritoneal Dialysis Society of India, 2004. And also he had orations in Khullar Oration of Indian Society of Nephrology 2005, Arogya Kalyan Nyas Oration of Peritoneal Dialysis Society of Nephrology 2012 and Georgi Abraham Oration of Peritoneal Dialysis Society of India 2016. He had 192 articles in indexed journals & 30 book chapters. And also he had an achievement in the CAPD program at SGPGIMS in 1993 which is the largest centre for CAPD in South Asia.
The number of patients with end stage renal disease is increasing around the world mainly because of the increase in incidence of diabetes mellitus. Although 80% of the world's population lives in developing countries, the number of patients on dialysis in developing countries is only 20% of the total number of dialysis patients around the world.
Financial constraints are the most important reason for the low number of patients on dialysis. However the other reason for fewer patients being on maintenance dialysis is the lack of access to hemodialysis. Hemodialysis requires investment in equipment and trained manpower which is expensive & is big task for any government who are already bogged down with management of communicable diseases and malnutrition.
Peritoneal dialysis in such situations is the ideal form of dialysis which can help provide dialysis to the vast majority of end stage renal disease patients who require renal replacement therapy. Continuous ambulatory peritoneal dialysis although cumbersome for the family can be performed at home and with good training can provide adequate removal of uremic toxins. CAPD does not require any expensive equipment, electricity supply or infrastructure in the form of space as is required in hemodialysis. It also does not require the patient to travel long distances to HD centers involving additional expenditure to the patient.
CAPD was started in India in 1990 but the growth of PD in India has been less than satisfactory. There is reluctance on part of patients to accept PD because of the "fear" of doing unsupervised treatment & also the "supposed high incidence of infections". Unavailability of good diagnostic facilities also adds to the problems of home treatment. Physician reimbursement is another reason why many nephrologists are partial towards HD as the only modality of renal replacement therapy to most patients. CAPD is essentially reserved for patients who have problems with HD or have run out of vascular access essential for HD.
Our centre is tertiary care teaching institution funded by the government and having full time nephrologists on the rolls. CAPD was started at this centre in 1993 and today it is the largest CAPD centre in India and South Asia. At present 230 patients are on follow up and 1700 patients have been initiated on PD. The 2 year & 5 year patient survival both in diabetic and non diabetic patients is similar to as what has been reported in literature. The 10 year actuarial survival is inferior to other centres.
Peritonitis rates are well within levels as recommended by the Internal guidelines. The incidence of fungal peritonitis is much higher as compared to the incidence reported from the West. However the patients who have chosen CAPD are generally happy and satisfied with the treatment. In view of our experience we believe that PD is the best option for starting RRT in developing countries that do not have adequate facilties for accepting all ESRD patients on HD. In our presentation we will discuss the medical & financial benefits of PD over HD for initiating dialysis in ESRD patients in developing countries.