10^th European Nephrology Conference October 24-26, 2016 Rome, Italy

Biography:

Viachaslau Barodka has completed his MD at Byelrussian State Medical University in 2000. In 2004, he moved to United States and completed his Residency Training in Anesthesiology at Thomas Jefferson University, Philadelphia, PA. In 2009, after completion of the Cardiothoracic Fellowship at The Johns Hopkins University Hospital, Baltimore, USA, he continued his career as an Assistant Professor of Cardiac Anesthesia. He has special expertise in cardiovascular physiology and outcomes after cardiac surgery. He has 25 publications in high impact peer reviewed journals. 

Abstract:

We sought to determine whether a goal-directed perfusion protocol (GDPP) could reduce the incidence of acute kidney injury (AKI) following cardiac surgery. Based on available literature, we identified goals to achieve during cardiopulmonary bypass (including maintenance of oxygen delivery above 300 mL O₂/min/m² body surface area, and reduction in vasopressor use) which were combined into the GDPP. GDPP patients were matched to controls that underwent cardiac surgery between 2010-2015 using propensity scoring across 15 variables. The primary and secondary outcomes were the incidence of AKI and the mean rise in serum creatinine within the first 72 hours following cardiac surgery. We utilized GDPP in 88 patients, and matched these to 88 control patients who were similar across all variables including mean age (61 years in controls vs. 64 in GDPP patients, p=0.12) and preoperative glomerular filtration rate (90 vs. 83, p=0.34). Controls received more phenylephrine on cardiopulmonary bypass (mean 2.1 vs. 1.4 mg, p<0.001) and had lower nadir oxygen delivery (mean 241 vs. 301 mL O₂/min/m², p<0.001). The AKI incidence was 23.9% in controls and 9.1% in GDPP patients (p=0.008); incidences of AKI stage 1, 2, and 3 were 19.3%, 3.4% and 1.1% in controls, and 5.7%, 3.4%, and 0% in GDPP patients. Control patients exhibited a larger mean percent increase in creatinine from baseline (35% vs. 16%, p<0.001). GDPP appears effective in reducing AKI incidence following cardiac surgery. A randomized trial is needed to confirm these findings.

Biography:

Vinod C Tawar has earned BSc Hons. and BSc Tech. Pharmaceuticals from University of Bombay. He was offered a Teaching Assistantship at the School of Pharmacy, University of Manitoba, Canada, where he achieved a Post-graduate (MSc) degree in Pharmacology followed by working as a Toxicologist at a university hospital in Winnipeg for a duration of 10 years. In due course, he developed a toxicology laboratory for patient management and forensic purposes. This later became a reference laboratory for the Province of Manitoba. In 1981, he decided to study medicine and graduated Medicine in 1985. Subsequently, he joined Douglas Hospital Research Centre at McGill University as a Psychiatry Research Consultant with participation in projects on depression, Alzheimer’s disease, alcoholism and schizophrenia. Here he had co-authored many research papers. After 5 years, he was offered a two year Residency Position for licensure in general practice. Currently, he has been in an office based group family medicine practice for 16 years. Eight years ago, he has completed Post-graduate studies in Family Medicine for the specialty while working. During his practice, he had conducted research on depression, hypertension, GERD and asthma. At present, he has maintained his interest on nephropathy and challenging tasks of medicine.

Abstract:

This study has been based on the improvements observed in predominantly diabetic patients with EGFR falling below normal, leading to stage III and stage IV renal damage. The study consisted of a review of 82 patients’ clinical records. Approximately 27% of the patients had demonstrated falling EGFR and were started on perindopril 8 mg or trandolopril 2–4 mg per day. The duration of treatment needed to restore to normal EGFR varied from 8 to 16 weeks depending on the extent of dysfunction (EGFR>40). The population consisted of male and female patients mainly of South Asian origin. Perindopril has shown to be beneficial in patients with EGFR of over 40 and trandolopril 4 mg dose has been useful in patients with stage IV cases. The findings have encouraged me to initiate diabetic patients with the above mentioned ACEI for prevention of renal dysfunction.

Biography:

Abstract:

Background: Controversy about the postnatal management of infants with antenatally detected hydronephrosis (ANH) still exists. We report the results of diuretic ^99mTc DTPA renography on 30 infants presenting with an antenatal diagnosis of unilateral renal pelvic dilatation.

Aim: Aim of this study was to assess the renal function determined by the pattern of drainage and split renal function (SRF) on diuretic renography and to correlate these findings with antero-posterior pelvic diameter (APD) estimated by ultrasonography.

Methods: Thirty infants with 60 renal units (RU) (25 boys and 5 girls, median age 6.0 months, range 2–24) who presented with unilateral hydronephrosis on ultrasound in newborn period underwent DTPA diuretic renal scintigraphy (F+15 protocol). We classified hydronephrosis into 3 groups according to APD: Mild (APD 5–9.9 mm) in 5/60 RU, moderate (APD 10–14.9 mm) in 10/60 RU and severe (APD≥15 mm) in 17/60 RU. The postnatal associated clinical diagnosis were pelviureteric junction obstruction (PUJ), simple hydronephrosis, megaureter, vesicoureteral reflux (VUR) and posterior urethrae valves in 11, 10, 6, 2 and 1 infant respectively. Images and Tmax/2 after diuretic stimulation on the background subtracted renographic curves were used as the criteria for classifying the drainage as 1) good 2) partial and 3) poor or no drainage. SRF was calculated with integral method.

Results: Good drainage was shown in 36/60, partial drainage in 13/60 and poor or no drainage in 11/60 RU. In infants with severe ANH (APD≥15 mm), obstruction was not excluded in 1/17 RU (94.1%); and in infants with mild to moderate ANH, obstruction excluded in 13/15 RU (86.7%); p<0, 001. Split renal function (SRF) >40% was observed in 55/60 RU, with no RU showing SRF less than 23.5%.

Conclusion: Although ANH is mostly benign condition and has favorable outcome, it can also cause a significant morbidity. Diuretic renography in antenatally detected hydronephrosis should be a useful tool in postnatal follow up, especially in differentiating nonobstructive form hydronephrosis from obstructive. In the presence of partial or no drainage, the SRF may not be significantly impaired. Finding of poor renal emptying is significantly more common among children with increasing renal pelvis APD.

Biography:

Nina Dunne obtained a scholarship to undertake a PhD from The University of Manchester, UK. Her research focus is centered on Pediatric Dialysis. She is currently a Senior Lecturer in Child Health at The University of Brighton, UK.

Abstract:

Hemodialysis has improved in recent years; however, despite such improvements, intra-dialytic hypotensive episodes still persist which can lead to a reduction in the overall effectiveness of the treatment. Profiling sodium levels during dialysis can improve vascular refilling and therefore may prevent hypotensive events. A number of profiling methods exist and this meta-analysis is set out to examine the effectiveness of these methods. A review and meta-analysis analytical framework was used to assess the effectiveness of hemodialysis sodium profiling techniques. Stata 11.2 (Stata Corp) was used to analyze the data. Actual numbers of hypotensive events were pooled between studies. Analysis of subgroups was performed on sodium profile type. The data were further investigated using meta-regression. Publication bias was also tested. Stepwise profiling was shown to be statistically significantly effective in reducing intradialytic hypotensive episodes. Results demonstrated that linear sodium profiling was not effective in reducing hypotensive events during dialysis. This review has shown that using stepwise profiling is more effective at reducing intra-dialytic symptoms than other profiling methods. There was no evidence that linear profiling method was any more effective than conventional dialysis and in fact the results showed the reverse.

Biography:

Joanne Reid’s predominate area of research is aligned with the MRC framework and focuses on cachexia. The quality of her research and its knowledge translation is evidenced by research outputs. She has received a Royal College of Nursing, Nurse of the Year Research Award for her competitively funded work on cachexia which has informed national guidelines, for example Royal College of Nursing end of life guidelines. She is an Associate Editor of BMC Palliative Care, and has been an invited guest Editor for Healthcare.

Abstract:

Cachexia contributes to increased morbidity and premature mortality in persons with chronic illnesses including cancer, cardiac failure and chronic kidney disease. It is a multifactorial syndrome which currently lacks a clear definition in a renal population. This presentation will present a study outline which aims to determine the clinical phenotype of cachexia specific to individuals with CKD and is scheduled to start in autumn, 2016. This is a longitudinal study which will run over 2 years. All adult hemodialysis patients who attend the Northern Ireland Regional Nephrology Unit (NIRNU), who have a confirmed diagnosis of stage 5 CKD (estimated GFR<15 mL/min/1.73 m²) will be eligible for inclusion into this study to determine if they experience (and to what degree) the known characteristics associated with cachexia. Patients will be monitored for 1 year (or time till death if <1 year). The NIRNU provides care to approximately 250 stage 5 CKD hemodialysis patients per annum. The recruitment window for this study is approximately 7 months, with a potential patient population of 145. Potential patients will be identified via inpatient wards and outpatient units at NIRNU. We are proposing to study all patients. Data collection measures (bloods plus validated tools to determine QoL, fatigue and anorexia; lean muscle mass and muscle strength) will be collected at routine hemodialysis appointments. The patients recruited will be followed for 1 year to ascertain the percentage that develops known characteristics of cachexia and to what degree they experience these characteristics.

Biography:

Hariharan Munganda is pursuing his DNB Medicine Post-graduate degree after his MBBS. He has participated in national and international conferences. He has published papers in reputed national and international journals and has been serving as a research student in Nephrology Department of reputed hospital in Delhi NCR, India. 

Abstract:

Introduction: Chronic renal disease patients on hemodialysis are at increased risk of infection by hepatitis C virus (HCV). Subjects undergoing treatment in dialysis centers without nephrologists and improper viral marker screening, dialysis at more than one center and no separate dialysis machine for HCV+ve patients and unscreened blood transfusion are at risk of cross contamination. Thus, there is a need to screen these subjects for prevalence of HCV seropositivity and study the impact of HCV positivity on clinical course of the disease.

Aim: Aim of or study was to assess prevalence of HCV positivity in CKD on hemodialysis subjects; and also to assess various characteristics of HCV positive subjects and compare them with HCV negative CKD subjects.

Methodology: In our Asian tertiary care hospital, dialysis unit a total of 100 CKD subjects were recruited for the study and after informed written consent, further detailed history, socioeconomic and clinical parameters including dialysis related parameters were analyzed and compared between the Hepatitis C seropositive and seronegative subjects. Hepatitis C positivity was assessed using chemiluminescence.

Result: Prevalence of seropositivity was found to be 16% in CKD subjects. Only 2% of the subjects have acquired HCV from our hospital while 14% have acquired HCV infection from other sources.

Conclusion: High prevalence of HCV infection exists in CKD subjects. Facilities for separate dialyzer under expert supervision from nephrologists are strictly recommended to contain the HCV infection.

Biography:

L Azouaou is a Teacher Assistant of Nephrology in College of Medicine of Algiers. She is a Graduate of the University of the Sorbonne in Paris in Nephropathology IUD, and Founder of the genetic study of SNCR in Algeria. She participated actively in several nephrology congresses in the world.

Abstract:

Introduction: The regulation of blood pressure is very difficult in hemodialysis patients. High blood pressure (hypertension) in hemodialysis was mainly due to a surplus of extracellular volume and increased peripheral resistance that result. Scribner described early in the non-drug treatment of this common complication by sodium diet and ultrafiltration. The correction of hypertension in hemodialysis is done by the dry weight method. The dry weight of the estimation error in chronic hemodialysis patients affects their morbidity and mortality. The aim of our study is to compare the results of estimating "Subjective" dry weight by the clinic with the results of impedance, ultrasound of the inferior vena cava and BNP testing in order identify risk factors for clinical estimation error of the dry weight.

Materials & Methods: This is a prospective study conducted in the hemodialysis center Nafisa Hamoud CHU Parnet of Algiers on 67 chronic hemodialysis patients. The estimate of the water status of patients was assessed by the three above-mentioned methods. We used the BCM (Body Composition Monitor) immediately before the dialysis session, excess post-dialysis fluid was calculated by a formula validated (excess of normal volume by BCM is -1,1 L to + 1.1 L). Serum BNP (B-type natriuretic peptide) was measured before and after dialysis and the calculation of the vein diameter lower cellar. We compared the target weight goal determined by these methods and the subjective target weight. The gap between the two was significant weight when it was greater than 1 kg.

Results: The median age of patients was 40±5 years, and a man sex ratio/woman of 0.84, average BMI of 21±3.5 kg/m². Les values ​​measured by the various techniques used, drop significantly after the session hemodialysis. We objectified a significant correlation between the results of the impedance, the BNP and the index of the maximum and minimum VCI. 41.5% of our patients have excess volume (hydration), while 49% were within the normal range or with normal hydrated and 8% were dehydrated. We corrected the dry weight of the patients according to the weight determined by the 3 methods, and after two months there has been a balancing of the hydration status of patients and their blood pressures.

Discussion: Determining the "Dry Weight" of patients with ESRD by clinical evidence is not sufficiently reproducible. Our results demonstrate that the clinical evaluation of the dry weight is correlated with dry weight of values ​​estimated by BCM, BNP assay and the IVC diameter.

Conclusion: This study is among the few studies that used the three above-mentioned methods for assessing hydration status of chronic hemodialysis to show a good correlation between these three methods. The existence of a gap between the subjective and objective target weight suggests the incessant need for a coupling between the various techniques evaluated on a strategy adapted to the characteristics of each patient.

Biography:

Marsida Duli is Advisor at Ministry of Health in Tirana, Albania. She is Nephrologist by her profession and is currently pursuing PhD at the Medical University of Tirana. She received her Master of Science in Health Services Management from University of Siena in Italy. She lectured at public and private universities where she chaired the Department of Public Health in Medicine Faculty. She has published regularly in national and international scientific journals on topics like nephrology, dialysis, health policies, Albanian health system and health services management.

Abstract:

Chronic kidney disease (SRK) increasingly constitutes a global public health problem of the importance of first-hand. In Albania the problem is practically unknown by the population, yet little-known and widely underestimated by doctors and by the government policy makers and public health authorities. Currently in Albania, chronic renal diseases have an increased incidence and prevalence, as well as a clear trend towards the terminal stage, towards renal replacement therapy. The dialysis service is provided by the public sector and the inability to provide this service in public hospitals of all those patients is increasing in number. Since 2007, half of them take it in private hospitals, where the state reimburses the bill for this service in the private sector. With recent developments in Albanian health policies, the development of health service packages for free, the dialysis service is offered to patients due to public-private partnership, from the private sector, even closer to home. This form of financing health services offers, flexibility for patients to be diagnosed and in need to be treated with dialysis, a continuous medication and without fail. Other challenges are still Albanian nephrology primary, secondary and tertiary prevention. The end result is intended to reduce morbidity and mortality from renal diseases, and improve the quality of health care provided to patients on dialysis.

Biography:

Vinod C Tawar has earned BSc Hons. and BSc Tech. Pharmaceuticals from University of Bombay. He was offered a Teaching Assistantship at the School of Pharmacy, University of Manitoba, Canada, where he achieved a Post-graduate (MSc) degree in Pharmacology followed by working as a Toxicologist at a university hospital in Winnipeg for a duration of 10 years. In due course, he developed a toxicology laboratory for patient management and forensic purposes. This later became a reference laboratory for the Province of Manitoba. In 1981, he decided to study medicine and graduated Medicine in 1985. Subsequently, he joined Douglas Hospital Research Centre at McGill University as a Psychiatry Research Consultant with participation in projects on depression, Alzheimer’s disease, alcoholism and schizophrenia. Here he had co-authored many research papers. After 5 years, he was offered a two year Residency Position for licensure in general practice. Currently, he has been in an office based group family medicine practice for 16 years. Eight years ago, he has completed Post-graduate studies in Family Medicine for the specialty while working. During his practice, he had conducted research on depression, hypertension, GERD and asthma. At present, he has maintained his interest on nephropathy and challenging tasks of medicine.

Abstract:

The current research, a retrospective study on early stage intervention on the development of diabetes, is based on a concept discussed in 2011 by Ralph A De Fronzo and Muhammad Abdul-Ghani in a publication by American Diabetes Association. The research comprises of early recognition of the patients at the stage of developing IGT and initiation of treatments with oral hypoglycemic agents in order to reach a normal HbA1C. The overall numbers of patients in practice were 5000 and those with IGT were 26. The research was started 7 years ago and has resulted in these patients reaching an HbA1C of 5.2; the target of treatment was maintaining lower than 5.2. Metformin has been mostly effective in patients reaching the target value, however in rare cases Gliclazide was needed. In one case Actos and insulin treatment was essential for a female patient with polycystic ovarian syndrome. The current success has resulted in preventing further complications from diabetes. In earlier years, clinicians were advised to start oral hypoglycemic agents, once the patients had shown an HbA1C of 7.5. However, the evidences have shown that by this stage many complications from diabetes would have occurred.

Biography:

Pradip Chowdhury has graduated from Kharkov Medical Institute, Ukraine. He did his Residency in Internal Medicine at Beth Israel Medical Center, Newark, New Jersey. After that, he finished is Fellowship in Nephrology under New York Medical College at San Vincent Hospital, Staten Island New York, and Metropolitan Hospital, New York City, New York. Then he worked as an Attending Nephrologist at Kaiser Permanente, Sacramento, California. Since 2001, he has been working as an Attending Nephrologist at different hospitals in the Los Angeles, and also different dialysis units of DaVita, Fresenius, US Renal Care, and Free Standing Dialysis Unit, Los Angeles. He is the Assistant Medical Director of Peritoneal Dialysis Center of America. 

Abstract:

Currently 1.9 million of people in the world are undergoing dialysis. This data is based on only people who registered for RRT. We do not know the exact percent of people reaching ESRD, and also who can afford dialysis. Some data suggests initiation of RRT in developing regions is restricted to fewer than a quarter of patients projected to developing ESRD. One of the big factors is the cost of RRT. Peritoneal dialysis may be cheaper, but it is clinically proven to be equivalent or even slightly superior to hemodialysis. This modality is under-utilized in most parts of the world. If we can promote this modality, more people will be benefitted by the effects of peritoneal dialysis. Materials for this talk are based on the articles of ASAN International Peritoneal Dialysis Journal, National Kidney Foundations and Nephrology Dialysis Transplant. 

Biography:

Areej Mohamed Ateya has completed her study at the Faculty of Pharmacy, Ain Shams University, Cairo, Egypt in 2013. She got her Pre-Master’s and started working as a Teaching Assistant at the Clinical Pharmacy Department of the same university in 2014. She had attended multiple conferences in different clinical pharmacy disciplines and was a guest speaker in one.    

Abstract:

Background: Cardiovascular disease is the leading cause of death in patients with end stage renal disease on maintenance hemodialysis (HD). Omega-3 fatty acids are beneficial in preventing atherosclerosis and reducing the cardiovascular events. Patients undergoing HD are susceptible to inadequate omega-3 intake due to renal dietary restrictions. This study evaluates the effects of omega-3 on serum lipid profile, oxidative stress and cardiovascular manifestations in children undergoing HD.

Methods: A single blinded randomized placebo-controlled trial including 49 pediatric patients (mean age=14.6 years) on regular HD, who were randomly assigned into omega-3 group (n=25) who received 1 g oral omega-3 capsule once daily for 16 weeks or placebo group (n=24) who received 1 g matching oral placebo capsule once daily for 16 weeks. Total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, malondialdehyde, glutathione peroxidase (GP) and superoxide dismutase (SOD) were measured at baseline and after 16 weeks of supplementation. Cardiovascular manifestations (chest pain, shortness of breath, palpitations, and feeling of fainting or dizziness) were also examined at baseline and at the end of the study.

Results: By the end of the study, children in omega-3 group showed a highly significant reduction (p<0.001) in TC and a highly significant increase (p<0.001) in GP and SOD. There was also a highly significant reduction in the number of children suffering from palpitations and chest pain in omega-3 group.

Conclusion: Omega-3 has a highly beneficial effect on serum lipid profile, oxidative stress and clinical manifestations of cardiovascular complications in pediatric patients on regular HD.

Biography:

Rahaf Z Attar has completed her Bachelor’s degree of General Medicine and Surgery from King Abdulaziz University of Jeddah. She is currently taking training at King Abdulaziz University Hospital in Pediatric Major. She has worked on several researches. 

Abstract:

Background & Aim: Systemic lupus erythematosus is an autoimmune multisystemic disease that can be present in myriad of ways. Thrombotic microangiopathy is a rare complication of SLE; even more rare if it was the initial presentation of the disease. Infection has been suggested to be one of the triggers for such an event. There are few cases reported on SLE patients initially presenting as HUS; other few cases on HUS triggered by a Streptococcal infection.

Methods: We describe a case of 9 year old boy who had a history of pharyngitis. Two weeks later he presented to the hospital with symptoms of severe anemia, hematuria and abnormal renal function. Investigations showed positive ASO, ANA and dsDNA antibodies.

Results: Biopsy revealed a picture of thrombotic microangiopathy in addition to a diffuse thickening of the glomerular basement membrane with membranoproliferative pattern of proliferation. Diagnosis of SLE and aHUS was made. The patient was improved after the treatment with prednisone and cyclophosphamide. No plasma exchange was required.

Conclusions: aHUS is a type of thrombotic microangiopathy that might present as a vascular complication of SLE. Infection is not only an important risk factor for SLE exacerbation but also a common trigger for thrombotic microangiopathic events in these patients. There are several cases reported in the literature of SLE patients first presenting as aHUS. However, the occurrence of aHUS triggered by Streptococcal infection as the first presentation in an SLE patient hasn’t been reported to the extent of our knowledge. The outcome is generally favorable.

Biography:

Daniel Schock Kusch finished his Doctoral thesis dealing with the development of novel markers for GFR measurement and their transcutaneous measurement at University of Heidelberg in 2008. He further participated in the development of that technique as Research Scientist at Innovation Lab GmbH, Heidelberg and Post-doc at University of Heidelberg and University of Applied Sciences Mannheim. In 2011, he became Co-founder of Mannheim Pharma & Diagnostics GmbH bringing the first system for transcutaneous measurement of kidney function for preclinical research to market. He is now Site Director at Medibeacon GmbH.            

Abstract:

Transcutaneous measurement of glomerular filtration rate (_tGFR) is now frequently used in preclinical in vivo animal studies. _tGFR allows consecutive measurements on the same animal, including multiple measurements on a daily basis. A description of the measurement device and its many applications, along with examples from the recent literature will be given. We will highlight the fields of interest in which the system is used and give an overview about its performance versus endogenous and other exogenous methods of GFR measurement. A special focus will be put on the precision of _tGFR compared to standard measurements employed in the research setting. A novel kinetic model for the description of transcutaneously measured excretion kinetics of the fluorescent GFR tracer FITC-Sinistrin was recently described. Using this new kinetic model designated _tGFR_3cp.b.m), _tGFR measurements in the rat model reached comparable precision as GFR measurements assessed using a gold standard technique based on constant infusion (cGFR). The precision of _tGFR assessment when using _tGFR_3cp.b.m, coupled with the capability of consecutive GFR measurements in the same animal over a long time span should enhance the quality of, and reduce the cost of, preclinical assessment of renal function in pharmaceutical research.