Volume 86 (2016), No. 7/2016(Supplement 1)
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10th 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
Keith C. Norris, Kowdle S. Prabhakar, Lawrence Agodoa, and Guillermo García-García
Page No. 1
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S1-S2)
Foreword: Kidney disease in disadvantaged populations: An unconquered challenge
Keith C. Norris, Kowdle S. Prabhakar, Lawrence Agodoa, and Guillermo García-García
Correspondence to:
Singapore
Email: [email protected]
Proceedings
The International Society of Nephrology (ISN). Roles & challenges in Africa and other resource-limited communities
John Feehally
Page No. 3
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S3-S7)
The International Society of Nephrology (ISN). Roles & challenges in Africa and other resource-limited communities
John Feehally
The John Walls Renal Unit, Leicester, General Hospital, Leicester, UK
ISN (the International Society of Nephrology) is a global organization with more than 9,000 members in 130 countries. The ISN’s mission is to “advance the diagnosis, treatment, and prevention of kidney diseases in the developing and developed world”. ISN delivers this mission in low-resource settings through its five education and training programs available exclusively to low- and middle-income countries. These programs are designed to enable sustainable growth in capacity in nephrology and related disciplines to provide the basis for the improvement of care for kidney patients worldwide. ISN also directs its efforts towards advocacy for kidney health and kidney care, seeking to increase understanding of kidney disease among the general population, health professionals, and health policy makers. Such advocacy is challenging because of the complexity of kidney health messages; there is a need to emphasize affordable healthcare solutions for prevention and treatment of acute kidney injury (AKI), as well as the prevention and management of chronic kidney disease (CKD), and the provision of renal replacement therapy (both chronic dialysis and kidney transplantation) that is both affordable and ethically acceptable.Correspondence to:
Prof. John Feehally
The John Walls Renal Unit, Leicester, General Hospital
Gwendolen Road, Leicester LE5 4PW, UK
Email: [email protected]
Proceedings
Clinical nephrology research in low-resource settings: opportunities, priorities, and challenges for young investigators
Shuchi Anand, John W. Stanifer and Bernadette Thomas
Page No. 8
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S8-S13)
Clinical nephrology research in low-resource settings: opportunities, priorities, and challenges for young investigators
Shuchi Anand1, John W. Stanifer2#3, and Bernadette Thomas4
1Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, 2Division of Nephrology, Department of Medicine, Duke University, 3Duke Global Health Institute, Duke University, Durham, NC, and 4Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
The increased recognition of the growing, worldwide burden of kidney disease has led to calls for prioritizing nephrology research in a global context. However, many challenges exist for young investigators interested in studying kidney disease in low-resource global settings. A lack of clear research priorities, limited funding options, poor infrastructure, difficulty forming partnerships, and unestablished paths for career advancement are a few examples. To discuss these issues, we held a moderated panel discussion in March 2015 as part of the 10th Conference on Kidney Disease in Disadvantaged Populations in Cape Town, South Africa. A group of senior investigators discussed research priorities for studying kidney disease in a global context, collaborations for clinical research, and strategies for dealing with the unique challenges faced by young investigators working in this field.Correspondence to:
John W. Stanifer, MD, MSc
Duke University Medical Center, Box 3182,
Durham, NC 27710, USA
Email: [email protected]
Proceedings
Burden of end-stage kidney disease: North Africa
Rashad S. Barsoum
Page No. 14
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S14-S17)
Burden of end-stage kidney disease: North Africa
Rashad S. Barsoum
Kasr-El-Aini Medical School, Cairo University, The Cairo Kidney Center, Cairo, Egypt
Geographical, ecological, and genetic factors result in many similarities among the six main countries of the African Sahara, including the epidemiology of kidney disease. With an average incidence of 182 and prevalence of 522 patients with end-stage kidney disease (ESKD) per million population, North Africa (NA) spends $650 million on dialysis and transplantation despite an estimated annual loss of 600,000 life years. The health burden of ESKD is not limited to its directly-related morbidity and mortality but affects even more significantly other body systems, particularly the cardiovascular system. In addition, dialysis units are reservoirs for infectious agents, such as hepatitis-C (HCV) and -B (HBV) viruses, and methicillin-resistant staphylococci (MRSA), which threaten the health of the community. Shortage of financial resources eventually creates inequity of health care at large since only the rich are able to find their way around the limited public services. ESKD is no exception; inequity being even further augmented by the trade of organs, particularly in Egypt. This is attributed to high demand in the absence of a deceased donor program and in the presence of a pool of young, healthy, unemployed potential donors who have no access to any social security plans. Many attempts to face the challenge of accommodating ESKD management in NA are underway, including relevant legislations, promoting deceased donor transplants, chronic kidney disease (CKD) prevention and early detection programs, and generating nontraditionally directed financial resources.Correspondence to:
Professor Rashad Barsoum, MD, FRCP. FRCPE
The Cairo Kidney Center
3 Hussein El-Memar Street, Kasr El-Nile,
POB 91 Bab El-Louk, Cairo 11513, Egypt
Email: [email protected]
Proceedings
The challenges of ESRD care in developing economies: sub-Saharan African opportunities for significant improvement
Ebun Ladipo Bamgboye
Page No. 18
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S18-S22)
The challenges of ESRD care in developing economies: sub-Saharan African opportunities for significant improvement
Ebun Ladipo Bamgboye
St Nicholas Hospital, Lagos, Nigeria
Chronic kidney disease (CKD) is a significant cause of morbidity and mortality in sub-Saharan Africa. This, along with other noncommunicable diseases like hypertension, diabetes, and heart diseases, poses a double burden on a region that is still struggling to cope with the scourge of communicable diseases like malaria, tuberculosis, HIV, and more recently Ebola. Causes of CKD in the region are predominantly glomerulonephritis and hypertension, although type 2 diabetes is also becoming a significant cause as is the retroviral disease. Patients are generally younger than in the developed world, and there is a significant male preponderance. Most patients are managed by hemodialysis, with peritoneal dialysis and kidney transplantation being available in only few countries in the region. Government funding and support for dialysis is often unavailable, and when available, often with restrictions. There is a dearth of trained manpower to treat the disease, and many countries have a limited number of units, which are often ill-equipped to deal adequately with the number of patients who require end-stage renal disease (ESRD) care in the region. Although there has been a significant improvement when compared with the situation, even as recently as 10 years ago, there is also the potential for further improvement, which would significantly improve the outcomes in patients with ESRD in the region. The information in this review was obtained from a combination of renal registry reports (published and unpublished), published articles, responses to a questionnaire sent to nephrologists prior to the World Congress of Nephrology (WCN) in Cape Town, and from nephrologists attending the WCN in Cape Town (March 13 – 17, 2015).Correspondence to:
Dr. Ebun Ladipo Bamgboye, FWACP
Consultant Physician/Nephrologist, Clinical Director
St. Nicholas Hospital
57 Campbell Street, Lagos, Nigeria
Email: [email protected]
Proceedings
End-stage renal disease care in South Asia: demographics, economics, and opportunities
Vivek Kumar and Vivekanand Jha
Page No. 23
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S23-S26)
End-stage renal disease care in South Asia: demographics, economics, and opportunities
Vivek Kumar1 and Vivekanand Jha1#2
1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, and 2George Institute for Global Health, New Delhi, India
The epidemiologies of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in South Asia are not well defined. Small studies suggest that there is a predominant affliction of younger individuals and presence of risk factors beyond the traditional ones like diabetes and hypertension. The underprivileged poor who do not have access to healthcare facilities are affected disproportionately, present late, and lack means to afford treatment. Renal replacement therapy (RRT) is not widely available and is mostly delivered through expensive private-sector hospitals. There are no CKD detection or prevention programs, and reimbursement for RRT is not available to most people. As more patients present for treatment, the limited infrastructure will come under further strain. There is an urgent need to identify unique preventable risk factors related to causation and progression of CKD and to institute appropriate care. South Asian countries need local solutions by tapping into local resources as well as innovating and coordinating so that a comprehensive care plan can be put in place. New models of integrated noncommunicable disease care delivery through manpower restructuring and technological support will help reduce the disease burden.Correspondence to:
Prof. Vivekanand Jha
George Institute for Global Health
219-221 Splendor Forum, Jasola, New Delhi 110025, India
Email: [email protected]
Proceedings
Current burden of end-stage kidney disease and its future trend in China
Luxia Zhang and Li Zuo
Page No. 27
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S27-S28)
Current burden of end-stage kidney disease and its future trend in China
Luxia Zhang1 and Li Zuo2
1Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, and 2Renal Division, Department of Medicine, Peking University People’s Hospital, Beijing, China
Introduction: Understanding the status and trends of patients with ESKD is important to evaluate and predict its impact on the health care system in China. Methods: Available publications and/or presentations from national and regional dialysis and transplantation registries were collected. Results and discussion: A national report in 1999 revealed that the prevalence and incidence of dialysis in China were 33.2 per million population (pmp) and 15.3 pmp, respectively. The numbers were updated to 237.3 pmp and 15.4 pmp in 2012. In big cities like Beijing and Shanghai, the numbers are much higher, with prevalence and incidence of 524.6 pmp and 107.3 pmp in Beijing in 2011, and 544.7 pmp and 82.9 pmp in Shanghai in 2011, respectively. The majority of patients received hemodialysis, accounting for 89.5% in 1999 and 89.1% in 2012. The increased prevalence of dialysis is partly due to increased affordability of dialysis; while affordability and accessibility still limit renal replacement therapy in China. Regarding causes of end-stage kidney disease in China, about half of the patients are diagnosed glomerulonephritis. The surge of hypertension and diabetes during the 1990s will probably have profound effects on prevalence and etiology of kidney disease in China.Correspondence to:
Luxia Zhang, MPH
Renal Division, Department of Medicine
Peking University First Hospital
8 Xishiku Street, Xicheng District, Beijing, China, 100034
Email: [email protected]
Proceedings
Burden of end-stage renal disease (ESRD) in Latin America
Guillermo Rosa-Diez, María Gonzalez-Bedat, Alejandro Ferreiro, Guillermo García-García, Juan Fernandez-Cean, and Walter Douthat
Page No. 29
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S29-S33)
Burden of end-stage renal disease (ESRD) in Latin America
Guillermo Rosa-Diez1#2, María Gonzalez-Bedat1#2, Alejandro Ferreiro1#2, Guillermo García-García2, Juan Fernandez-Cean2, and Walter Douthat2
1Executive Board of the Latin American Dialysis and Transplant Registry (RLADTR), and 2Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH)
Introduction: End-stage renal disease (ESRD) represents a major challenge for Latin America (LA). Epidemiological information needed to assist in the development of ESRD care in the region. The Latin American Dialysis and Renal Transplant Registry (RLADTR), has published several reports and its continuity has implied a sustained effort of the entire LA Nephrology community. This paper summarizes the results corresponding to year 2012. Methods: Our methods have been reported previously. Participant countries complete an annual survey collecting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities. Results: 20 countries participated in the surveys, more than 90% of the Latin America. The prevalence of ESRD under RRT in LA increased from 119 patients Per million population (pmp) in 1991 to 661 pmp in 2012. HD continues to be the treatment of choice in the region (82%). A wide rate variation in incidence is observed: from 472.7 in Jalisco (Mexico) to 14 pmp in Guatemala. Diabetes remained the leading cause of ESRD. The most frequent cause of death was cardiovascular. There is a wide rate variation of nephrologist by country, from 1.8 pmp in Honduras to 45.2 pmp in Cuba. Discussion: The heterogeneity or even absence of registries in some LA countries is congruent with the inequities in access to RRT in such countries, as well as the availability of qualified personnel. The SLANH is currently running training programs as well as cooperation programs between LA countries to help the least developed start ESRD programs. In this spirit, RLADTR is training personnel to carry out dialysis and transplant registries in LA.Correspondence to:
Dr. Guillermo Rosa-Diez
Nephrology Division
Hospital Italiano de Buenos Aires
Peron 4190, Buenos Aires, Argentina
Email: [email protected]
Proceedings
Prevalence and incidence of renal disease in disadvantaged communities in Europe
Fergus J. Caskey
Page No. 34
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S34-S36)
Prevalence and incidence of renal disease in disadvantaged communities in Europe
Fergus J. Caskey1#2
1UK Renal Registry, Southmead Hospital, and 2School of Social and Community Medicine, University of Bristol, Bristol, UK
Despite well-established, publicly-funded national health systems, kidney disease inequalities exist in Europe. There are differences between countries in rates of treated end-stage renal disease, at least some of which appears explained by organizational and economic factors. Pooling of chronic kidney disease (CKD) prevalence data is allowing new like-for-like comparisons between countries, which suggest that there are also differences in underlying rates of kidney disease. The few studies that exist suggest a paradoxically lower rate of earlier stages of kidney disease in ethnic minority groups, which have long been known to have higher rates of end-stage disease. Once on renal replacement therapy, children of South Asian and Black origin are now being reported to have lower rates of survival and lower chances of receiving a kidney transplant. New challenges are reportedly being faced by renal services with immigrants arriving in Europe requiring immediate dialysis with limited ability to communicate with clinical staff and increased infection risk. And data are at last emerging on the risk of chronic kidney disease in Europe’s biggest minority, disadvantaged population, the Roma. A public health approach to address these issues requires, as a first step, the extent of the problem to be measured.Correspondence to:
Dr. Fergus Caskey
Medical Director, UK Renal Registry
Southmead Hospital, Bristol BS9 4DX, UK
Email: [email protected]
Proceedings
ESRD: epidemiology and treatment in developing countries in Southeast Asia
Sydney C.W. Tang
Page No. 36
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S136-S138)
ESRD: epidemiology and treatment in developing countries in Southeast Asia
Sydney C.W. Tang
Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
Southeast Asia generally is understood to include the countries of Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam. Nine of these 11 sovereign states are categorized to have low-to-middle income by the World Bank. Like other regions of the world, the provision of renal replacement therapy (RRT) in developing economies in South-East Asia is limited by the lack of financial and other resources. The number of nephrologists in most of these countries remains low. While some countries have well developed registries of ESRD treatment, data are completely unknown in others. Here, an appraisal of the status of ESRD from only 4 South-East Asia countries is presented.Correspondence to:
Prof. Sydney C.W. Tang
Division of Nephrology, Department of Medicine
The University of Hong Kong, Queen Mary Hospital
102 Pokfulam Road, Hong Kong
Email: [email protected]
Proceedings
Chronic kidney disease and end-stage renal disease in disadvantaged communities of North America: an investigational challenge to limit disease progression and cardiovascular risk
Renu Regunathan-Shenk, Farah N. Hussain and Anjali Ganda
Page No. 37
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S37-S40)
Chronic kidney disease and end-stage renal disease in disadvantaged communities of North America: an investigational challenge to limit disease progression and cardiovascular risk
Renu Regunathan-Shenk1#2, Farah N. Hussain2, and Anjali Ganda1#2
1Division of Nephrology, and 2Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are growing public health issues associated with significant morbidity and mortality around the world. In the United States, Black and Hispanic minorities suffer higher rates of CKD and ESRD, mostly attributed to Diabetic Kidney Disease (DKD). DKD is the leading cause of both CKD and ESRD in the developed world and disproportionately affects minority populations such as African Americans, Hispanic Americans, and Aboriginal Americans in comparison with Whites. This review will discuss the incidence, prevalence, and etiology of renal disease in disadvantaged minorities in the U.S. and will take a closer look at diabetic kidney disease as it is the primary cause of kidney disease in these populations.Correspondence to:
Anjali Ganda, MD, MS
Assistant Professor of Medicine
Division of Nephrology, Department of Medicine
College of Physicians & Surgeons, Columbia University, PH4-124
622 West 168th Street, New York, NY 10032, USA
Email: [email protected]
Proceedings
HIV-associated renal disease – an overview
Nicola Wearne and Ikechi G. Okpechi
Page No. 41
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S41-S47)
HIV-associated renal disease – an overview
Nicola Wearne and Ikechi G. Okpechi
Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
The cause of the human immunodeficiency virus (HIV) epidemic in South Africa (SA) was worsened by the denial by key political players that HIV causes acquired immunodeficiency syndrome (AIDS). South Africa continues to have the highest rate of HIV world-wide, which has had a huge impact on the development of both chronic kidney disease and acute kidney injury. Fortunately, there is now an effective antiretroviral therapy (ART) roll-out program. SA is also dealing with a collision of epidemics of HIV, tuberculosis, and non-communicable disease, particularly hypertension and diabetes. This has been evidenced by recent data seen in the reinstated SA renal registry. There is also an unacceptably high rate of tuberculosis in regions of SA, this has led to high rates of granulomatous interstitial nephritis (GIN) and case reports of TB-GIN immune reconstitution inflammatory syndrome (IRIS). HIV-associated nephropathy (HIVAN) remains common in SA and responds well to ART. The definitive diagnosis requires a renal biopsy, which is often not possible in many regions of sub-Saharan Africa. Unfortunately, there is still a high rate of HIVAN in SA due to late presentation and lack of effective screening for renal disease in HIV-positive patients. Transplantation for HIV-positive donors to positive recipients offers a unique and encouraging way forward for these patients.Correspondence to:
N. Wearne, MBChB, FCP(SA)
Cert Nephrology (SA)
Division of Nephrology and Hypertension
University of Cape Town, Cape Town, South Africa
Email: [email protected]
Proceedings
Community-acquired acute kidney injury in adults in Africa
Dwomoa Adu, Perditer Okyere, Vincent Boima, Michael Matekole, and Charlotte Osafo
Page No. 48
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S48-S52)
Community-acquired acute kidney injury in adults in Africa
Dwomoa Adu, Perditer Okyere, Vincent Boima, Michael Matekole, and Charlotte Osafo
School of Medicine and Dentistry, University of Ghana, Accra, Ghana
Aims: We review recent published data on demographics, causes, diagnoses, treatment, and outcome of acute kidney injury (AKI) in Africa. Methods: A review of the incidence, etiology, diagnoses, and treatment of AKI in adults in Africa from studies published between the years 2000 and 2015. Results: The incidence of AKI in hospitalized patients in Africa ranges from 0.3 to 1.9% in adults. Between 70 and 90% of cases of AKI are community acquired. Most patients with AKI are young with a weighted mean age of 41.3 standard deviation (SD) 9.3 years, and a male to female ratio of 1.2 : 1.0. Medical causes account for between 65 and 80% of causes of AKI. This is followed by obstetric causes in 5 – 27% of cases and surgical causes in 2 – 24% of cases. In the reported studies, between 17 and 94% of patients who needed dialysis received this. The mortality of AKI in adults in Africa ranged from 11.5 to 43.5%. Conclusions: Most reported cases of AKI in Africa originate in the community. The low incidence of hospital-acquired AKI is likely to be due to under ascertainment. Most patients with AKI in Africa are young and have a single precipitating cause. Prominent among these are infection, pregnancy complications and nephrotoxins. Early treatment can improve clinical outcomes.Correspondence to:
Dr. Dwomoa Adu
School of Medicine and Dentistry
University of Ghana, P. O. Box 4236, Accra, Ghana
Email: [email protected]
Proceedings
Spectrum of kidney diseases in Africa: malaria, schistosomiasis, sickle cell disease, and toxins
Fatiu A. Arogundade, Muzamil O. Hassan, Bolanle A. Omotoso, Stephen O. Oguntola, Oluyomi O. Okunola, Abubakr A. Sanusi, and Adewale Akinsola
Page No. 53
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S53-S60)
Spectrum of kidney diseases in Africa: malaria, schistosomiasis, sickle cell disease, and toxins
Fatiu A. Arogundade, Muzamil O. Hassan, Bolanle A. Omotoso, Stephen O. Oguntola, Oluyomi O. Okunola, Abubakr A. Sanusi, and Adewale Akinsola
Renal Unit, Department of Medicine, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Nigeria
Kidney diseases have assumed epidemic proportions in both developed and developing countries, particularly chronic kidney disease (CKD). While treatment modalities are available and accessible in developed economies with improvement in outcomes, survival, and quality of life, they are either unavailable or inaccessible in nations with emerging economies, particularly in sub-Saharan Africa (SSA), with an attendant worsening outcome and survival for CKD patients. The epidemiology of CKD in SSA has revealed that it preferentially affects adults in their economically productive years, usually below the age of 50 years, with consequent drain on the economy. This derives mainly from the major etiologies in the region, which are infection-induced chronic glomerulonephritis and hypertension, compounded by poverty as well as societal and health underdevelopment, poor resource allocation to health, and underdeveloped health infrastructures. This has made preventive nephrology a major goal in the sub-region, although those who have already developed CKD must be managed up to tertiary levels. In this review, we assessed the contributions of parasitic diseases (i.e., malaria and schistosomiasis), sickle cell disease and nephrotoxins with the aim of espousing their contributions to the burden of kidney disease, and proposing management options with the goal of ultimately reducing the burden of kidney disease in these disadvantaged populations.Correspondence to:
Fatiu A. Arogundade, MBBS, FMCP, FWACP
Renal Unit, Department of Medicine
Obafemi Awolowo University/
Teaching Hospitals Complex, Ile-Ife, Nigeria
Email: [email protected]
Proceedings
Success stories showing the diversity of kidney foundations: Turkish Kidney Foundation
Timur Erk
Page No. 61
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S61-S63)
Success stories showing the diversity of kidney foundations: Turkish Kidney Foundation
Timur Erk
Turkish Kidney Foundation, Turkey
Founded in 1985, the Turkish Kidney Foundation serves the society with 3 dialysis centers and a 113-bed general hospital. Interacting with public authorities and advocating end-stage renal disease (ESRD) patients’ rights are essential services of this non-governmental organization (NGO). Over the last 30 years, keeping with the trend of chronic kidney disease (CKD) in the country, the foundation raised awareness in the population for this condition and prepared an activity road map by using statistical facts and data. Goals were set keeping in mind the local culture and traditions, debating on them with colleagues, PR agencies, and other experts in this field. The best strategy embrace the society, and all activities are made as cost-effective as possible in keeping with a tight budget. Various communication channels, especially social media, are used to communicate the message to the public, always keeping in mind that such messages are to be succinct and precise. Every effort is taken to make our foundation reliable and trustworthy in the eyes of the public at large. Reliability, credibility, and trust are the key success corner stones of our NGO. Every opportunity is taken to capitalize on participation of celebrities and real stories of people. Testimonies of real ESRD patients are always interesting and can touch the hearts of the rest of the population.Correspondence to:
Timur Erk
Bahçelievler Mahallei, Güneş Sokaği, No: 2
34590 Bahçelievler, Istanbul, Turkey
Email: [email protected]
Proceedings
The role of the Kidney Foundation of Bangladesh in promoting kidney care in a resource-limited environment
Harun Ur Rashid, Sakibuzzaman Arefin, Sazid Hasan, and Khurshidul Alam
Page No. 64
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S64-S68)
The role of the Kidney Foundation of Bangladesh in promoting kidney care in a resource-limited environment
Harun Ur Rashid1, Sakibuzzaman Arefin2, Sazid Hasan3, and Khurshidul Alam4
1Department of Nephrology, 2Urology and 3Transplant, and 4Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
Background: Prior to 2003 in Bangladesh, ~ 80% of kidney-failure patients could not afford treatment. The Kidney Foundation Bangladesh (KFB) was formed in 2003 with an aim to create awareness, to promote prevention of kidney disease to families and population, at risk as well as offer treatment to those afflicted with kidney failure. Methods: KFB runs a 150-bed hospital for treatment of kidney disease, dialysis, and transplantation at an affordable price. New patients visiting the OPD pay only US$ 5.00 to consult a specialist, and dialysis and transplant patients pay US$1 for each consultation. All laboratory tests are discounted by 30% for all patients except patients with dialysis and transplantation who enjoy a 50% discount. Patients on HD pay only US$ 20.00 per session, and a renal transplant surgery costs US$ 3,000.00. Results: From October 2004 to December 2014, there were 102,578 patients who received treatment in OPD in KFB at an affordable price. Similarly, more than 40,000 people per year benefited from various laboratory tests. A total of 11,099 patients were admitted in KFB hospital from January 2010 to December 2014. Of them, 2,409 (22%) were diagnosed as ESRD, and all of them were initially managed with dialysis either through a noncuffed catheter (82%) or by an AV fistula (8%); of the 388 continued on HD, 300 underwent transplantation, 289 agreed to shift to CAPD treatment, and rest of the patients were shifted to other HD centers. Simultaneously, a total of 3,600 patients were screened in rural, urban, and disadvantaged populations from 2004 to 2007 for detection of CKD. Conclusion: KFB is offering treatment for patients with kidney disease and kidney failure, not only at an affordable price, but also without compromising quality.Correspondence to:
Prof. Harun Ur Rashid, PhD, FCPS, FRCP, Chief consultant, Nephrology Kidney Foundation Hospital and Research Institute, Mirpur, Dhaka-1216, Bangladesh
Email: [email protected]
Proceedings
Promotion of kidney care in countries with limited resources: How does the National Kidney Foundation of South Africa fare?
Anthony M. Meyers
Page No. 69
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S69-S73)
Promotion of kidney care in countries with limited resources: How does the National Kidney Foundation of South Africa fare?
Anthony M. Meyers
Donald Gordon Medical Centre, Klerksdorp Hospital, and National Kidney Foundation of South Africa, Johannesburg, South Africa
Introduction: An often-quoted remark is to present problems as challenges, which invariably end up in the “in-box”, eventually to be swept under the carpet. The chronic kidney disease burden in the South African black population poses a challenging crisis requiring immediate intervention even in a country with limited resources. Aims, materials, and methods: The National Kidney Foundation of South Africa (NKFSA) reports on 3 major projects. The schools project is aimed at prevention, early diagnosis, and appropriate management of chronic kidney disease (CKD) on a national basis. The second “urgency” is to educate primary healthcare workers (including doctors) about relevant kidney diseases and their treatment. The third illustrates the suboptimal number of dialysis facilities and the dismal number of kidney transplants performed in the public sector compared to treatment in the private sector. This accentuates the unacceptable two-tiered system in South Africa (SA). Results: The NKFSA school survey showed that in black adolescent learners, hypertension was found in 12% of females and 16% of males (often associated with familial hypertension). An increase in body mass index (BMI) showed better correlation in hypertensive females than in males (p < 0.004). Of 4 obese females, 3 had newly diagnosed type II diabetes. Urine dipsticks showed 1 student with hematuria, 1 with overt proteinuria, and many with active urinary tract infections. The educational book will appear as continuing medical education (CME) articles in two issues of the South African Medical Journal. The prevalence of patients obtaining treatment for end-stage renal disease (ESRD) (2012) was 73 pmp in the public and 620 pmp in the private sector. Depending on the region, the mean number of live-related transplants pmp/year varied between 0.6 and 5.3 (average 2.2) in the public and 10 to 33 (average 20.4) in the private sector. Deceased donor (DD) transplants varied between 0.75 and 7.0 (average 3.5) pmp/year in the public and 5.2 to 24.0 (average 17.1) in the private sector. Conclusions: The schools project has demonstrated that early prevalence of hypertension in the black population validates the need for an extensive, nationwide study, which should result in prevention and early diagnosis of hypertension thus reducing progression to renal failure. We hope to enhance the education, of both public and medical personnel, on the major problems of CKD in SA through the CME articles. The huge disparity in the treatment of ESRD between the public and private sectors as well as a marked variation in regional treatment needs urgent attention. Because living donor transplants in the black population remains very limited, novel methods of obtaining more DD organs must be formulated.Correspondence to:
Anthony M. Meyers; MB BCh, FCP (SA), Cert Nephrology (SA), FRCP (Lond)
Donald Gordon Medical Centre
Klerksdorp Hospital,
and National Kidney Foundation of South Africa
Johannesburg, South Africa
Email: [email protected]
Proceedings
The impact of kidney foundations in alleviating the burden of CKD in India – an example, Tamilnad Kidney Research Foundation
Georgi Abraham, Madhusudan Vijayan, Rajalakshmi Ravi, Latha Kumaraswami, and Malathy Venkatesan
Page No. 74
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S74-S77)
The impact of kidney foundations in alleviating the burden of CKD in India – an example, Tamilnad Kidney Research Foundation
Georgi Abraham1, Madhusudan Vijayan2, Rajalakshmi Ravi3, Latha Kumaraswami3, and Malathy Venkatesan3
1Madras Medical Mission, Chennai, Pondicherry Institute of Medical Science, Pondicherry, 2Kilpauk Medical College, and 3Tamilnad Kidney Research Foundation, Chennai, India
Chronic kidney disease (CKD) is a major public health problem in India. The CKD registry of India has been formed to understand the epidemiology of CKD in India. Due to health economics in India, the majority of CKD-affected patients cannot afford renal replacement therapy (RRT) services. There is an unmet need to improve the awareness of kidney disease in India, and the focus should be on prevention and early detection of CKD by screening high risk populations. The Tamilnad Kidney Research (TANKER) Foundation is a charitable trust established in 1993 with the aim to improve awareness and provide quality affordable treatment to underprivileged patients. TANKER is supported by contributions from well-wishers. It has three arms: i) treatment arm, ii) research arm, and iii) awareness and screening arm. TANKER Foundation offers free and subsidized dialysis twice weekly to 227 underprivileged patients. TANKER dialysis has been supported by state government funding schemes. TANKER actively supports and conducts research in nephrology. More than 100,000 people have benefitted from TANKER’s kidney awareness programs. The screening programs have provided for early detection of CKD in both urban and rural areas. TANKER award functions are held annually to recognize research and exemplary service to society. The TANKER Foundation can be used as a model for developing countries to address the unmet needs in CKD management.Correspondence to:
Georgi Abraham
No 4-A, Madras Medical Mission Hospital
Dr. J Jayalalitha Nagar,
Mogappair, Chennai-600037, India
Email: [email protected]
Proceedings
The Sustainable Kidney Care Foundation’s contribution to the improvement of AKI management in developing countries using peritoneal dialysis
Mary Carter, Nathan W. Levin, Calvin S. Carter, and John Callegari
Page No. 78
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S78-S83)
The Sustainable Kidney Care Foundation’s contribution to the improvement of AKI management in developing countries using peritoneal dialysis
Mary Carter, Nathan W. Levin, Calvin S. Carter, and John Callegari
Sustainable Kidney Care Foundation, West Palm Beach, FL, University of Iowa, Iowa City, IA, and 3Mt. Sinai School of Medicine, New York, NY, USA
Professional organizations, such as kidney foundations, have been active for over half a century in the field of nephrology, serving as the basic institutions for advocacy, disease education, prevention, and treatment. These organizations have focused efforts in four areas: supporting the training of clinical specialists, raising awareness about kidney disease, improving patient outcomes, and organizing continuing medical education. These activities, while essential for the success of nephrology organizations, do not usually initiate renal service programs in the neediest of places. To remedy the lack of renal programs in many developing countries, the Sustainable Kidney Care Foundation (SKCF) was founded with the objective of establishing treatment programs for acute kidney injury (AKI) in areas of the world where none exist. Today SKCF is active in 5 sub-Saharan African countries and is growing.Correspondence to:
Mary Carter, PhD
Sustainable Kidney Care Foundation
West Palm Beach, FL, USA
Email: [email protected]
Proceedings
Nephrology in Africa – challenges of practice in resource-limited environment
Saraladevi Naicker
Page No. 84
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S84-S89)
Nephrology in Africa – challenges of practice in resource-limited environment
Saraladevi Naicker
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Chronic kidney disease (CKD), a major public health problem, is especially challenging for patients and healthcare personnel in Africa, a region with poor economic resources and a massive shortage of health-care workers. The burden of kidney disease is increased in poorly-resourced regions due to increased exposure to infections, poverty, poor access to healthcare, and genetic predisposition to kidney disease, contributing further to the problems when managing CKD and acute kidney injury. The vast majority of patients do not have access to renal replacement therapy. Urgent attention to cost of dialysis is required for wider expansion of services so that renal replacement therapy is affordable for the governments and populations of Africa. Priority needs to be given to prevention and treatment of acute kidney injury. Lack of resources has hampered the widespread utilization of prevention strategies; these are optimally delivered in a primary healthcare setting by doctors, nurses, and other healthcare workers with access to protocols for screening, disease management, achievement of treatment goals (with availability of therapy to retard progression), and criteria for referral to specialist and nephrology expertise. A regional or national renal registry is an important initiative to obtain accurate data on the burden of disease and outcomes of therapeutic interventions.Correspondence to:
Saraladevi Naicker, MB ChB, MD, FRCP PhD
Department of Internal Medicine
Faculty of Health Sciences
University of the Witwatersrand
7 York Road, Parktown, Johannesburg, 2193, South Africa
Email: [email protected]
Proceedings
Transplantation in Africa – an overview
Elmi Muller
Page No. 90
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S90-S95)
Transplantation in Africa – an overview
Elmi Muller
Groote Schuur Hospital, University of Cape Town, South Africa
Africa is underdeveloped in terms of treatment options for patients with end-stage renal failure. Economic growth and corresponding increases in health expenditures in the African region mean that we can confidently anticipate increased demand for organ transplantation within the region over the next few years. Renal failure in Africa occurs mainly due to glomerular nephropathies, hypertension, diabetes, and HIV. For the subset of the population that might be considered medically suitable for transplantation, demand for transplantation is tightly constrained by the availability of specialist physicians and surgeons, pathology facilities, capacity to achieve acceptable graft outcomes, cultural and religious attitudes towards organ donation, trust in the health system, and the extent to which patients are able to meet the costs of surgery and ongoing immunosuppression. There are currently several countries in Africa which are building up living-related-donor transplantation. Active living-donor transplantation already takes place in South Africa, Tunisia, and Sudan, but deceased donation is only available in South Africa. Whereas living-donor transplantation might be successfully driven by a motivated individual and a single institution, deceased-donor transplantation requires dialysis programs, tissue typing and crossmatching facilities, an organ procurement program, an on-call surgical team, capacity to fund this infrastructure, and an appropriate legislative framework. A significant and recurring barrier to transplantation in the African region is the high cost of transplantation and follow-up care, and, in particular, the cost of maintenance immunosuppression. A positive environment that could potentially change this scenario will have to include governmental funding, academic support to clinicians as well as a legislative framework, which is still needed in many African countries.Correspondence to:
Dr. Elmi Muller
Head Transplantation Services
Groote Schuur Hospital
University of Cape Town, South Africa
Email: [email protected]
Proceedings
Advances and challenges in renal transplantation in Latin America
Luis E. Morales-Buenrostro
Page No. 96
Abstract
Advances and challenges in renal transplantation in Latin America
Luis E. Morales-Buenrostro
Transplant Nephrology. Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
Latin America is a region made up of 33 countries that share many characteristics with each other. Since the first kidney transplant in Argentina in 1957, most of the Latin American countries have had a continuous increase in renal transplant activity, accounting for an increase in the total number of kidney transplants over time. In the last years, several advances have been made in the area of renal transplantation in Latin America: There are transplantation activities in almost all countries, the kidney transplantation rate from deceased donors has steadily increased, and almost all the countries have an appropriate legislation for transplantation activity. But much remains to be done to increase the kidney transplantation rate in order to cover the current demand. This could be achieved by ensuring unlimited access to renal transplantation, by improving deceased-donor programs to match the increasing burden of chronic diseases, and by incorporating new technology, new tools, and more trained people in transplant programs.Correspondence to:
Luis Eduardo Morales-Buenrostro, MD, PhD
Transplant Nephrology
Department of Nephrology and Mineral Metabolism
National Institute of Medical Sciences and Nutrition Salvador Zubirán
Vasco de Quiroga 15
Belisario Dominguez Seccion XVI
Tlalpan, Mexico City, D.F. 14080. Mexico
Email: [email protected]
Proceedings
Kidney transplantation in the Middle East
Alireza Heidary Rouchi and Mitra Mahdavi-Mazdeh
Page No. 101
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S101-S105)
Kidney transplantation in the Middle East
Alireza Heidary Rouchi and Mitra Mahdavi-Mazdeh
Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
Aims: To delineate the kidney transplantation programs in the Middle East and to provide a comparative summary with other international datasets where deemed appropriate. Patients and methods: Data regarding kidney transplantation as the treatment of choice amongst renal replacement therapies in different countries in the Middle East was analyzed from 2004 to 2013. The number of kidney transplants and the source of kidneys were important topics of comparison. All data was collected from published reports and international registries. Results: Eight of 23 countries in the Middle East had active kidney transplantation programs from both living and deceased donors in 2013. The kidney transplantation rate in 2013 was 11.5 per million population in the Middle East compared with 31.68 in America, 27.38 in Europe, 5.68 in the Western Pacific, 3.38 in South Asia, and 0.5 in Africa. The proportion of kidney transplants from deceased donors was 69.5%, 63.1%, 60.9%, 30.2%, 19.4%, and 6.2% in Europe, America, the Western Pacific, the Middle East, South Asia, and Africa, respectively. Conclusions: Public education on the subject of brain death and cadaveric organs as a reliable source of saving lives and provision of better infrastructure could increase the rate of kidney transplantation from brain-dead donors. Lack of funds and a negative attitudes towards organ donation are the main barriers in the Middle East.Correspondence to:
Mitra Mahdavi-Mazdeh
Iranian Tissue Bank and Research Center
Imam Khomeini Hospital Complex
Keshavarz Blvd., Tehran 1419731351, Iran
Email: [email protected]
Invited Papers from Free Communications
Chronic kidney disease of uncertain etiology in Sri Lanka is a possible sequel of interstitial nephritis!
Zeid Badurdeen, Nishantha Nanayakkara, Neelakanthi V.I. Ratnatunga, Abdul W.M. Wazil, Tilak D.J. Abeysekera, Premil N. Rajakrishna, Jalitha P. Thinnarachchi, Ranjith Kumarasiri, Dulani D. Welagedera, Needika Rajapaksha, and Adambarage P.D. Alwis
Page No. 106
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S106-S109)
Chronic kidney disease of uncertain etiology in Sri Lanka is a possible sequel of interstitial nephritis!
Zeid Badurdeen1, Nishantha Nanayakkara1#4, Neelakanthi V.I. Ratnatunga1#2, Abdul W.M. Wazil4, Tilak D.J. Abeysekera1, Premil N. Rajakrishna4, Jalitha P. Thinnarachchi4, Ranjith Kumarasiri3, Dulani D. Welagedera4, Needika Rajapaksha4, and Adambarage P.D. Alwis4
1Centre for Education Research and Training on Kidney Diseases (CERTKiD), 2Department of Pathology, 3Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradenya, and 4Renal Transplant and DialysisUnit, Teaching Hospital, Kandy, Sri Lanka
Introduction: The majority of published data on chronic kidney disease of uncertain etiology (CKDu) is on asymptomatic patients who were detected in screening programs. The clinicopathological profile of a group of patients presenting with acute symptoms and renal dysfunction from CKDu endemic regions in Sri Lanka was studied. Methods: 59 patients > 10 years of age with backache, feverish fatigue feeling, dysuria, joint pain, or dyspepsia, singly or in combination with elevated serum creatinine (> 116 and > 98 µmol/L for male and females, respectively) were included in the study. Those patients who had normal-sized kidneys were biopsied after excluding clinically detectable causes for renal dysfunction. Histology was scored with activity and chronicity indices. These patients’ urinary sediment and inflammatory markers were checked. Patients were stratified into three groups based on duration of symptom onset to the time of biopsy. The natural course of the disease was described using serial mean serum creatinine and histological activity as well as chronicity indices in these 3 groups. Results: These patients’ mean age, occupation, and sex ratio were 44 (9) years, 57 farmers, and male : female 55 : 4, respectively. Mean serum creatinine at biopsy was 143.8 (47.9) µmol/L. Elevated inflammatory markers and active urine sediment were reported. Histology was compatible with an interstitial nephritis with a mixture of acute and chronic tubulointerstitial lesions and glomerular scarring. In the natural course of an acute episode of CKDu, serum creatinine and histological activity were reduced while histological chronicity increased. Conclusion: CKDu may be preceded by an acute episode of tubulointerstitial nephritis (TIN).Correspondence to:
Dr. Zeid Badurdeen
Centre for Education Research and
Training on Kidney Diseases (CERTKiD)
Faculty of Medicine, University of Peradeniya, Sri Lanka
Email: [email protected]
Invited Papers from Free Communications
Nephrology training curriculum and implications for optimal kidney care in the developing world
Julius Okel, Ike G. Okpechi, Bilal Qarni, Timothy Olanrewaju, Mark J. Courtney, Valerie Luyckx, Sarala Naicker, and Aminu K. Bello
Page No. 110
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S110-S113)
Nephrology training curriculum and implications for optimal kidney care in the developing world
Julius Okel1, Ike G. Okpechi2, Bilal Qarni1, Timothy Olanrewaju3, Mark J. Courtney1, Valerie Luyckx4, Sarala Naicker5, and Aminu K. Bello1
1Department of Medicine, University of Alberta, Edmonton, Canada, 2Division of Nephrology and Hypertension, University of Cape Town, South Africa, 3Department of Medicine, University of Ilorin, Nigeria, 4Institute of Biomedical Ethics, Zürich, Switzerland, and 5Department of Internal Medicine and Nephrology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
An effective workforce is essential for delivery of high-quality chronic disease care. Low-income nations are challenged by a dearth and/or maldistribution of an essential workforce required for all chronic disease care including chronic kidney disease (CKD). Nephrology education and training in developed countries have grown at pace with the technological advancement in the practice of medicine in order to meet the standards required of kidney health professionals towards high-quality, patient-centered medical care. The standards designed by institutions and/or professional societies, such as Royal Colleges and Medical Councils in high-income nations with well-developed health systems and infrastructures, are often not easily translatable to issues critical to nephrology practice in low-income nations. Little or no guidance is provided on common nephrological issues of regional nature or pertaining to ethnic minorities and disadvantaged groups living in those countries. There is an emergent need for a training curriculum that meets the needs and peculiarities of the developing nations, and this needs to leverage on the existing and well-validated systems of training across the globe. We evaluated nephrology training programs across 25 upper-middle and high-income nations to identify best practices and opportunities for adoption in low-income nations. We reviewed training guidelines from major professional societies on content and process of training. There are similarities and differences in structure, content, and process of training programs across countries, and there are clearly adoptable concepts/frameworks for application in low-income nations. We provide recommendations and a strategic plan for the future focus of nephrology training in the developing world to align with current trends in technological advancement and development as well as the need for emphasis on prevention of CKD. The essential competencies (patient- and population-based) required of a nephrologist in a developing world setting are outlined with practical measures and an action plan for adoption.Correspondence to:
Aminu K. Bello
11-107 CSB, University of Alberta
8440 112 St NW, Edmonton, Alberta, Canada T6B 2B7
Email: [email protected]
Invited Papers from Free Communications
From man to fish: What can Zebrafish tell us about ApoL1 nephropathy?
Opeyemi Olabisi, Khaldoun Al-Romaih, Joel Henderson, Ritu Tomar, Iain Drummond, Calum MacRae, and Martin Pollak
Page No. 114
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S114-S118)
From man to fish: What can Zebrafish tell us about ApoL1 nephropathy?
Opeyemi Olabisi1#2#4, Khaldoun Al-Romaih2#4#5, Joel Henderson6, Ritu Tomar1,4, Iain Drummond1#4, Calum MacRae3#4, and Martin Pollak2#4
1Renal Division, Massachusetts General Hospital, 2Renal Division, Beth Israel Deaconess Medical Center, 3Division of Cardiology, Brigham and Women’s Hospital, 4Harvard Medical School, Boston MA, USA, 5King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, and 6Department of Pathology and Lab Medicine, Boston University School of Medicine, Boston, MA, USA
Background: Risk variant Apolipoprotein L1 (G1/G2) are strongly associated with a spectrum of kidney disease in people of recent African descent. The mechanism of ApoL1 nephropathy is unknown. Podocytes and/or endothelial cells are the presumed target kidney cells. Given the close homology in structure and function of zebrafish (ZF) pronephros and human nephron, we studied the effect of podocyte-specific or endothelium-specific expression of ApoL1 (G0, G1, or G2) on the structure and function of ZF pronephros. Methods: Wild type (G0) or risk variant ApoL1 (G1/G2) were expressed in podocyte-specific or endothelium-specific under podocin/Flk promoters, respectively, using Gal4-UAS system. Structural pronephric changes were studied with light and electron microscopy (EM). Proteinuria was assayed by measuring renal excretion of GFP-vitamin D binding protein. Puromycin aminonucleoside (PAN) was used as inducer of podocyte injury. Results: Endothelial-specific transgenic expression of G1/G2 is associated with endothelial injury indicated by endothelial cell swelling, segmental early double contours, and loss of endothelium fenestrae. Podocyte specific expression of G1 is associated with segmental podocyte foot process effacement and irregularities relative to G0. Despite the histological changes, the expression of G1/G2 alone in podocyte or endothelium compartment is not associated with edema, proteinuria, or gross whole fish phenotype. Moreover, PAN produced equal pericardial edema in all transgenic fish as well as nontransgenic controls. Conclusions: Transgenic expression human ApoL1 (G1/G2) is associated with histologic abnormalities in ZF glomeruli but is insufficient to cause quantifiable renal dysfunction. This finding supports the necessity of a “second hit” in the pathogenesis/progression of ApoL1-associated nephropathy.Correspondence to:
Dr. Martin Pollak
99 Brookline Ave, Boston, MA 02215, USA
Invited Papers from Free Communications
Renal histology patterns in a prospective study of nephrology clinics in Lagos, Nigeria
Theophilus I. Umeizudike, Jacob O. Awobusuyi, Christiana O. Amira, Taslim B. Bello, Monica O. Mabayoje, Adebowale O. Adekoya, Olufemi O. Adelowo, and Mumuni A. Amisu
Page No. 119
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S119-S122)
Renal histology patterns in a prospective study of nephrology clinics in Lagos, Nigeria
Theophilus I. Umeizudike1, Jacob O. Awobusuyi1#2, Christiana O. Amira3#4, Taslim B. Bello3#4, Monica O. Mabayoje3#4, Adebowale O. Adekoya1#2, Olufemi O. Adelowo1#2, and Mumuni A. Amisu1
1Department of Medicine, Lagos State University Teaching Hospital, 2Lagos State University College of Medicine, Ikeja, 3College of Medicine, University of Lagos, and 4Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
Background: The burden of chronic kidney disease (CKD) in Nigeria is quite alarming. The prevalence of CKD ranges from 11 – 23.5%. Hypertension and chronic glomerulonephritis (CGN) remain the two leading causes of CKD in Nigeria. The etiology of CKD in many of these patients remains unknown, as few biopsies are done. In order to demystify the various glomerular diseases that culminate in CGN, performing a kidney biopsy offers a ray of hope. Few studies on renal biopsies have emanated from Nigeria; this study, however, is unique as the histopathological analysis involves light, immunofluorescence, and electron microscopies. Methods: This study involved two teaching hospitals in Lagos. Patients from these centers, who met the inclusion criteria, underwent real-time renal biopsy; after providing written informed consent. Results: Among the 52 patients analyzed 26, (50%) were males. The mean age was 31.7 ± 12.8, with age range of 13 – 56 years. The most common indication for kidney biopsy was nephrotic syndrome, accounting for 73%. Focal segmental glomerulosclerosis (FSGS) was the most frequent histopathological diagnosis seen in 25 patients (48.1%). Conclusion: The findings from this study highlight the role that renal biopsy plays in making a concrete diagnosis in nephrology practice in a developing country like Nigeria. As almost 80% of the study population was made up of patients with FSGS and lupus nephritis, it remains to be determined by further studies among our patients, the role that Apolipoprotein L1 (APOL 1) gene mutation will play in the etiology of renal diseases in Nigeria.Correspondence to:
Theophilus I. Umeizudike
Department of Medicine
Lagos State University Teaching Hospital
Ikeja, Lagos State, Nigeria
Email: [email protected]
Invited Papers from Free Communications
Overview of dialysis in indigenous compared to nonindigenous Australians
Namrata Khanal, Philip Clayton, Stephen McDonald, and Matthew Jose
Page No. 123
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S123-S127)
Overview of dialysis in indigenous compared to nonindigenous Australians
Namrata Khanal1#2, Philip Clayton2#3, Stephen McDonald1#2, and Matthew Jose2#4
1School of Medicine, The University of Adelaide, 2The Australian and and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health Medical Research Institute (SAHMRI), Adelaide, 3Sydney School of Public Health, University of Sydney, Sydney NSW, and 4School of Medicine, Department of Nephrology, University of Tasmania, Royal Hobart Hospital, Tasmania, Australia
Introduction: Indigenous Australians (Aboriginal and Torres Strait Islanders, ATSI) make up 3% of the total Australian population [1] and comprised ~ 10% of new patients beginning renal replacement for end-stage kidney disease (ESKD) in Australia during 2013 [2]. In this study, we examined the differences in characteristics, incidence, and prevalence of different modalities of dialysis and survival between indigenous and nonindigenous Australians. Methods: We examined outcomes of all adults (aged ≥ 18 years at the start of renal replacement therapy (RRT)) in the ANZDATA registry who started RRT from 1st Jan 2003 to 31st Dec 2013 in Australia. Adjusted patient survival on dialysis was calculated using standard techniques. Results: A total of 25,528 participants were included, of whom 2,447 (9.5%) were indigenous Australians. Use of facility hemodialysis was more common among indigenous people, odds ratio (OR) 1.79 (95% confidence interval (CI), 1.37, 2.35). Of several interactions between indigenous status and other comorbidities, the most clinically significant was one with diabetes. In fully adjusted models, compared to nonindigenous with diabetes; death risk was higher for indigenous people with diabetes, HR 1.15 (95% CI, 1.06, 1.25). There was no difference between the two groups without diabetes, HR 0.86 (95% CI, 0.73, 1.05). There was no variation in the risks associated with ethnicity over year of dialysis start. Conclusion: There are differences in adjusted outcomes of indigenous Australians compared to nonindigenous with ESKD. Interactions suggest that the influence of reported comorbidities may differ in this group. Further investigations will be valuable in closing the gap and improving health outcome of indigenous Australians on RRT.Correspondence to:
Dr. Namrata Khanal
Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)
Level 9 – EastWing, Royal Adelaide Hospital,
North Terrace, Adelaide SA, 5000 Australia
Email: [email protected]
Invited Papers from Free Communications
Fever, thrombocytopenia, and AKI-A profile of malaria, dengue, and leptospirosis with renal failure in a South Indian tertiary-care hospital
Mayoor V. Prabhu, Arun S, and Venkat Ramesh
Page No. 128
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S128-S130)
Fever, thrombocytopenia, and AKI-A profile of malaria, dengue, and leptospirosis with renal failure in a South Indian tertiary-care hospital
Mayoor V. Prabhu, Arun S, and Venkat Ramesh
Kasturba Medical College, Department of Medicine, Kasturba Medical College, Mangalore (Manipal University), India
Introduction: In the tropics, the triad of fever, thrombocytopenia, and AKI portends a grim prognosis with high mortality and a severe strain on already-stretched resources. Malaria, dengue, and leptospirosis account for most cases. We undertook a review of cases to determine factors accounting for adverse prognosis. Methods: All patients presenting to the emergency room (ER) with a history of fever, thrombocytopenia, and renal failure were included in the study. Patients were followed until discharge or death, and end points looked at were 1-week and 30-day mortality, and renal function upon discharge. Parameters like liver function test (LFT), renal function, and platelet count upon discharge were also documented. Results: A total of 43 patients was included in the study. Mean age was 42.5 years with 86% males. Mean APACHE and SOFA scores on admission were 23.89 and 15.42, respectively. Mean admission platelet counts were 41,000. Mean serum creatinine was 4.1, and bilirubin was 9.94. A platelet count of < 34,000, serum creatinine of > 4, albumin of > 2.3, SOFA score of > 20, and APACHE score of > 32.2 were significantly predictive of 1 week mortality. Need for mechanical ventilation, oliguria on admission, and need for dialysis all were highly predictive of 30-day mortality. In addition, a serum bicarbonate of < 12, INR of > 1.5, hemoglobin of < 9.5 were highly predictive of higher 30 day mortality. Overall, 1-week mortality was 16.3%, of which 48% was accounted for by patients with leptospirosis. Conclusions: Factors like low platelet count, oliguria, need for dialysis, high APACHE and SOFA scores on admission, need for mechanical ventilation, and low serum albumin portend a grave prognosis. There is need for randomized control trials (RCT) to further determine adverse prognostic factors in this subsect of patients.Correspondence to:
Dr. Mayoor V. Prabhu, MD, DNB (Neph), FASN
Asst. Professor of Nephrology
Kasturba Medical College, Mangalore (Manipal University), India
Email: [email protected]
Invited Paper from Best Posters
Correlation between volume overload, chronic inflammation, and left ventricular dysfunction in chronic kidney disease patients
Muzamil Olamide Hassan, Raquel Duarte, Therese Dix-Peek, Ahmed Vachiat, Sagren Naidoo, Caroline Dickens, Sacha Grinter, Pravin Manga, and Saraladevi Naicker
Page No. 131
Abstract
Clinical Nephrology, Vol. 86 – Suppl. 1/2016 (S131-S135)
Correlation between volume overload, chronic inflammation, and left ventricular dysfunction in chronic kidney disease patients
Muzamil Olamide Hassan1#4#5, Raquel Duarte2#4, Therese Dix-Peek2#4, Ahmed Vachiat3#4, Sagren Naidoo1#4, Caroline Dickens2#4, Sacha Grinter3#4, Pravin Manga3#4, and Saraladevi Naicker4
Divisions of 1Nephrology and 3Cardiology, Department of Internal Medicine, 2Internal Medicine Research Laboratory, Department of Internal Medicine, 4Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa, and 5Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
Background: Fluid overload is common in chronic kidney disease (CKD) patients, potentially driving chronic inflammation and left ventricular dysfunction. We investigated the association between volume overload, chronic inflammation, and left ventricular dysfunction across subgroups of CKD patients. Methods: The study included 160 participants, comprising peritoneal dialysis (PD), hemodialysis (HD), stage-3 CKD patients, and age- and sex-matched controls (40 in each group). Fluid status was assessed using a body composition monitor (BCM); serum endotoxin, lipopolysaccharide binding protein (LBP), C-reactive protein (CRP). and interleukin-6 (IL-6) levels were measured as markers of inflammation. Echocardiography was done to assess left ventricular dimension and function. Results: Endotoxemia and volume overload were common across the spectrum of CKD patients and were aggravated by worsening kidney function. Among HD cohorts, postdialysis endotoxemia was increased among patients with dialysis-induced hemodynamic instability and was also closely related to ultrafiltration volume. Endotoxin, IL-6, CRP, and LBP levels were elevated in patients with volume overload compared to euvolemic patients (p < 0.05). Patients with elevated circulating endotoxemia had higher left ventricular mass index (LVMI) compared to patients with lower endotoxin levels. Fluid overload correlated with endotoxin levels, IL-6, and LVMI; while LVMI correlated weakly with LBP and CRP. Conclusion: CKD patients typically presented with significant endotoxemia and overt volume overload, which may contribute significantly to chronic low-grade inflammation and left ventricular dysfunction. An additive contribution from hemodialysis treatment may strongly enhance the severity of endotoxemia in HD patients.Correspondence to:
Dr. Muzamil Olamide Hassan
Renal Unit, Department of Medicine
Obafemi Awolowo University Teaching Hospital
PMB 5538, Ife-Ife, Osun State, Nigeria
Email: [email protected]
