Volume 83 (2015), No. 7/2015(Supplement 1)
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9th Conference on Kidney Disease in Disadvantaged Populations
The whole issue as pdf-file
Editor of the Proceedings: Kowdle S. Prabhakar
Page No. 0
Abstract
The whole issue as pdf-file
Editor of the Proceedings: Kowdle S. Prabhakar
Foreword
Kidney disease in disadvantaged populations: an unconquered challenge
Kowdle S. Prabhakar, Keith C. Norris, Lawrence Agodoa, and Guillermo García-García
Page No. 1
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S1-S2) © 2015
Kidney disease in disadvantaged populations: an unconquered challenge
Kowdle S. Prabhakar, Keith C. Norris, Lawrence Agodoa, and Guillermo García-García
Correspondence to:
K. S. Prabhakar
Editor of the proceedings of
the satellite meeting of CKHDP,
an advisory committee of the
International Society of Nephrology
Email: [email protected]
Proceedings
Burden of disease: prevalence and incidence of ESRD in Latin America
Marta Gonzalez-Bedat, Guillermo Rosa-Diez, Roberto Pecoits-Filho, Alejandro Ferreiro, Guillermo García-García, Ana Cusumano, Juan Fernandez-Cean, Oscar Noboa, and Walter Douthat
Page No. 3
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S3-S6)
Burden of disease: prevalence and incidence of ESRD in Latin America
Marta Gonzalez-Bedat1,2, Guillermo Rosa-Diez1,2, Roberto Pecoits-Filho1,2, Alejandro Ferreiro2, Guillermo García-García2, Ana Cusumano2, Juan Fernandez-Cean2, Oscar Noboa2, and Walter Douthat2
1Executive Board of the Latin American Dialysis and Transplant Registry (LADTR), and 2Latin American Dialysis and Transplant Society (SLANH)
Introduction: Chronic kidney disease (CKD) represents a major challenge for Latin America (LA), due to its epidemic proportions and high burden to the population affected and to public health systems. Methods: Our methods have been reported previously: This paper shows the data for the last 10 years until 2010, from the Latin American Dialysis and Renal Transplantation Registry (RLADTR). Results: 20 countries participated in the surveys, covering 99% of Latin America (LA). The prevalence of end-stage renal disease (ESRD) under renal replacement therapy (RRT) in LA increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (hemodialysis (HD) 413 pmp, peritoneal dialysis (PD) 135 pmp, and LFG 111 pmp). HD proportionally increased more than PD and transplant and continues to be the treatment of choice in the region (75%). The kidney transplant rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of transplants in 2010 was 10,397, with 58% being deceased donors. The total RRT prevalence correlated positively with gross national income (GNI) (r = 0.86; p < 0.05) and life expectancy at birth (r = 0.58; p < 0.05). The global incidence rate correlated significantly only with GNI (r = 0.56; p < 0.05). Diabetes remained the leading cause of ESRD. Conclusion: The prevalence and incidence of RRT continues to increase. In countries with 100% public health or insurance coverage for RRT the rates are comparable to those displayed by developed countries with better GNI. PD is still an underutilized strategy for RRT in the region. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost effective forms of RRT are needed in the region.Correspondence to:
Dr. Guillermo Rosa-Diez
Perón 4190, Buenos Aires, Argentina
Email: [email protected]
Proceedings
ESRD burden in South Asia: the challenges we are facing
Vivekanand Jha
Page No. 7
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S7-S10)
ESRD burden in South Asia: the challenges we are facing
Vivekanand Jha
George Institute for Global Health, New Delhi, Postgraduate Institute for Medical Education and Research, Chandigarh, India
South Asia, one of the most populous regions of the world, suffers from a large and increasing burden of untreated endstage renal disease (ESRD). Tropical ecology and increasing burden of non-communicable diseases are major drivers. Disease is diagnosed late, and access to treatment has been limited due to socioeconomic reasons but is increasing. System-level solutions, such as development of low-cost techniques and training of manpower to provide care to these patients are required. Individuals at high risk of developing progressive kidney disease should be identified early so that preventive measures can be instituted in a timely manner. This requires use of technology and workforce re-engineering to strengthen community-based prevention efforts.Correspondence to:
Prof. Vivekanand Jha
George Institute for Global Health 219-221,
Splendor Forum, Plot No. 3,
Jasola District Centre,
New Delhi 110025 India
Email: [email protected]
Proceedings
ESRD management in Africa during the last decade
Aziz El Matri
Page No. 11
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S11-S13)
ESRD management in Africa during the last decade
Aziz El Matri
Tunis Dialysis Center, Tunis, Tunisia
Aims: This study was initiated under the auspices of the African Association of Nephrology to evaluate end-stage renal disease (ESRD) development by using data collected in 3 successive surveys performed during the last decade. Materials and methods: Questionnaires were sent in 2004, 2006, and 2012 to national renal societies and to leading nephrologists. Data were also collected from dialysis supply companies, personal communication, and by using research on Medline, Pubmed, etc. So data could be obtained from 33 countries. Results: During the last decade the total number of nephrologists increased from 1,022 to 2,500 in 33 countries – i.e., an average growth rate of 15% per year. But there are still few hospital units dedicated to renal healthcare. The number of dialysis units increased from 1,200 to 1,600 and the number of dialysis patients (97% on hemodialysis) grew from 36,000 to 87,400 i.e., an average growth rate of 14% per year. Peritoneal dialysis, which covers less than 3% of RRT, increased from 1,300 to 2,400 with a yearly growth rate of 8% but it is still located in few countries. Renal transplant is implemented mainly in public hospitals in 5 North African and 7 sub. Saharan and South African countries. Only 5 countries have sustained programs that perform more than 100 operations per year. Conclusion: During the last decade, several countries improved the quality and quantity of care offered to ESRD patients. It is hoped that there will be a sustained improvement with a greater emphasis on education and development of kidney transplantation.Correspondence to:
Aziz El Matri, MD
Tunis Dialysis Center
3 rue Habib Khanfir,
Menzah 9, Tunis,Tunisia
Email: [email protected]
Proceedings
Silent kidney disease and hypertension in Cambodia – a pilot study in Mercy Medical Center Cambodia
Paul Kin-shing Wong
Page No. 14
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S14-S16)
Silent kidney disease and hypertension in Cambodia – a pilot study in Mercy Medical Center Cambodia
Paul Kin-shing Wong
Mercy Medical Center Cambodia, Phnom Penh, Cambodia
The incidence and prevalence of end-stage renal disease (ESRD) has been increasing in most developed countries. In developing countries, however, there has been a lack of reliable data. Aim: To assess the frequency of unsuspected urine abnormality and hypertension in Cambodia. Method: From April to December 2012, 1,013 new patient records of the Mercy Medical Center (MMC) in Cambodia were reviewed. 915 patients aged ≥ 18 years were included for analysis. Patients with history of hypertension (HT) were excluded for blood pressure (BP) analysis. Patients with history of diabetes mellitus (DM), hypertension (HT), chronic kidney disease (CKD), or with symptoms of renal disease were excluded for urinalysis study. Results: 820 patients had no history of HT. Among this group, 73 (8.9%) had abnormal BP with 60 (7.3%) having BP ≥ 140/90 mmHg and 13 (1.6%) having isolated systolic HT (BP ≥ 140/<90 mmHg). No association with family history of HT was found. 728 patients had no history of DM, HT, CKD and not presented with renal symptoms. Urinalysis in 510 of these patients found 62 (12.2%) having significant proteinuria (≥ 1+ on dipstick), 125 (24.5%) having significant hematuria (urine red blood cell count (RBC) ≥ 1+ or > 5/high power field (HPF)), 156 (30.6%) having either significant proteinuria or hematuria; and 199 (39.0%) had urine white blood cell count (WBC) ≥ 1+. Overall, 275 patients (53.9%) had 1 or more urinary abnormalities on urinalysis. Conclusion: Abnormal urinalysis (53.9%) and abnormal BP measurement (8.9%) were common findings among asymptomatic patients referred to the MMC. Unlike findings in other countries, no association of family history of DM, HT, or CKD and the risk of kidney disease or abnormal BP was found. A comprehensive community screening program for HT and kidney disease is urgently needed to prevent ESRD in Cambodia.Correspondence to:
Dr. Paul Kin-shing Wong
Mercy Medical Center Cambodia, House # 3
Street 604, Khan Toul Kork, Phnom Penh, Cambodia
Postal Address:
PO Box 570, Phnom Penh, Cambodia
Email: [email protected]
Proceedings
Current ESRD burden and its future trend in Beijing, China
Liangying Gan and Li Zuo
Page No. 17
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S17-S20)
Current ESRD burden and its future trend in Beijing, China
Liangying Gan and Li Zuo
Department of Nephrology, Peking University People’s Hospital, Beijing Blood Purification Quality Control and Improvement Center, Beijing, China
Aims: To report the trend of incidence, prevalence, and mortality of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) in Beijing, China from 2007 to 2013. Methods: Patient-level data was collected from Beijing hemodialysis (HD) facilities by the Beijing Hemodialysis Quality Control and Improvement Center (BJHDQCIC). Rates for incidence, prevalence, and mortality were calculated. Results: The incidence rate declined from 136.3 per million population (pmp) in 2009 to 94.4 pmp in 2013. From 2010, the leading cause of incident ESRD has changed from chronic glomerulonephritis to diabetes mellitus. The prevalence rate showed an increasing trend and reached 579 pmp at the end of 2013. Chronic glomerulonephritis was still the leading cause of ESRD in prevalent MHD patients. The annual mortality rate showed a declining trend and reached 6.4% in 2013. Conclusions: In Beijing, there is a declining incidence rate, increasing prevalence rate, and declining mortality for MHD patients.Correspondence to:
Li Zuo, MD
Beijing Blood Purification Quality Control and
Improvement Center
Department of Nephrology, Peking University
People’s Hospital, Beijing, China
Email: [email protected]
Proceedings
Latin American special project: kidney health cooperation project between Uruguay and Bolivia
Laura Sola, Raúl Plata-Cornejo, and Juan Fernández-Cean
Page No. 21
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S21-S23)
Latin American special project: kidney health cooperation project between Uruguay and Bolivia
Laura Sola1, Raúl Plata-Cornejo2, and Juan Fernández-Cean3
1Comité de Salud Renal del Ministerio de Salud Publica de Uruguay, Montevideo, Uruguay, 2Director Instituto de Nefrología de Bolivia, La Paz, Bolivia and 3Presidente de la Sociedad Latinoamericana de Nefrología e Hipertensión, Uruguay
Uruguay and Bolivia are two countries that show heterogenicity of the Latin American region, including the national income, the expenditure on health and the services for renal care. In Bolivia, there is manpower shortage for renal care with only 5 nephrologists per million people (pmp) and the prevalence of patients on dialysis is only 200 pmp. This is much lower than the mean prevalence rate of renal replacement therapy for Latin America as a whole. Uruguay on the other hand has more dedicated renal resources with 50 nephrologists pmp, and renal replacement therapy is provided to ~ 1,000 dialysis patients pmp. In November 2012, a collaborative project financed by the Uruguayan International Cooperation Agency was signed by both the Uruguay and Bolivia Ministries of Health, and the goal was to develop a comprehensive program for the prevention and management of all stages of chronic kidney disease (CKD) in Bolivia. The specific objectives were to: a) promote renal healthcare in the primary healthcare setting, b) identify kidney disease in populations at risk, and c) optimize patient care at all stages of CKD, including dialysis and transplantation supported with a national ESRD registry in Bolivia. As a first step, delegates from the Bolivian Health Ministry, visited Uruguay in April 2014, primarily to strengthen the development of tools required for developing and maintaining a national registry. In addition, during this visit, a meeting with the president of the Latin American Society of Nephrology and Hypertension (SLANH) culminated in designing a training program for peritoneal dialysis. This highly cooperative relationship is advancing the prevention and care of CKD in Bolivia and may serve as a model for international approaches to advance system level CKD care in countries with limited healthcare resources.Correspondence to:
Laura Solà, MD
Ministerio de Salud Publica
18 de Julio 1892
Montevideo, 11200, Uruguay
Email: [email protected]
Proceedings
Epidemiological characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities of El Salvador
Carlos M. Orantes Navarro, Raúl Herrera Valdés, Miguel Almaguer López, Denis J. Calero, Jackeline Fuentes de Morales, Nelly P. Alvarado Ascencio, Xavier F. Vela Parada, Susana M. Zelaya Quezada, Delmy V. Granados Castro, and Patricia Orellana de Figueroa
Page No. 24
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S24-S31)
Epidemiological characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities of El Salvador
Carlos M. Orantes Navarro1, Raúl Herrera Valdés2, Miguel Almaguer López2, Denis J. Calero3, Jackeline Fuentes de Morales4, Nelly P. Alvarado Ascencio5, Xavier F. Vela Parada1, Susana M. Zelaya Quezada1, Delmy V. Granados Castro1, and Patricia Orellana de Figueroa1
1National Health Institute, Ministry of Health (MINSAL), San Salvador, El Salvador, 2Nephrology Institute, Havana, Cuba, 3Bajo Lempa’s Monseñor Romero Specialized Family Community Health Unit (UCSF-E), Usulután Department, El Salvador, 4San Miguel UCSF-E, San Miguel, El Salvador, and 5Western Health Region, MINSAL, Santa Ana, El Salvador
Introduction: In El Salvador end-stage renal disease (ESRD) was the first cause of hospital mortality overall, the first cause of hospital deaths in men, and the fifth cause of hospital mortality in women in 2013. In agricultural communities, chronic kidney disease (CKD) occurs predominantly in male agricultural workers, but it also affects women to a lesser degree, even those who are not involved in agricultural work. Internationally, most epidemiological CKD studies emphasize men and no epidemiological studies focused exclusively on women. Objective: To describe the epidemiological characteristics of CKD in females in agricultural communities of El Salvador. Methods: A cross-sectional epidemiological study was carried out in 2009 – 2011 based on active screening for CKD and risk factors in women aged ≥ 18 years in 3 disadvantaged populations of El Salvador: Bajo Lempa (Usulután Department), Guayapa Abajo (Ahuachapán Department), and Las Brisas (San Miguel Department). Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. CKD cases were confirmed at 3 months. Results: Prevalence of CKD was 13.9% in 1,412 women from 1,306 families studied. Chronic kidney disease of nontraditional causes (CKDu), not attributed to diabetes mellitus, hypertension, or proteinuric primary glomerulopathy (proteinuria > 1 g/L) was 6.6%. Prevalence of chronic renal failure was 6.8%. Prevalence of renal damage markers was 9.8% (microalbuminuria (30 – 300 mg/L) 5.7%; macroalbuminuria (> 300 mg/L) 2%; and hematuria, 2.1%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9.3%; hypertension, 23%; family history of CKD, 16%; family history of diabetes mellitus (DM), 18.7%; family history of hypertension (HT), 31.9%; obesity, 21%; central obesity, 30.7%; NSAID use, 84.3%; agricultural occupation, 15.2%; and contact with agrochemicals, 33.1%. Conclusions: CKD in women of Salvadoran agricultural communities is associated with disadvantaged populations, traditional (DM, HT, obesity) and non-traditional causes (environmental and occupational exposure to toxic agents and inadequate working conditions). Our results reinforce the hypotheses emerging from other studies, suggesting a multifactorial etiopathology including environmental and occupational nephrotoxic exposure.Correspondence to:
Carlos M. Orantes Navarro, MD, Nephrologist
Head of the Health Research Department
National Health Institute
Ministry of Health (MINSAL), San Salvador, El Salvador
Calle Gabriela Mistral, avenida del Prado N J-234,
Col. Buenos Aires I, San Salvador, El Salvador
(503) 25203000
Email: [email protected]
Proceedings
HIV and chronic kidney disease
Saraladevi Naicker, Sadaf Rahmanian, and Jeffrey B. Kopp
Page No. 32
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S32-S38)
HIV and chronic kidney disease
Saraladevi Naicker1, Sadaf Rahmanian1, and Jeffrey B. Kopp2
1Division of Nephrology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, and 2Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
Chronic kidney disease (CKD) is a frequent complication of HIV infection, occurring in 3.5 – 48.5%, and occurs as a complication of HIV infection, other co-morbid disease and infections and as a consequence of therapy of HIV infection and its complications. The classic involvement of the kidney by HIV infection is HIV-associated nephropathy (HIVAN), occurring typically in young adults of African ancestry with advanced HIV disease in association with APOL1 high-risk variants. HIV-immune complex disease is the second most common diagnosis obtained from biopsies of patients with HIV-CKD. CKD is mediated by factors related to the virus, host genetic predisposition and environmental factors. The host response to HIV infection may influence disease phenotype through activation of cytokine pathways. With the introduction of antiretroviral therapy (ART), there has been a decline in the incidence of HIVAN, with an increasing prevalence of focal segmental glomerulosclerosis. Several studies have demonstrated the overall improvement in kidney function when initiating ART for HIV CKD. Progression to end stage kidney disease has been reported to be more likely when high grade proteinuria, severely reduced eGFR, hepatitis B and/C co-infection, diabetes mellitus, extensive glomerulosclerosis, and chronic interstitial fibrosis are present. Improved renal survival is associated with use of renin angiotensin system blockers and viral suppression. Many antiretroviral medications are partially or completely eliminated by the kidney and require dose adjustment in CKD. Certain drug classes, such as the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors, are metabolized by the liver and do not require dose adjustment. HIV-infected patients requiring either hemoor peritoneal dialysis, who are stable on ART, are achieving survival rates comparable to those of dialysis patients without HIV infection. Kidney transplantation has been performed successfully in HIV-infected patients; graft and patient survival appears to be similar to that of HIV-uninfected recipients. Early detection of kidney disease by implementation of screening on diagnosis of HIV infection and annual screening thereafter will have an impact on the burden of disease, together with access to ART to those who require it. Programs for prevention of HIV infection are essential to prevent this lethal disease.Correspondence to:
Saraledevi Naicker, MD, PhD
Faculty of Health Sciences
School of Clinical Medicine, Room 4B41
7 York Road, Parktown, 2193, Johannesburg, South Africa
Email: [email protected]
Proceedings
Transplantation in resource-limited setting: using HIV-positive donors for HIV-positive patients
Elmi Muller
Page No. 39
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S39-S41)
Transplantation in resource-limited setting: using HIV-positive donors for HIV-positive patients
Elmi Muller
Groote Schuur Hospital, University of Cape Town, South Africa
Background: A HIV positiveto- positive program was started in South Africa in 2008. The program was started because dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. Patients and Methods: Between September 2008 and March 2015, 29 patients were transplanted from HIV-positive brain-dead donors at Groote Schuur Hospital transplant team. Donors were either naïve to anti-retroviral therapy or on first line therapy. The recipients were selected to have undetectable plasma HIV type 1 RNA levels and be on a stable antiretroviral regimen. CD4+ T-cell counts of at least 200/mm3 in last 6 months prior to transplant, with no previous serious opportunistic infections. Results: Survivors in the study were followed for a median of 2.4 years. The rate of patient survival was 84% at 1 year and 74% at 5 years. The corresponding graft survival rate was 93% and 84%. Conclusion: Using HIV-positive donors might resolve some of the problems we are experiencing in getting enough donors for our patients wit ESRD. In the USA the HOPE act was accepted in 2014 and this might now also impact on the use of HIV positive donors elsewhere in the world.Correspondence to:
Prof. Elmi Muller, MD
Groote Schuur Hospital
University of Cape
Town, South Africa
Email: [email protected]
Proceedings
Need for chronic kidney disease prevention programs in disadvantaged populations
Norberto Perico and Giuseppe Remuzzi
Page No. 42
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S42-S48)
Need for chronic kidney disease prevention programs in disadvantaged populations
Norberto Perico1 and Giuseppe Remuzzi1,2
1Clinical Research Center for Rare Diseases “Aldo e Cele Dacco” – IRCCS Istituto di Ricerche Farmacologiche Mario Negri, and 2Department of Medicine, Unit of Nephrology and Dialysis, A.O. Papa Giovanni XXIII, Bergamo, Italy
Chronic kidney disease (CKD) is a key determinant of the poor health outcomes for major non-communicable diseases that are the leading cause of death in the world. CKD is a worldwide threat to public health, but the size of the problem is not fully appreciated. Early recognition of CKD and concomitant co-morbid conditions, can potentially slow progression to renal failure, increase longevity, improve quality of life, and reduce healthcare costs. Although screening programmes are attractive, there is no consensus yet on which individuals should be prioritized (high-risk group for CKD, or general population) especially in resourcepoor regions. In these settings there is not a unique blueprint of screening strategy, so that the approaches should be adapted on single-nation conditions and socioeconomic status. Effective multimodal tools are available to prevent CKD by managing its risk factors, and to slow or even halt disease progression to end-stage renal failure, as well as reduce the associated risk of cardiovascular morbidity and mortality. They can be adapted even to the poorest populations who are at the highest risk of CKD. Where management strategies have been implemented, the incidence of end-stage renal disease (ESRD) has been reduced. The hope is that all these efforts will assist to make major advances in addressing the neglected aspect of renal health, especially of poor and disadvantaged populations worldwide. Beside saving young lives, such action would minimize the present health inequity that arises mainly from the unaffordable cost of renal replacement therapy if ESRD is not prevented.Correspondence to:
Giuseppe Remuzzi, MD, FRCP
IRCCS – Istituto di Ricerche Farmacologiche Mario Negri
Clinical Research Center for Rare Diseases “Aldo e Cele Daccò”
Via GB Camozzi 3, 24020, Ranica, BG, Italy
Email: [email protected]
Proceedings
Early detection and prevention programs for kidney diseases in Hong Kong
Tze Hoi Kwan, Yuk Lun Cheng, and Philip Kam Tao Li
Page No. 49
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S49-S51)
Early detection and prevention programs for kidney diseases in Hong Kong
Tze Hoi Kwan1, Yuk Lun Cheng2, and Philip Kam Tao Li3
1Renal Division, Department of Medicine & Geriatrics, Tuen Mun Hospital, 2Renal Division, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, and 3Division of Nephrology, Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
Two local studies were performed in Hong Kong for early detection and prevention of chronic kidney disease (CKD) which demonstrated the efficacy for screening asymptomatic individuals in the population for silent kidney disease while first degree relatives of known CKD patients should have a higher priority on future screening in view of their higher prevalence of silent CKD. Simple measures like urine dipstick tests and blood pressure measurement would suffice for screening. Regular health education programs are useful for conveying the key messages of kidney protection to the general public.Correspondence to:
Tze Hoi Kwan, MBBS, FRCP (Edin & London)
Renal Division, Department of Medicine & Geriatrics Tuen Mun Hospital, Tuen Mun,
Hong Kong SAR, China
Email: [email protected]
Proceedings
The Kidney Early Evaluation Program (KEEP) of Japan
Kosaku Nitta, Kazuyoshi Okada, Mitsuru Yanai, and Susumu Takahashi
Page No. 52
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S52-S55)
The Kidney Early Evaluation Program (KEEP) of Japan
Kosaku Nitta, Kazuyoshi Okada, Mitsuru Yanai, and Susumu Takahashi
International Kidney Evaluation Association Japan (IKEAJ), Tokyo, Japan
The International Kidney Evaluation Association Japan (IKEAJ) was created to improve public health awareness of chronic kidney disease (CKD) by screening high-risk CKD populations. This study aimed to retrospectively examine data from KEEP Japan and detect the CKD risk factors for the onset and the progression of CKD. A total of 1,947 participants (mean age: 56.9 ± 16.4 years) to KEEP Japan were enrolled. More than 70% of the participants had no CKD. However, 7.5% of the participants were classified as high risk. The participants with a history of hypertension and older than 60 years had significantly higher odds ratio for occurrence of CKD. In addition, the participants with history of diabetes or cardiovascular disease, high blood pressure (BP), anemia, and low HDL-C had high odds ratios. It is therefore suggested that the appropriate control of BP, blood glucose, anemia, and HDL-C is important for populations with CKD risk factors to reduce the likelihood of CKD.Correspondence to:
Kosaku Nitta, MD, PhD
Department of Medicine, Kidney Center
Tokyo Womens’s Medical University
8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
Email: [email protected]
Proceedings
Clinical characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities in El Salvador
Raúl Herrera Valdés, Carlos M. Orantes, Miguel Almaguer López, Laura López Marín, Pedro Alfonso Arévalo, Magaly J. Smith González, Fabrizio E. Morales, Raymed Bacallao, Héctor D. Bayarre, and Xavier F. Vela Parada
Page No. 56
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S56-S63)
Clinical characteristics of chronic kidney disease of non-traditional causes in women of agricultural communities in El Salvador
Raúl Herrera Valdés1, Carlos M. Orantes2, Miguel Almaguer López1, Laura López Marín1, Pedro Alfonso Arévalo3, Magaly J. Smith González4, Fabrizio E. Morales3, Raymed Bacallao5, Héctor D. Bayarre6, and Xavier F. Vela Parada7
1Nephrology Institute, Havana, Cuba, 2National Health Institute, Ministry of Health, 3San Juan de Dios National Hospital, San Miguel, El Salvador, 4Renal Physiopathology Department, 5Physiopathology Department, Nephrology Institute, 6National School of Public Health, Havana, Cuba, and 7Renal Health Research Unit (RHRU), National Health Institute Health, Ministry of Health, San Salvador, El Salvador
Introduction: A chronic kidney disease of non-traditional causes (CKDu) has emerged in Central America and elsewhere, predominantly affecting male farmworkers. In El Salvador (2009), it was the second cause of death in men > 18 years old. Causality has not been determined. Most available research focused on men and there is scarce data on women. Objectives: Describe the clinical and histopathologic characteristics of CKDu in women of agricultural communities in El Salvador. Methodology: A descriptive study was carried out in 10 women with CKDu stages 2, 3a, and 3b. Researchers studied demographics, clinical examination; hematological and biochemical analyses, urine sediment, renal injury markers, and assessed renal, cardiac, and peripheral arteries, liver, pancreas, and lung anatomy and functions. Kidney biopsy was performed in all. Data was collected on the Lime Survey platform and exported to SPSS 19.0. Results: Patient distribution by stages: 2 (70%), 3a (10%), 3b (20%). Occupation: agricultural 7; non-agricultural 3. Risk factors: agrochemical exposure 100%; farmworkers 70%; incidental malaria 50%, NSAIDs use 40%; hypertension 40%. Symptoms: nocturia 50%; dysuria 50%; arthralgia 70%; asthenia 50%; cramps 30%, profuse sweating 20%. Renal markers: albumin creatinine ratio (ACR) > 300 mg/g 90%; β microglobulin and neutrophil gelatinase- associated lipocalin (NGAL) presence in 40%. Kidney function: hypermagnesuria 100%; hyperphosphaturia 50%, hypercalciuria 40%; hypernatriuria 30%; hyponatremia 60%, hypocalcemia 50%. Doppler: tibial artery damage 40%. Neurological: reflex abnormalities 30%; Babinski and myoclonus 20%. Neurosensorial hypoacusis 70%. Histopathology: damage restricted mostly to the tubulo-interstitium, urine was essentially bland. Conclusions: CKDu in women is a chronic tubulointerstitial nephropathy with varied extrarenal symptoms.Correspondence to:
Prof. Raúl Herrera Valdés, MD, PhD, Nephrologist
PAHO advisor, Full professor and distinguished Researcher
Nephrology Institute, Havana, Cuba
Email: [email protected]
Proceedings
Balkan nephropathy
Vladisav Stefanovic, Draga Toncheva, and Momir Polenakovic
Page No. 64
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S64-S69)
Balkan nephropathy
Vladisav Stefanovic1, Draga Toncheva2, and Momir Polenakovic3
1Faculty of Medicine, University of Nis, Nis, and Serbian Academy of Sciences and Arts, Belgrade, Serbia, 2Department of Genetics, University of Medicine, Sofia, Bulgaria, and 3Macedonian Academy of Sciences and Arts, Skopje, Macedonia
Balkan endemic nephropathy (BN), frequently associated to upper urothelial cancer, is a familial chronic tubulointerstitial disease with insidious onset and slow progression to end-stage renal disease. After 60 years of research, its cause remains the major unanswered question. Etiology assumes polygenic susceptibility to the disease in interaction with multiple environmental factors. Chronic intoxication with Aristolochia is the major environmental risk factor for this disease. The mycotoxin hypothesis considers that BN is produced by ochratoxin A. The Pliocene lignite hypothesis assumes that the disease is caused by long-term exposure to organic toxins leached from coal nearby the endemic villages. Exome sequencing of 22,000 genes revealed that mutant genes (CELA1, HSPG2, and KCNK5) in BN patients encode proteins involved in basement membrane/extracellular matrix and vascular tone, which are tightly connected to the process of angiogenesis. SEC61G, IL17RA, and HDAC11 proved to be differently methylated throughout all patient-control pairs. The acetylation of histone lysine residues was detected and found increased at specific sites of H3 and total H4 histones isolated from urothelial cells of patients with BN. The results of molecular biological research will allow the discovery of genetic markers of BN and associated urothelial cancer, permitting early detection of BN-predisposing mutations and identification of susceptible individuals who might be at risk of exposure to environmental agents. The research of gene-gene and gene-environment interactions could lead to further studies to determine the precise risk for BN.Correspondence to:
Prof. Vladisav Stefanovic, MD, PhD
Faculty of Medicine
Bul. Zorana Djindjica 81, 18000 Nis, Serbia
Email: [email protected]
Proceedings
Acute kidney injury in children in Nigeria
Wasiu A. Olowu
Page No. 70
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S70-S74)
Acute kidney injury in children in Nigeria
Wasiu A. Olowu
Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria
Aim: To highlight the epidemiologic characteristics and therapeutic challenges of childhood acute kidney injury (AKI) in Nigeria. Method: A review of AKI publications on Nigerian children between January 1990 and December 2012 was carried out. Results: Mean age at presentation varied between 3.1 ± 2.6 and 6.28 ± 4 (0.05 – 16) years. Male/female ratio ranged between 1.38 and 2.5 to 1. Hospital-acquired AKI (hAKI) and community-acquired AKI (cAKI) accounted for 17.1 – 27.2% and 72.8 – 82.9% of all AKI cases, respectively. 12 – 35 new AKI cases are seen per year. A single-center study puts cAKI and hAKI incidences at 9.8 per million children population (pmcp)/year (0.46%) and 3.7 pmcp/ year (0.17%), respectively; cAKI and hAKI prevalence rates were 49.2 pmcp (2.23%) and 18.3 pmcp (0.84%), respectively. Leading causes of AKI, accounting for 80.0% of all etiologies, were nephrotoxins (29.0%), infection (20.0%), intravascular volume depletion (17.9%), and glomerular disease (13.1%). Financial constraints, late presentation, presence of ≥ 2 comorbidities, need for dialysis, non-dialysis when indicated, severe hypertension, white cell count > 15 000/mm3, and platelet count < 100 000/mm3 are significant mortality risk factors in childhood AKI in our environment. Mean all-cause mortality rate from pooled data was 50.4 ± 25.2% (range: 28.4 – 86.5%). Conclusion: AKI incidence and its leading causes, in Nigerian children, can be significantly reduced if attention is paid to public health education, enforcement of environmental sanitation laws, and prompt utilization of healthcare services during sickness.Correspondence to:
Prof. Wasiu A. Olowu
Pediatric Nephrology and Hypertension Unit
Obafemi Awolowo University
Teaching Hospitals Complex
PMB 5538, Ile-Ife, State of Osun, Nigeria
Email: [email protected]
Proceedings
The multideterminant model of renal disease in a remote Australian Aboriginal population in the context of early life risk factors: lower birth weight, childhood post-streptococcal glomerulonephritis, and current body mass index influence levels of albumi
Wendy E. Hoy, Andrew V. White, Bernard Tipiloura, Gurmeet Singh, Suresh K. Sharma, Hilary Bloomfield, Cheryl E. Swanson, Alison Dowling, and David A. McCredie
Page No. 75
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S75-S81)
The multideterminant model of renal disease in a remote Australian Aboriginal population in the context of early life risk factors: lower birth weight, childhood post-streptococcal glomerulonephritis, and current body mass index influence levels of albumi
Wendy E. Hoy1, Andrew V. White2, Bernard Tipiloura1,3, Gurmeet Singh4, Suresh K. Sharma4, Hilary Bloomfield1, Cheryl E. Swanson1, Alison Dowling1, and David A. McCredie5
1Centre for Chronic Disease, University of Queensland, 2Currently James Cook University, Townsville, Queensland, 3Tiwi Community Elder and Project Officer, Nguiu, Bathurst Island, NT, 4Menzies School of Health Research, Charles Darwin University, and Royal Darwin Hospital, NT, and 5Royal Children’s Hospital, Melbourne, University of Melbourne, Victoria, Australia
Background: Australian Aborigines in remote areas have very high rates of kidney disease, which is marked by albuminuria. We describe a “multihit” model of albuminuria in young adults in one remote Aboriginal community. Methods: Urinary albumin/creatinine ratios (ACR) were measured in all subjects who volunteered to participate in a community-wide health screen. Subjects for this study were young adults who had birth weights recorded and whose medical records were inspected for a history of post-streptococcal glomerulonephritis (PSGN). Urine ACR levels were evaluated in the context of birth weights, PSGN history and current BMI. Results: 580 subjects (335 males and 245 females) who were aged 18 – 39 years at time of screening and qualified for inclusion. 26% of subjects had birth weights of < 2.5 kg, and the median birth weight was 2.8 kg. 23% of subjects had a remote history of PSGN, all 3 or more years earlier. Median BMI for the group was 21 kg/m2. Urine ACR levels exceeded the microalbuminuria threshold of 3.4 g/mol in 35.5% of subjects. Birth weight (inversely), remote PSGN, and current BMI were all independent predictors of ACR levels. Median levels of ACR were lowest in those with birth weights ≥ 2.5 kg, and no history of PSGN, intermediate in those with either birth weights < 2.5 kg or a history of PSGN, and highest in those with both low birth weights and a PSGN history. ACR levels were higher in those with BMIs above the median values, most notably in those with lower birth weights or a PSGN history or both. Interpretation: Much of the great excess of disease in this population is explained by high rates of the early life risk factors, low birth weight and PSGN. Their effects are expressed through amplification of ACR in the context of increasing age, and are further moderated by levels of current body size. Both early life risk factors are potentially modifiable.Correspondence to:
Prof. Wendy E. Hoy, FRACP
The University of Queensland
Health Sciences Building, Level 8,
Royal Brisbane & Women’s Hospital
Herston, Queensland,4029, Australia
Email: [email protected]
Proceedings
Comprehensive approach to pediatric kidney diseases in Guatemala
Randall Lou-Meda
Page No. 82
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S82-S84)
Comprehensive approach to pediatric kidney diseases in Guatemala. Foundation for Children with Kidney Diseases (FUNDANIER)
Randall Lou-Meda
Servicio de Nefrología, Hipertensión, Diálisis y Trasplante, Hospital Roosevelt/Fundación para el Niño Enfermo Renal (FUNDANIER), Guatemala
The Foundation for Children with Kidney Diseases (FUNDANIER) has been the driving force that has facilitated changes in the Guatemalan health system in order to establish a comprehensive pediatric nephrology program. We previously described the creation and early phases of the FUNDANIER project. This article describes the recent accomplishments of the project with the intention of sharing a model that might be applicable in other developing countries.Correspondence to:
Randall Lou-Meda, MD, MSc, MA
6 avenida 9 – 18 zona 10, Ala 1, Oficina 804,
Edificio Sixtino 2, Guatemala, 01010
Email: [email protected]
Proceedings
Transplant commercialism and organ trafficking: The Declaration of Istanbul with special relevance to disadvantaged populations living with kidney disease
Adeera Levin, Elmi Muller, Mona Alrukhaimi, Saralah Naicker, and Annika Tibbel
Page No. 85
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S85-S89)
Transplant commercialism and organ trafficking: The Declaration of Istanbul with special relevance to disadvantaged populations living with kidney disease
Adeera Levin1, Elmi Muller2, Mona Alrukhaimi3, Saralah Naicker4, and Annika Tibbel5
1University of British Columbia, Vancouver, Canada, 2Transplant Unit Groote Schuur Hospital, University of Cape Town, South Africa, South Africa, Dubai Medical College, Dubai, United Arab Emirates, 4School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa, and 5Karolinska Institute, Stockholm, Sweden
This paper provides a historical perspective on organ trafficking and transplant commercialism, an overview of the Declaration of Istanbul [1, 2], and an update on current state. We highlight the importance of this problem pertaining to disadvantaged populations living with or at risk for kidney disease. It was presented during the Kidney Disease in Disadvantaged Populations Satellite Symposium of the World Congress of Nephrology in Hong Kong 2013 (www.theisn.org).Correspondence to:
Adeera Levin, MD, FRCPC, FAPC
Division of Nephrology
University of British Columbia
1081 Burrard Rm, 6010 A, Vancouver, BC, Canada
Email: [email protected]
Proceedings
Development of a kidney transplantation program – inverted funnel approach
Mitra Mahdavi-Mazdeh, Alireza Heidary Rouchi, and Seyed Mohammadreza Khatami
Page No. 90
Abstract
Clinical Nephrology, Vol. 83 – Suppl. 1/2015 (S90-S94)
Development of a kidney transplantation program – inverted funnel approach
Mitra Mahdavi-Mazdeh1, Alireza Heidary Rouchi2, and Seyed Mohammadreza Khatami1
1Nephrology Research Center, Tehran University of Medical Sciences, Tehran, and 2Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
Introduction: The history of organ shortage has been approached differently by different countries. This review tries to discuss the inverted funnel approach of Iran. Methods: The whole history of transplants in the country can be divided in three phases of legally regulated living unrelated kidney donation, legislation of brain death donation and lastly how it has been implemented. In each phase, there have been attempts to clarify the role of each sector: the government, professionals, and the public. Results: Based on more than 20 years of experience, it has been shown that kidney transplants from brain dead donors (BDDs) increased from 0.4 per million population (pmp) in 2000 to 2.9 pmp in 2005, 7.9 in 2010, and 15.1 pmp in 2013 and it could eventually change the rate from living source from 20.1 pmp, 24.5 pmp, 21.8 pmp, and 19.5 pmp in these years, respectively. Discussion: It has been shown that the government began to take part when it was convinced that an organ procurement program from BDDs is not a luxury program but can lessen the economic burden on the health budget and be supported by legislations and budget allocation. Professionals took the responsibility not only to make decision makers and the public aware of the subject and adapt the national protocols to consider the general population concerns, but also to train as many medical teams as possible nationwide. Persistence and publishing the results can pave the way for the public to accept the program and take their own responsibilities to solve the problem of organ shortage by taking the opportunity to give life to others after the death of a loved one.Correspondence to:
Dr. Mitra Mahdavi-Mazdeh
Emam Hospital
Iranian Tissue Bank and Research Center
Tehran
Keshavarz Blvd.
1471738681, Iran
Email: [email protected]
