Day 1 :
Keynote Forum
Phoebe Anne M. Dino-Santos
Philippine Children’s Medical Center, Philippines
Keynote: Comparison of outcomes of erythropoietin beta and erythropoietin alpha for treatment of anemia in children with chronic kidney disease on maintenance hemodialysis: A retrospective cohort study
Time : 09:00-09:40
Biography:
Phoebe Anne M. Diño-Santos is a Diplomate in Pediatric Nephrology. Her passion for research writing led her to pursue further training in Clinical Research. She wishes to advance her knowledge in the field of research and write outstanding research papers that can contribute to the development and improvement of children’s health.
Abstract:
Statement of the problem: Anemia is a common complication of chronic kidney disease that can be treated with Erythropoietin. This study aims to compare the outcomes of Erythro-Poietin Alpha (EPO A) and Erythro-Poietin Beta (EPO B) in children on maintenance hemodialysis.
Methodology & theoretical orientation: This is a retrospective study involving hemodialysis patients aged 12 to <19 years old with Hemoglobin (Hb) >8 to <11 g/dL. Patients were grouped according to the type of EPO they received. Successful treatment was defined as achievement of Hb>11 g/dL within 3 months of treatment and successful maintenance as Hb>11 g/dL for >3 months after successful treatment. The effectiveness and treatment cost using EPO A and EPO B were compared.
Findings: Thirty-two subjects were included, sixteen for each EPO group. A higher percentage of successful treatment (75% vs. 31.2%, P=0.03; AOR 0.07 95% CI: 0.01-0.71) and maintenance (50% vs. 40% p=1.0) were observed in EPO B compared with EPO A. Lower doses of EPO B were required for successful treatment (208 ± 151 vs. 393 ± 140, P=0.03) and maintenance (P=1.0). The median increase of Hb using EPO B was higher (P=0.002) after 1st month. Hypertensive episodes were similar in both groups. A lower cost of EPO B was computed for successful treatment (P=0.04) and maintenance (P=0.32).
Conclusion: This study has shown that EPO B is more effective than EPO A in the management of anemia among children on maintenance hemodialysis. Both EPOs have comparable safety profiles. This is the first study that directly compares EPO A and EPO B in children and prospective studies may be done to reinforce these findings.
- Pediatric Nephrology | Nephrology Nursing & Health Care |
Location: Rome, Italy
Session Introduction
Giezebel H. Arago
Philippine Children’s Medical Center, Philippines
Title: Outcomes of prolonged intermittent renal replacement therapy combined with hemoperfusion among patients aged <18 years old with severe dengue in a tertiary hospital: A retrospective cohort study
Biography:
Giezebel H. Arago is a Diplomate of Pediatric Nephrology Society of the Philippines. She has attained the Degree of Doctor Medicine in the University of Santo Tomas, Manila, Philippines in 2012. She had her Pediatric Residency Training in Mandaluyong City Medical Center (MCMC), Mandaluyong, Philippines. She finished fellowship training in Pediatric Nephrology at Philippine Children’s Medical Center, Quezon City, Metro Manila, Philippines. From her experiences gained in her trainings, she aspires to continue to deliver great and outstanding pediatric nephrology care in her country.
Abstract:
Statement of the problem: In the Philippines, management of Severe Dengue (SD) is quite challenging despite of intensive care especially if patients developed significant Fluid Overload (FO) thus requiring Renal Replacement Therapy (RRT). Hence this study aimed to determine the outcomes of Prolonged Intermittent Renal Replacement Therapy (PIRRT) plus Hemo-Perfusion (HP) in treating SD among pediatric patients.
Methodology: This retrospective cohort study was conducted at the Hemodialysis Unit to all pediatric patients with SD according to WHO definition who underwent PIRRT + HP from June 2018 to January 2020. Among 357 SD patients, only 27 were included in the study. The primary outcome measure was 28-day all-cause mortality, adjusted for Body Mass Index (BMI), Fluid Overload (FO), baseline kidney function (eGFR) and Vasopressor Dependency (VD) using regression analysis. Secondary outcomes were as follows: average length of PICU stay, hospital day, day on ventilation, hemodynamic tolerability and change in % fluid overload.
Findings: Baseline demographic and clinical characteristics were not significantly different between two groups except in PIRTT group noted higher % FO at initiation of RRT (p=0.05) and obesity and overweight was higher in PIRRT+HP group (p=0.01) (Table 1). There were no significant differences in 28-day mortality (p=0.40) and secondary outcomes between two groups (p values>0.05) Using univariate and multivariate analysis, the following variables: BMI, FO, eGFR and VD were not significantly associated with mortality.
Conclusion: In this study, hemoperfusion was found to be comparable with PIRRT alone in terms of hemodynamic tolerability in SD patients however no significant difference in mortality after two treatment sessions although HP showed an increase in survival percentage (44.4% vs. 22.2%) which might have clinical impact. Timing of initiation of RRT and number of subsequent HP sessions might be considered in future prospective studies.
- Cardiovascular Impacts of Kidney Diseases
Location: Rome, Italy
Session Introduction
Yu Ma
Tian Jin chest Hospital，China
Title: Effect of PCSK9 inhibitor on contrast-induced acute kidney injury in patients with acute myocardial Infarction undergoing intervention therapy
Time : 11:00-11:30
Biography:
Abstract:
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to inhibit pyroptosis and apoptosis, which play important roles in the development and progression of contrast-induced acute kidney injury (CI-AKI). However, to the best of our knowledge, no studies have investigated the potential effect of PCSK9 inhibitors on the prevalence of CI-AKI after percutaneous coronary intervention (PCI). This study aimed to determine whether PCSK9 inhibitors are associated with the prevalence of CI-AKI. The medical records of 309 (mean age, 63.35 years; 71.84% male) patients with acute myocardial infarction who underwent PCI at our institution were retrospectively analyzed. Overall, 149 and 160 patients were assigned to the evolocumab and control groups, respectively. Serum creatinine levels were examined preoperatively and 24–72 h postoperatively and compared between groups. Data were grouped according to the occurrence of CI-AKI, and a univariate analysis was conducted to exclude suspected influencing factors that led to CI-AKI occurrence. After adjusting for confounding factors, a logistic regression analysis was performed to assess the association between evolocumab administration (independent variable) and CI-AKI occurrence (dependent variable). The prevalence of CI-AKI was significantly lower in the evolocumab group (6.7%) than in the control group (20.0%; p<0.01).We further evaluated the correlation between exposure factor and outcome. The relative risk(RR) between the use of evolocumab and the occurrence of CI-AKI was 0.34.This result indicate a significant association between the use of evolocumab and a reduction in the incidence of CI-AKI. The logistic regression analysis results revealed that evolocumab was significantly associated with CI-AKI. The use of PCSK9 inhibitors, hydration therapy, and statin administration appears promising for preventing CI-AKI in patients with acute myocardial infarction undergoing PCI.