Volume 93 (2020), No. 7/2020(Supplement 1)
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11th Conference on Kidney Disease in Disadvantaged Populations
The whole issue as pdf-file
Page No. 0
Abstract
The whole issue as pdf-file
Editorial
Kidney disease and poverty in disadvantaged populations
Keith C. Norris, Kowdle S. Prabhakar, Lawrence Agodoa, Guillermo García-García
Page No. 1
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S1-S2)
Kidney disease and poverty in disadvantaged populations
Keith C. Norris, Kowdle S. Prabhakar, Lawrence Agodoa, Guillermo García-García
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Burden of end-stage renal disease in sub-Saharan Africa
Fatiu A. Arogundade, Bolanle A. Omotoso, Adegbola Adelakun, Titilope Bamikefa, Remigus Ezeugonwa, Babaniji Omosule, Abubakr A. Sanusi, and Rasheed A. Balogun
Page No. 3
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S3-S7)
Burden of end-stage renal disease in sub-Saharan Africa
Fatiu A. Arogundade1, Bolanle A. Omotoso1, Adegbola Adelakun1, Titilope Bamikefa1, Remigus Ezeugonwa1, Babaniji Omosule1, Abubakr A. Sanusi1, and Rasheed A. Balogun2
1Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, and 2Division of Nephrology, University of Virginia School of Medicine, Medical Director, Renal Unit & Extracorporeal Therapies, Division of Nephrology, University of Virginia Health System, Charlottesville, VA, USA
Chronic kidney disease (CKD) particularly in its most severe form, end-stage renal disease (ESRD), is highly prevalent globally. Although both the incidence and prevalence appears to be increasing, the rate of increase is far higher in developing countries, probably as a result of underdevelopment, high incidence of communicable and noncommunicable diseases, poverty as well as inaccessible, unavailable, or unaffordable treatment modalities. The epidemiology differs remarkably between developing and developed economies – it afflicts the young and middle-aged in the former and older individuals in the latter. The etiologies also differ significantly, and the outcome is mainly determined by accessibility and availability of renal replacement therapies. While the three modalities of treatment namely hemodialysis, peritoneal dialysis, and kidney transplantation are available in sub-Saharan Africa, affordability of care remains a major challenge due to nonavailability of healthcare insurance in many of the countries, and where state support is available, dialysis and transplant rationing based on certain criteria remains a major limitation. Data on CKD and ESRD are largely unreliable because of a lack of renal registries in most countries, but the reactivation of the South African Renal Registry and its extension to cover other African countries may improve data quality.
Correspondence to:
Prof. Fatiu A. Arogundade
Renal Unit, Department of Medicine
College of Health Sciences
Obafemi Awolowo University
P.M.B 5538, Ile-Ife, Osun State, Nigeria
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Burden and etiopathogenesis of acute kidney injury in the tropics
Fatiu A. Arogundade, Bolanle Aderonke Omotoso, Abubakr Abefe Sanusi, and Rasheed A. Balogun
Page No. 8
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S8-S16)
Burden and etiopathogenesis of acute kidney injury in the tropics
Fatiu A. Arogundade1, Bolanle Aderonke Omotoso1, Abubakr Abefe Sanusi1, and Rasheed A. Balogun2
1Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, and 2Division of Nephrology, University of Virginia School of Medicine, University of Virginia Health System, Charlottesville, VA, USA
Acute kidney injury (AKI) is prevalent and is associated with high morbidity and mortality globally. The epidemiology differs remarkably between developing and developed economies. Infections, diarrheal illnesses, obstetric causes and nephrotoxins are very rampant in the tropics. Even though the etiologies are different, the final common pathway in the pathogenesis is similar – tubular damage or necrosis, tubular blockage, and back leak of glomerular filtrate. The mechanism of AKI in infections could be through ischemic insult consequent to hypovolemia and/or hemoglobinuria, as seen in malaria and viral hemorrhagic fevers, interstitial inflammation, or nephrotoxicity. On the contrary, the mechanism of nephrotoxin-induced AKI includes direct toxic effect on the renal tubules, intratubular precipitation of substances like djenkolic and oxalic acids (crystalluria) as well as intratubular obstruction and AKI. Toxicity could also be indirect by interacting with the pharmacokinetic profile of other coadministered medications. Bites and envenomation as well as obstetric complications also induce AKI through hypovolemia, interstitial nephritis, and other unclear mechanisms in eclampsia and preeclampsia. Outcome is variable and dependent on etiology. Prognosis appears to be significantly better in hypovolemic or prerenal and/or obstructive AKI compared to intrarenal or intrinsic AKI.Correspondence to:
Prof. Fatiu A. Arogundade
Renal Unit, Department of Medicine
College of Health Sciences
Obafemi Awolowo University
P.M.B 5538, Ile-Ife, Osun State, Nigeria
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Establishing a cost-effective hemodialysis program in the developing world
John T. Ball
Page No. 17
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S17-S20)
Establishing a cost-effective hemodialysis program in the developing world
John T. Ball
Medical Director of “The Bridge of Life”, a renal care-related charity, Chicago, IL, USA
The percentage of the population in low-middle-income countries (LMIC) with hemodialysis availability has gradually increased over the last 8 years. Note that only 3% of the treatments of these countries are done as peritoneal dialysis, which is the more cost-effective modality. The best current estimate of hemodialysis access for Africa is 25%, Southeast Asia 35%, and South America 65% [1]. The main issues that impede hemodialysis access remain poverty, the unaffordability of treatment, the substantial cost of setting up a dialysis unit as well as the lack of options to purchase dialyzers, tubing, and unit supplies at reasonable costs. This article presents cost-saving approaches for providing hemodialysis in LMIC along with words of caution on how to determine the sustainability of the project in areas with high levels of need and limited resources.Correspondence to:
John T. Ball, MD
3227 North Seminary Ave.
Chicago, IL, 60657-3310, USA
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Kidney care in low- and middle-income countries
Bilal Qarni, Mohamed A. Osman, Adeera Levin, John Feehally, David Harris, Kailash Jindal, Timothy O. Olanrewaju, Arian Samimi, Michelle E. Olah, Branko Braam, Aminu Muhammad Sakajiki, Meaghan Lunney, Natasha Wiebe, Feng Ye, Vivekanand Jha, Ikechi Okpechi, Mark Courtney, Scott Klarenbach, David W. Johnson, and Aminu K. Bello
Page No. 21
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (21-30)
Kidney care in low- and middle-income countries
Bilal Qarni1, Mohamed A. Osman1, Adeera Levin2, John Feehally3, David Harris4, Kailash Jindal1, Timothy O. Olanrewaju5, Arian Samimi1, Michelle E. Olah1, Branko Braam1, Aminu Muhammad Sakajiki6, Meaghan Lunney7, Natasha Wiebe1, Feng Ye1, Vivekanand Jha8#9, Ikechi Okpechi10#11, Mark Courtney1, Scott Klarenbach1, David W. Johnson12#13#14, and Aminu K. Bello1
1Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, 2Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada, 3University of Leicester, Leicester, UK, 4Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia, 5Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria, 6Department of Medicine, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria, 7Department of Community Health Sciences, University of Calgary, AB, Calgary, Canada, 8George Institute for Global Health India, UNSW, New Delhi, India, 9University of Oxford, Oxford, UK, 10Division of Nephrology and Hypertension, 11Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa, 12Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), 13Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, and 14Translational Research Institute, Brisbane, Australia
Optimal kidney care requires a trained nephrology workforce, essential healthcare services, and medications. This study aimed to identify the access to these resources on a global scale using data from the multinational survey conducted by the International Society of Nephrology (ISN) (Global Kidney Health Atlas (GKHA) project), with emphasis on developing nations. For data analysis, the 125 participating countries were sorted into the 4 World Bank income groups: low income (LIC), lower-middle income (LMIC), upper-middle income (UMIC), and high income (HIC). A severe shortage of nephrologists was observed in LIC and LMIC with < 5 nephrologists per million population. Many LIC were unable to access estimated glomerular filtration rate (eGFR) and albuminuria (proteinuria) tests in primary-care levels. Acute and chronic hemodialysis was available in most countries, although acute and chronic peritoneal dialysis access was severely limited in LIC (24% and 35%, respectively). Most countries had kidney transplantation access, except for LIC (12%). HIC and UMIC funded their renal replacement therapy (RRT) and renal medications primarily through public means, whereas LMIC and LIC required private and out-of-pocket contributions. In conclusion, this study found a huge gap in the availability and access to trained nephrology workforce, tools for diagnosis and management of CKD, RRT, and funding of RRT and essential medications in LIC and LMIC.Correspondence to:
Aminu Bello, MD PhD, FRCP
Division of Nephrology and Immunology
Department of Medicine, University of Alberta
11-107 Clinical Sciences Building
8440 112 Street NW, Edmonton, AB, T6B 2B7 Canada
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Renal length and volume prediction in healthy children
Maria E. Bianchi, Daniel Forlino, Gustavo A. Velasco, Pablo O. Rodriguez, Germán López, and Ana M. Cusumano
Page No. 31
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S31-S35)
Renal length and volume prediction in healthy children
Maria E. Bianchi1, Daniel Forlino2, Gustavo A. Velasco3, Pablo O. Rodriguez4, Germán López2, and Ana M. Cusumano4
1Argentine Northeast Kidney Foundation, Chaco, 2School of Medicine, National Northeast University, Corrientes, 3Julio C. Perrando Hospital, Resistencia, Chaco, and 4IUC (CEMIC University Institute), Buenos Aires Autonomous City, Argentina
Introduction: Little information is available regarding the evaluation of renal volume in healthy Latin-American children of different ages. The objective of this work was to establish a predictive model of renal size (volume and length) and develop a web-based calculator.
Materials and methods: A selective and representative sample was obtained randomly from the database of healthy children living in Resistencia city, Chaco, Argentina: a) the National Health Program for children under 6 years old; b) school children until 18 years old (primary and middle education). Renal dimensions were obtained by ultrasonography via a single experienced operator at the indicated site (schools or primary health care centers). Renal volume was calculated using Dinkel’s formula. A multiple linear regression model was applied using potential predictors. The final model was implemented in a free web-based application.
Results: Random selection was made from the database to include 882 subjects with ages between 0.03 and 230.63 months. The data was divided into two sets (one for training and the other for model testing). The training set (423) included 212 (50%) females. Significant predictors included age, height, current weight and birth weight, and the interaction between age and present weight. Using the test dataset, both renal volume and length root mean square errors were 5.06 cm3 and 0.59 cm.
Conclusion: The prediction model was accurate and allowed for the development a freely-available web app: Renal size prediction (https://porbm28.shinyapps.io/RenalVolume/). Once the models are validated by additional studies, the app could be a useful tool to predict renal volume and length in pediatric clinical practice.Correspondence to:
María E. Bianchi, MD
Gonzalez Montaner 74. Resistencia
Chaco, H3508FUA, Argentina
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Food as medicine for CKD: Implications for disadvantaged populations
Deidra C. Crews
Page No. 36
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S36-S41)
Food as medicine for CKD: Implications for disadvantaged populations
Deidra C. Crews
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Johns Hopkins Center for Health Equity,
Johns Hopkins University, Baltimore, MD, USA
Persons with or at risk for chronic kidney disease (CKD) and their healthcare clinicians seek ways to prevent adverse kidney outcomes. Recent studies highlight that specific healthful dietary patterns may lead to favorable kidney outcomes; these include dietary patterns rich in fruits and vegetables such as the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, and dietary patterns low in dietary acid load. However, for many socioeconomically disadvantaged individuals, healthful dietary patterns are inaccessible due to inability to afford or access healthful foods. Barriers may exist at multiple levels, including the individual level (e.g., knowledge and beliefs about healthful eating habits) and the institutional level (e.g., rules and regulations about healthy food availability and cost). In this review, recent studies are described that document dietary patterns that may promote kidney health. A framework for considering barriers and facilitators of healthful eating among disadvantaged individuals modified from the social ecological model is offered, and their potential impact on kidney diseases is discussed. Recent epidemiologic and intervention studies addressing dietary factors in the setting of chronic kidney disease and other conditions are detailed. Finally, knowledge gaps in intervention studies, evaluation of public programs, and advocacy efforts are discussed towards promoting “food as medicine” to support kidney health for all.
Correspondence to:
Deidra C. Crews, MD, ScM
Division of Nephrology, Department of Medicine
Johns Hopkins University School of Medicine
301 Mason F. Lord Drive, Suite 2500
Baltimore, MD 21224, USA
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Chronic kidney disease of unknown cause in Mexico: The case of Poncitlan, Jalisco
Guillermo Garcia-Garcia, Alfonso Gutiérrez-Padilla, Hector R. Perez-Gomez, Jonathan S. Chavez-Iñiguez, Evelyn F. Morraz-Mejia, Melina J. Amador-Jimenez, Alexia C. Romero-Muñoz, Maria del Mar Gonzalez-De la Peña, Scott Klarenbach, and Marcello Tonelli
Page No. 42
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S42-S48)
Chronic kidney disease of unknown cause in Mexico: The case of Poncitlan, Jalisco
Guillermo Garcia-Garcia1, Alfonso Gutiérrez-Padilla1, Hector R. Perez-Gomez1, Jonathan S. Chavez-Iñiguez1, Evelyn F. Morraz-Mejia1, Melina J. Amador-Jimenez1, Alexia C. Romero-Muñoz1, Maria del Mar Gonzalez-De la Peña1, Scott Klarenbach2, and Marcello Tonelli3
1Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Guadalajara, Jal., Mexico, 2University of Alberta, Edmonton, and 3University of Calgary, Calgary, AB, Canada
Chronic kidney disease of unknown cause (CKDu) is relatively common in low- and middle-income countries. A high prevalence of CKDu has been reported among the inhabitants of Poncitlan, Mexico. We did a cross-sectional study to compare the characteristics of residents in Poncitlan, a very poor municipality, with those from other municipalities in Jalisco state. We also estimated the prevalence of renal replacement therapy (RRT) in this region. We assessed 51,789 individuals in Jalisco: 16,351 (32.1%) were men, mean age 51.8 ± 15.3 years; 650 (1.3%) were aged < 18 years. Overall the prevalence of CKD (10.5%) and proteinuria (11.5%), were similar to the overall Mexican population. There were 283 adult and 144 child participants who resided in Poncitlan: adults were more likely to be female (78.0 vs. 67.9%, p = 0.000) but were of similar age as compared to those from other municipalities; children were younger (8.78 ± 3.97 vs. 15.03 ± 2.57 years, p = 0.000) but had a similar proportion of females compared to children from other municipalities. In Poncitlan, the prevalence of CKD and proteinuria were both higher in adults compared to those from other municipalities (CKD: 20.1 vs. 10.4%, p = 0.002; proteinuria: 36.1 vs. 11.0%, p = 0.000), and the prevalence of proteinuria in children was also higher (44.4 vs. 4.8%, p = 0.000). However, the prevalence of diabetes mellitus and obesity were lower in Poncitlan than elsewhere. The prevalence of RRT in Poncitlan was 2,228 pmp, twice as high as the prevalence for Jalisco state as a whole. In conclusion, CKD and proteinuria were detected frequently in residents of the Poncitlan community. Future studies should consider the possibility that CKDu is due to multifactorial causes, especially in poor communities.
Correspondence to:
Guillermo Garcia-Garcia, MD
Nephrology Service, Hospital Civil de Guadalajara
Fray Antonio Alcalde
Hospital 278, Guadalajara, Jal. 44280, Mexico
Email: ggarcia1952@
gmail.com
Kidney disease and poverty in disadvantaged populations
Nontraditional (non-Western pharmaceutical) treatments for chronic kidney disease
Glenda C. Gobe and Ken Wojcikowski
Page No. 49
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S49-S54)
Nontraditional (non-Western pharmaceutical) treatments for chronic kidney disease
Glenda C. Gobe1#2 and Ken Wojcikowski3
1Kidney Disease Research Collaborative, The University of Queensland, Translational Research Institute, Woolloongabba, 2NHMRC Centre for Research Excellence (CKD.QLD), The University of Queensland, Health Sciences Building, Royal Brisbane & Women’s Hospital, Herston, Brisbane, and 3School of Health and Human Sciences, Southern Cross University, Lismore, Australia
Nontraditional, non-Western medicines, often called complementary and alternative medicines (CAM), for chronic kidney disease (CKD) patients are, potentially, a huge low-cost therapy resource for poorer populations in the world. Use of CAM, particularly from plant sources, is common in poorer communities, but the scientific basis for their use is still under-researched and under-published. This review presents information on the treatment of kidney disease with CAM, particularly CKD and its closely associated cardiovascular disease (CVD), which might benefit vulnerable populations. The challenges of developing CAM therapies for resource-limited environments are also discussed, particularly with reference to targeting oxidative stress, a known cause of progressive diseases such as CKD and CVD. Oxidative stress is a mechanism often targeted by CAM, with good scientific basis. Dietary supplementation with antioxidants is one approach to reducing CKD incidence or morbidity. Antioxidant supplementation in populations with sufficient dietary antioxidant intake often report little benefit. In comparison, poorer populations that may have restricted nutritional dietary antioxidant intake may benefit from supplementation with antioxidants. Also needing consideration are the recorded instances of nephrotoxicity from CAM therapies, particularly related to nephrotoxic plant extracts, extract-drug reactions, and toxicity from contaminants within the extracts. As long as the possible toxicity of plant-derived CAM is considered, we argue that populations having marked deficiency in, or poor access to, dietary antioxidants, or high exposure to environmental oxidants, may benefit from these nontraditional medicines.Correspondence to:
A/Prof. Glenda Gobe, BSc, MSc, PhD
Faculty of Medicine
Translational Research Institute
37 Kent Street, Woolloongabba, Brisbane, Australia 4102
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Burden of disease: Closing the gaps in the burden of end-stage kidney disease in Latin America
María C. Gonzalez-Bedat, Guillermo Rosa-Diez, Alejandro Ferreiro-Fuentes, Walter Douthat, Alfonso Cueto-Manzano, and Juan M. Fernandez-Cean
Page No. 55
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S55-S59)
Burden of disease: Closing the gaps in the burden of end-stage kidney disease in Latin America
María C. Gonzalez-Bedat1, Guillermo Rosa-Diez1, Alejandro Ferreiro-Fuentes2,3, Walter Douthat3, Alfonso Cueto-Manzano3, and Juan M. Fernandez-Cean3
1Coordinator of the Latin American Dialysis and Renal Transplantation Registry (RLADTR), Montevideo, Uruguay, 2Executive Board of the Latin American Dialysis and Renal Transplantation Registry (RLADTR), Buenos Aires, Argentina, and 3Executive Board of Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH), Córdoba, Argentina, Guadalajara, México and Montevideo, Uruguay
End-stage kidney disease (ESKD) represents a major challenge for Latin America (LA). The Latin American Dialysis and Renal Transplantation Registry (LADRTR) has published several reports, and its continuity has implied a sustained effort of the nephrology community to improve care of ESKD in the region; this paper summarizes results of the year 2014. Methods have been reported previously; participant countries complete annual surveys collecting data on incident and prevalent patients undergoing renal replacement therapy (RRT) in all modalities. 20 countries participated in the surveys (more than 90% of the region). Prevalence of treated ESKD in RRT increased from 119 patients per million population (pmp) in 1991 to 709 pmp in 2014; hemodialysis continues to be the treatment of choice in the region (68%). A wide variation was observed in the incidence rate, from 421 pmp in Jalisco (Mexico) to 23 pmp in Paraguay; diabetes was the cause of 36% of incident cases. Additionally, great heterogeneity was observed in the number of nephrologists by country, from 2 pmp in Colombia to 53 pmp in Uruguay. Heterogeneity, or even absence of registries in some LA countries, is concordant with inequities in RRT access as well as with the limited availability of qualified personnel. The LADRTR is leading the personnel training to develop and strengthen national dialysis and transplant registries in LA within the frame of the Pan-American Health Organization (PAHO) – Sociedad Latinoamericana de Nefrología e Hipertension (SLANH) cooperation program.Correspondence to:
María C. González-Bedat
Coordinator of RLADTR
Fco. Simón 2005, Apto 1001
Montevideo, CP 11600 Uruguay
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities
Raúl Herrera Valdés, Miguel Almaguer López, Carlos M. Orantes Navarro, Laura López Marín, Elsy G. Brizuela Díaz, Héctor Bayarre Vea, Juan C. Amaya Medina, Luis C. Silva Ayçaguer, Xavier F. Vela Parada, Susana Zelaya Quezada, Patricia Orellana de Figueroa, Magaly Smith González, Yudit Chávez Muñoz, Xenia A. García Ortiz, and Raymed Bacallao Méndez
Page No. 60
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S60-S67)
Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities
Raúl Herrera Valdés1, Miguel Almaguer López1, Carlos M. Orantes Navarro2, Laura López Marín1, Elsy G. Brizuela Díaz3, Héctor Bayarre Vea4, Juan C. Amaya Medina5, Luis C. Silva Ayçaguer6, Xavier F. Vela Parada7, Susana Zelaya Quezada7, Patricia Orellana de Figueroa2, Magaly Smith González8, Yudit Chávez Muñoz9, Xenia A. García Ortiz5, and Raymed Bacallao Méndez8
1Nephrology Institute, Havana, Cuba, 2National Institute of Health, Ministry of Health, 3Metropolitan Health Region, San Salvador, El Salvador, 4National School
of Public Health, Havana, Cuba, 5San Juan de Dios National Hospital, San Miguel,
El Salvador, 6National Medical Sciences Information Center, Havana, Cuba,
7Renal Health Research Unit, National Health Institute, Ministry of Health,
San Salvador, El Salvador, 8Renal Physiopathology Department, and
9Anatomical Pathology Department, Nephrology Institute, Havana, Cuba
In El Salvador, a form of chronic kidney disease (CKD) of nontraditional causes (CKDnt) affecting farmers is being reported. Its behavior has been epidemic and is responsible for tens of thousands of deaths. This article summarizes the results obtained from a series of studies conducted to identify the epidemiology and clinical behavior of this disease, proposing a case definition and an etiopathogenic hypothesis. Methods included a survey of CKD in agricultural communities studying 2,388 people ≥ 18 years and 1,755 < 18, a descriptive clinical study followed by histopathological assessment conducted in 46 possible cases of CKDnt ≥ 18 years, and a national survey to study the prevalence of CKD and associated risk factors in 4,817 participants ≥ 20 years followed by a nested case-control study. In the agricultural communities, the prevalence of CKD in adults was 18% (men: 23.9%, women: 13.9%), 26.8% in agricultural workers (non-agricultural 13.8%), CKDnt accounted for 51.9% of cases. CKD in the population < 18 years was 3.9% (mean estimated glomerular filtration rate > 160 mL/1.73m2). The national CKD prevalence was 12.6% (urban: 11.3%; rural: 14.4%; males: 17.8%, females 8.5%), and CKDnt was only 3.8%; with associations between CKD and exposure to agrochemicals. The clinical study revealed the presence of markers of kidney damage (A3 albuminuria: 80.4%; β2-microglobulin: 78.2%), urine electrolyte anomalies (100% hypermagnesuria, 45.7% hypernatriuria, 43.5% osmotic polyuria), abnormal osteotendinous reflexes (45.7%), sensorineural hearing loss (56.5%), and damage of the tibial arteries by Doppler imaging (66.7%). Biopsies revealed a chronic tubulointerstitial nephropathy. The etiopathogenesis of CKDnt is possibly multifactorial, including environmental contamination by agrochemicals, heat stress, and dehydration.Correspondence to:
Raúl Herrera Valdés, MD MSc PhD DrSc
Nephrology Institute, Havana, Cuba
Email: raul.herrera@
infomed.sld.cu
Kidney disease and poverty in disadvantaged populations
Prevalence and incidence of chronic kidney disease in Cuba
Raúl Herrera Valdés, Miguel Almaguer López, José A. Chipi Cabrera, Jorge F. Pérez-Oliva Díaz, Orlando Landrove Rodríguez, and Alexander Mármol Sóñora
Page No. 68
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S68-S71)
Prevalence and incidence of chronic kidney disease in Cuba
Raúl Herrera Valdés1, Miguel Almaguer López1, José A. Chipi Cabrera2, Jorge F. Pérez-Oliva Díaz1, Orlando Landrove Rodríguez3, and Alexander Mármol Sóñora4
1Nephrology Institute, 2Héroes del Baire Hospital, Isle of Youth, 3Non-Communicable Diseases Department, and 4National Transplantation Organization, Ministry of Public Health, Havana, Cuba
Chronic kidney disease (CKD) is a health problem worldwide. This article’s objective is to describe CKD’s integration into Cuba’s National Noncommunicable Diseases (NCD) Program and the main outcomes regarding the burden of CKD and associated risk factors in Cuba. Cuba offers free health services to all its citizens on the basis of a strong primary healthcare system focused on prevention. The CKD National Program is coordinated by the Institute of Nephrology and includes the National Program for Prevention of CKD, which addresses all levels of prevention. The following indicators for renal replacement treatment are from 2016. The incidence of new patients on dialysis was 109 per million population (pmp); the two main causes were hypertension (34.4%) and diabetes mellitus (29.2). In 6.3% of patients, CKD cause could not be determined because they presented at advanced stages. The prevalence of patients on dialysis was 289 pmp; 90% of dialysis patients were on hemodialysis. The main causes of death were cardiovascular diseases (30.25%), cerebrovascular diseases (11.1%), and infections (29.5%). The kidney transplant rate was 14.3 pmp. Kidney transplants performed with cadaveric donors were 86.5% of total, with living related donors 13.5%. The Isle of Youth Study (ISYS) was designed to assess predialysis chronic kidney disease patterns; its methodology has been published previously. Results: Risk factors: age > 59 years 32%, women 67.8%, overweight 34.3%, obesity 22.8%, hypertension 41.5%, diabetes 13%. Estimated CKD prevalence was 9.63%. The integration of CKD into Cuba’s NCD Program has gathered knowledge of burden and trends of CKD and better risk factor control.Correspondence to:
Raúl Herrera Valdés, MD, MSc, PhD, DrSc
Institute of Nephrology
Ave. 26 y Rancho Boyeros, Municipio Plaza
Havana, Cuba
Email: raul.herrera@
infomed.sld.cu
Kidney disease and poverty in disadvantaged populations
Cost-effectiveness of acute peritoneal dialysis: Considerations from Africa
Kajiru Gad Kilonzo, Huda Farid Akrabi, and Karen Elizabeth Yeates
Page No. 72
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S72-S75)
Cost-effectiveness of acute peritoneal dialysis: Considerations from Africa
Kajiru Gad Kilonzo1#2, Huda Farid Akrabi1#2, and Karen Elizabeth Yeates3
1Internal Medicine Department, Kilimanjaro Christian University College, 2Internal Medicine Department, Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania, and 3Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
Acute kidney injury (AKI) is currently an important public health problem with high morbidity and mortality especially in low- and middle-income countries. In these low-resource settings, prevention of death from severe AKI involves well-coordinated intensive care services, which are often absent or expensive. Provision of cost-effective interventions that are widely available and accessible to everyone is important. Acute peritoneal dialysis (PD), which is technically more economical than hemodialysis, could potentially become a cost-effective solution in the management of severe AKI. An acute PD project in Moshi, Tanzania, was used to assess the cost-effectiveness of PD using a comparison between subsidized and privately procured resources. The average cost per AKI course of treatment with PD when subsidized was USD 420, while if the same treatment was privately procured it was USD 788. Using a WHO guideline that categorizes interventions costing less than once the national annual GDP per capital as highly cost-effective, the Moshi PD project was found to be an appropriate example because the intervention cost (USD 788) was lower than the GDP per capita of Tanzania (USD 879 in 2012). If more countries develop similar programs in sub-Saharan Africa, particularly for children, this would allow for increased opportunity for economies of scale in the supply of consumables and could lower costs over the long term. Ministries of health in low-resource settings should consider developing programs for provision of acute PD to achieve equitable, cost-effective, and sustainable programs for treatment of AKI and subsidies to increase access to lower-income patients.Correspondence to:
Kajiru Kilonzo, MPhil.
Internal Medicine Department, KCMC
P.O. Box 3010, Longuo B, Moshi, Kilimanjaro, Tanzania
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Epidemiologic and socioeconomic profile of Guatemalan hemodialysis patients: Assessment and dissemination via a free-access information system
Randall M. Lou-Meda, Ana Lucía Valle, Carlos Urla, and Jacobo Mazariegos
Page No. 76
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S76-S81)
Epidemiologic and socioeconomic profile of Guatemalan hemodialysis patients: Assessment and dissemination via a free-access information system
Randall M. Lou-Meda1, Ana Lucía Valle2, Carlos Urla2, and Jacobo Mazariegos2
1Foundation for Children with Kidney Diseases (Fundanier) and 2Galileo University, Guatemala
There is wide variation in the presence of renal replacement therapy (RRT) registries throughout the world, which is a major obstacle to designing and implementing coordinated strategies for chronic kidney disease care and resource planning. Guatemala does not have a national registry of patients on RRT. We describe the result of a cross-sectional study at a national level on epidemiologic and socioeconomic characteristics of hemodialysis patients in Guatemala: most patients were male (57%), above the age of 20 (90%), unemployed (60%), married or in a civil union (53%), had an elementary school education (47%), and living in the geographical clusters in the south of the country. We also describe a free-access website created with the results of the study. Given that Guatemala is still years away from a complete national registry, this information can be used by interested parties in the meantime to promote rational use of limited resources and to inform data-driven health policies.Correspondence to:
Randall M. Lou-Meda, MD
Fundación para el Niño Enfermo Renal
6 avenida 9-18 zona 10, Ala 1, oficina 804,
Edificio Sixtino 2, Guatemala 01010, Central America
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Interleukin-6 gene polymorhisms and interleukin-6 levels are associated with atherosclerosis in CKD patients
Muzamil Olamide Hassan, Raquel Duarte, Caroline Dickens, Therese Dix-Peek, Sagren Naidoo, Ahmed Vachiat, Sacha Grinter, Pravin Manga, and Saraladevi Naicker
Page No. 82
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S82-S86)
Interleukin-6 gene polymorhisms and interleukin-6 levels are associated with atherosclerosis in CKD patients
Muzamil Olamide Hassan1, Raquel Duarte2, Caroline Dickens2, Therese Dix-Peek2, Sagren Naidoo1, Ahmed Vachiat3, Sacha Grinter3, Pravin Manga3, and Saraladevi Naicker4
1Divisions of Nephrology, 2Internal Medicine Research Laboratory, 3Division of Cardiology, Department of Internal Medicine, and 4Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
Inflammation is a major risk factor for atherosclerosis. Genetic polymorphisms in the inflammatory cytokine genes have been associated with atherosclerosis. Because levels of inflammatory cytokines are markedly elevated in patients with chronic kidney disease (CKD), we hypothesized that genotypic variations in the interleukin-6 (IL-6) gene are a cause of systemic inflammatory states and atherosclerosis in South African CKD patients. 120 CKD patients and 40 healthy controls were included. Serum IL-6 and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Functional polymorphisms in the IL-6 genes were genotyped using polymerase chain reaction-sequence specific primer (PCR-SSP) methods. Carotid intima-media thickness (CIMT) and the presence of plaque were assessed by B-mode ultrasonography. Serum IL-6 and hs-CRP levels were increased in patients with CKD compared with healthy controls (p < 0.001). In CKD patients, serum IL-6 above the median value was associated with carotid plaque (OR: 2.11; 95% CI: 1.74 – 2.57, p = 0.004), with excess risk confined to the group with high IL-6 levels. Significant associations were found between the IL-6 gene and atherosclerosis in the CKD group (for G/G genotype: OR = 1.21, 95% CI = 1.05 – 1.39, p = 0.012; for GG+GC vs. CC: OR = 1.14, 95% CI = 1.02 – 1.28, p = 0.035). Patients with GG+GC genotype of the IL-6 gene polymorphism had higher levels of IL-6 than those with CC genotype (p = 0.029). In South African CKD patients, the IL-6 gene promoter polymorphism is associated with high serum IL-6 levels and atherosclerosis. The relationship between atherosclerosis and –174G/C polymorphism in the IL-6 gene suggests that IL-6 may be a potential pro-inflammatory mediator of atherosclerosis in CKD patients.Correspondence to:
Dr. Muzamil Olamide, Hassan, FMCP Cert Nephrology(SA), PhD
Department of Medicine
Ladoke Akintola University of Technology Teaching Hospital
Osogbo, Osun State, Nigeria
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
HIV/AIDS and chronic kidney disease
Saraladevi Naicker
Page No. 87
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S87-S93)
HIV/AIDS and chronic kidney disease
Saraladevi Naicker
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Chronic kidney disease (CKD) is a frequent complication of HIV infection. 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 histologically the second most common diagnosis. 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 overall improvement in kidney function with initiation of ART. Many antiretroviral medications are partially or completely eliminated by the kidney and require dose adjustment in CKD. HIV-positive patients requiring either hemo- or 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-positive patients; graft and patient survival is similar to that of HIV-negative 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. Programs for prevention of HIV infection are essential.Correspondence to:
Saraladevi Naicker, MD, PhD
Department of Internal Medicine
School of Clinical Medicine
Faculty of Health Sciences
University of the Witwatersrand
7 York Road, Parktown, Johannesburg, 2193, South Africa
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Application of new innovations/technology for care of end-stage renal disease in a resource-limited environment
K. Shivanand Nayak, Akash N. Karopadi, Subhramanyam V. Sreepada, and Sinoj Antony
Page No. 94
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S94-S99)
Application of new innovations/technology for care of end-stage renal disease in a resource-limited environment
K. Shivanand Nayak1#2, Akash N. Karopadi2, Subhramanyam V. Sreepada1#2, and Sinoj Antony1
1Department of Nephrology, Virinchi Hospitals, Banjara Hills, Hyderabad, and 2DND Center, Nanal Nagar, Hyderabad, India
The costs involved in the management of end-stage renal disease (ESRD) patients are overwhelming the healthcare commitments of countries worldwide and even more so in resource-limited settings. Some countries have intelligently managed to implement universal healthcare coverage for their citizens. Many others, unable to achieve this, have sensibly concentrated on spending their limited resources on less expensive but more important healthcare issues, such as preventive care especially in the areas of waterborne diseases and implementation of universal vaccination. This however leaves a large section of the population with ESRD vulnerable, and it is up to the various stakeholders, including the medical professions, to innovate and partly alleviate their suffering as a social responsibility.Correspondence to:
Dr. K. Shivanand Nayak, Senior Nephrologist
Department of Nephrology
Department of Nephrology, Virinchi Hospitals
Banjara Hills, Hyderabad, 500034, India
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Monthly direct and indirect costs of management of CKD 3 – 5 non-dialysis patients in an out-of-pocket expenditure system: The Case of Yaoundé
Francois Tchokouaha Ngeugoue, Zachariaou Njoumemi, and Francois Folefack Kaze
Page No. 100
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S100-S102)
Monthly direct and indirect costs of management of CKD 3 – 5 non-dialysis patients in an out-of-pocket expenditure system: The Case of Yaoundé
Francois Tchokouaha Ngeugoue1#2, Zachariaou Njoumemi3, and Francois Folefack Kaze2#4
1Bafoussam Regional Hospital, Bafoussam, 2Department of Internal Medicine and Specialties, 3Health Economy Unit, Department of Public Health, Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, and 4Yaoundé University Teaching Hospital, Yaoundé, Cameroon
Chronic kidney disease (CKD) affects ~ 10% of the world population. In most developing nations, the costs for the treatment of CKD are met by patients. Data on the economic burden of early stages of CKD are scarce; few studies have evaluated the cost of management of CKD stages 3 – 5 in non-dialysis (ND) patients in an out-of-pocket expenditure system. This study estimated the direct, indirect, and global economic cost of management of CKD stages 3 – 5 ND patients in Yaoundé, Cameroon. It was 1-month retrospective cost analysis. Sampling was consecutive and exhaustive of CKD 3 – 5 ND patients. We evaluated direct medical, direct non-medical, and indirect costs. 69 patients were included in the study, and the mean age was 55 years. The median monthly salary of the population was USD 162. Only 1.4% of patients had 100% health insurance coverage. The total cost of management was ~ USD 163. Direct medical, direct non-medical, and indirect costs accounted for 86.4%, 7.1%, and 6.3%, respectively. That global cost was prohibitive to Cameroonians and was tantamount to 2.7 times the minimal wage in Cameroon.Correspondence to:
Francois Tchokouaha Ngeugoue, MD, Nephrologist
Head of Service
Nephrology & Hemodialysis Service
Bafoussam Regional Hospital, Cameroon
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Hypertension and kidney disease progression
Diego Rigo and Marcelo Orias
Page No. 103
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S103-S107)
Hypertension and kidney disease progression
Diego Rigo1 and Marcelo Orias1#2
1Nephrology Department, Sanatorio Allende, and 2Universidad Nacional de Córdoba, Córdoba, Argentina
Hypertension is a common finding in patients with chronic kidney disease (CKD) and it is associated with kidney disease progression. Hypertensive nephropathy is a diagnosis, mostly based on clinical suspicion and defines many cases of CKD of unknown etiology. The risk of progression of hypertension-attributed nephropathy seems to have a genetic background as has been demonstrated in African-American patients with <i>APOL1</i> gene risk variants.Correspondence to:
Marcelo Orias, MD
Hipolito Yrigoyen Av. Nº384 zip code 5000, Córdoba, Argentina
Email: marcelo.orias@
gmail.com
Kidney disease and poverty in disadvantaged populations
Estimating the prevalence of undocumented immigrants with end-stage renal disease in the United States
Rudolph Rodriguez, Lilia Cervantes, and Rajeev Raghavan
Page No. 108
Abstract
Estimating the prevalence of undocumented immigrants with end-stage renal disease in the United States
Rudolph Rodriguez1, Lilia Cervantes2#3, and Rajeev Raghavan4#5
1Department of Medicine, University of Washington, Seattla, WA, 2Department of Medicine, Denver Health, 3University of Colorado School of Medicine, Denver, CO, 4Harris Health, and 5Department of Medicine, Baylor College of Medicine, Houston, TX, USA
In the current political environment, the plight of undocumented immigrants in the United States (U.S.) remains perilous and uncertain, and this precarious situation is magnified for undocumented immigrants with end-stage renal disease (ESRD). For this population, access to hemodialysis varies dramatically from standard-of-care thrice-weekly hemodialysis, to the other extreme of emergency-only hemodialysis which is the practice of offering hemodialysis only after a patient meets “critically ill criteria.” Due to the exclusion from Medicare, undocumented immigrants are not included in the United States Renal Data System (USRDS), and therefore the prevalence of undocumented immigrants with ESRD in the U.S. remains unknown. In this review, we assemble the published literature, press reports, and other data sources to arrive at an estimated crude prevalence of undocumented immigrants with ESRD. In 2015, USRDS data reported an adjusted ESRD prevalence of 2,988 per million population (PMP) among documented U.S. Hispanics and 1,902 PMP among documented U.S. non-Hispanics, adjusted for age, sex, and race. Although 77.8% of undocumented immigrants in the U.S. are from Latin America, simply applying USRDS-adjusted prevalence estimates for U.S. Hispanics with Medicare to undocumented immigrants would likely overestimate the undocumented immigrant population with ESRD given the younger age of the immigrant population. Applying the estimates from the states with the largest population of undocumented immigrants, the range for California and Texas is 500 – 798 PMP which results in an estimate of 5,500 – 8,857 undocumented immigrants with ESRD living in the U.S.Correspondence to:
Rudolph A. Rodriguez, MD
Puget Sound VA Health Care System
1660 South Columbian Way, Building 1, Room 229
Seattle, WA 98119, USA
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
An analysis of hot spots of ESRD in the United States: Potential presence of CKD of unknown origin in the USA?
Jennifer Bragg-Gresham, Hal Morgenstern, Vahakn Shahinian, Bruce Robinson, Kevin Abbott, and Rajiv Saran
Page No. 113
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S113-S119)
An analysis of hot spots of ESRD in the United States: Potential presence of CKD of unknown origin in the USA?
Jennifer Bragg-Gresham1, Hal Morgenstern2, Vahakn Shahinian1, Bruce Robinson3, Kevin Abbott4, and Rajiv Saran1
1Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology
and Cost Center, 2Department of Epidemiology, School of Public Health, University of Michigan, 3Arbor Research Collaborative for Health, Ann Arbor, MI, and
4National Institutes of Health – NIDDK, Bethesda, MD, USA
We hypothesized that high incidence rates of end-stage renal disease (ESRD) in certain counties of the U.S. are partly due to patients with a type of ESRD resembling chronic kidney disease of uncertain etiology (CKDu), which has been observed in Central America and other countries. Using data on 338,126 incident ESRD patients from the United States Renal Data System (USRDS) (2011 – 2013) and the Behavior Risk Factor Surveillance System (BRFSS) Supplement on county-level variables (2006), we describe both patient-level and county-level characteristics in counties with the highest quartile of ESRD incidence rate standardized for age, sex, and race (> 420 cases/million population/year) compared to the rest of the U.S. and two specific “hotspots” of ESRD: the San Joaquin Valley and the Rio Grande Valley. Logistic regression was used to examine characteristics associated with patients who had either missing cause of ESRD or “unknown” listed as the primary cause of ESRD. High incidence rates of ESRD were observed in southern Texas, the Southeast and parts of California (including the San Joaquin valley area), while low rates were seen in the Northwest and the Mountain Regions. The median crude incidence rate of ESRD was 335 (range 0 – 2,341) new cases per million population per year among counties. Significant predictors of missing/unknown primary cause of ESRD included: older age, white or unknown race, non-Hispanic ethnicity, lack of comorbidities at ESRD onset, lower estimated glomerular filtration rate (eGFR) at initiation, and lack of pre-dialysis care. Large areas of the U.S. have very high rates of ESRD incidence. We cannot confirm that CKDu is present in the U.S. based on this preliminary work. This topic therefore requires further investigation, as many of these patients may well be undocumented aliens working as farm laborers and therefore not registered in the USRDS.
Correspondence to:
Rajiv Saran, MBBS, DTCD, MD, MRCP, MS
Professor of Internal Medicine and Epidemiology
Division of Nephrology
Department of Internal Medicine
University of Michigan
Kidney Epidemiology and Cost Center
1415 Washington Heights, Suite 3645 SPH 1
Ann Arbor, MI 48109-2029, USA
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Burden of disease: Prevalence and incidence of endstage renal disease in Middle Eastern countries
Faissal A.M. Shaheen, Besher Al-Attar, Mohammad Kamal Ahmad, and Paul Mark Follero
Page No. 120
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S120-S123)
Burden of disease: Prevalence and incidence of endstage renal disease in Middle Eastern countries
Faissal A.M. Shaheen, Besher Al-Attar, Mohammad Kamal Ahmad, and Paul Mark Follero
Saudi Center for Organ Transplantation, Riyadh, Kingdom of Saudi Arabia
Background: End-stage renal disease (ESRD) is one of the leading non-communicable diseases worldwide which at the same time costs immense amount of both financial and human resources. The number of ESRD patients continues to grow, and the need to provide different modalities of renal replacement therapy (RRT) increases.
Materials and methods: We conducted a retrospective study on the incidence and prevalence of RRT in the Middle East (ME) and the treatment modality, and correlated the findings with the economic status.
Results: The predominant age group of patients receiving RRT in ME countries is 0 – 39, compared with the age group of 25 – 59 in Western countries. The reported prevalence of RRT is directly proportional to the economic status of the country, with low-income countries having low prevalence of RRT and high-income countries having higher prevalence. Diabetes mellitus (DM) as the leading cause of ESRD has a high prevalence in the ME according to the World Health Organization (WHO); the projected prevalence by the year 2035 is 85%. RRT in ME shows 75.81% of patients are on hemodialysis (HD), 3.25% on peritoneal dialysis (PD), and 20.93% were post-transplant recipients. Internationally, 77%, 16%, and 6% were on HD, PD, and post-transplant, respectively, in Europe; 63.1%, 6.9%, and 29.6% in the USA; and 12%, 70%, and 18% in Mexico. HD was the predominant modality of RRT in ME, while PD is underutilized, and transplantation was mostly from living donors; deceased-donor transplantation is not available in many countries. The Ministry of Health (MOH) is the main provider of RRT in ME; next, charitable organizations provide a significant proportion of RRT; and lastly, through private sectors for patients who could afford the cost of the therapy. In our survey, kidney transplantation in ME was mainly from living donors with almost 77.7% of the total kidneys transplanted while deceased donors comprised 22.3%. The overall graft survival was 93.7% and 84.23% after 1 and 5 years, respectively. Internationally, there are 17 accessible renal registries, compared with only 1 in the ME, resident in Saudi Arabia. Of the patients receiving RRT, 80% are on HD; chronic kidney disease (CKD) is found in ~ 10% of the population in the region.
Conclusion: There is a high CKD burden in the ME countries. There needs to be emphasis on prevention of ESRD and provision of adequate care for the total ESRD patient population. National renal registries are needed to monitor the status of ESRD patients. Health expenditures should be increased to cover all aspects of RRT in ME Countries.Correspondence to:
Faissal A.M. Shaheen, BSN
Saudi Center for Organ Transplantation
Nahda Street, Rabwa District
Riyadh 11417, P.O. Box: 27049, Kingdom of Saudi Arabia
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
An update on chronic kidney disease in Aboriginal Australians
Wendy E. Hoy, Susan A. Mott, and Stephen P. McDonald
Page No. 124
Abstract
Clinical Nephrology, Vol. 93 – Suppl. 1/2020 (S124-S128)
An update on chronic kidney disease in Aboriginal Australians
Wendy E. Hoy1, Susan A. Mott1, and Stephen P. McDonald2
1Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Brisbane, Australia, and 2University of Adelaide and Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, Australia
We provide a brief update on some aspects of chronic kidney disease (CKD) in Indigenous Australians, with CKD referring to all stages of pre-terminal kidney disease, as well as to end-stage kidney failure (ESKF), whether or not a person receives renal replacement therapy (RRT). Recently recorded rates of ESKF and RRT were 6- and 8-fold those recoded for non-Indigenous Australians with age adjustment, while non-dialysis CKD hospitalizations and CKD-attributed deaths were 8-fold and 3-fold higher. The median age of Indigenous people who developed ESKF was ~ 30 years less than for non-Indigenous people, and 84% of them received RTT, while only half of non-Indigenous people with ESKF did so. However, the nationwide average Indigenous incidence rate of RRT appears to have stabilized. The 2012 Australian Health Survey showed elevated levels of CKD markers in Indigenous people at the community level. For all CKD parameters, rates among Indigenous people were strikingly correlated with increasing remoteness of residence and socioeconomic disadvantage, and there was a female predominance in remote areas. The burden of renal disease in Australian Indigenous people is seriously understated by Global Burden of Disease Mortality methodology, because it employs underlying cause of death only, and because deaths of people on RRT are frequently attributed to non-renal causes. These data give a much-expanded view of CKD in Aboriginal people. Methodologic approaches must be remedied for a full appreciation of the burden, costs, and outcomes of the disease, to direct appropriate policy development.Correspondence to:
Wendy E. Hoy, AO, FAA, Professor of Medicine, Director
NHMRC CKD Centre for Research Excellence
Director of Centre for Chronic Disease
School of Clinical Medicine
The University of Queensland
Brisbane, Australia
Email: [email protected]
Kidney disease and poverty in disadvantaged populations
Potential urine biomarkers for the diagnosis of prediabetes and early diabetic nephropathy based on ISN CKHDP program
Dongfeng Gu, Yunying Chen, Monica Masucci, Chongxiang Xiong, Hequn Zou, and Harry Holthofer
Page No. 129
Abstract
Potential urine biomarkers for the diagnosis of prediabetes and early diabetic nephropathy based on ISN CKHDP program
Dongfeng Gu1#3*, Yunying Chen1*, Monica Masucci2, Chongxiang Xiong1, Hequn Zou1, and Harry Holthofer4#5
1Department of Nephropathy, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China, 2Department of Medicine, Rhode Island Hospital and Brown University School of Medicine, Province, RI, USA, 3Department of Nephropathy, Zhengzhou People’s Hospital Affiliated with Southern Medical University, Zhengzhou, China, 4Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland, and 5Freiburg Institute for Advanced Studies, Albert-Ludwigs University Freiburg, Freiburg, Germany
Background: Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), and the most frequent cause of end-stage renal disease (ESRD) in many countries. Urinary extracellular vesicles (UEVs) are considered a rich non-invasive source of markers for renal diseases. In this study, UEV enrichment and analysis in diabetic nephropathy (DN) was performed in a community epidemiological survey supported through the ISN CKHDP program
Materials and methods: Patients were divided into five groups according to severity of kidney damage. A hydrostatic dialysis method was used for UEV enrichment followed by quantitation using Coomassie protein assays and subsequent adjustment using urinary creatinine levels. UEVs were then characterized by transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA), and Western blotting of tumor susceptibility gene product TSG101. Two-dimensional DIGE (2D-DIGE) was used to analyze differential protein expression in the UEVs. Mass spectrometry (MS) was conducted and MASCOT search engine was used to identify potential biomarkers.
Results: Bradford protein assay showed that protein concentration of UEVs in diabetics with kidney injury increased significantly as compared to normal controls. UEVs present a round, cup-shaped, membrane-encapsulated structure under TEM, and the main peak of UEVs show 55 – 110 nm nanoparticles with NTA. MS and MASCOT identified 22 differential proteins, and MASP2, CALB1, S100A8, and S100A9 were selected as potential biomarkers of early DN based on bioinformatic analysis.
Discussion: Our results show UEV proteome changes in different stages of DN. The results of this study show four unique proteins that undergo changes in early DN. These promising discoveries may prompt a new field of research focused on improving the diagnosis of DN.Correspondence to:
Hequn Zou, MD
Institute of Nephrology and Urology
The Third Affiliated Hospital of Southern Medical University
Zhong Shan Da Dao 183
Guangzhou 510630, China
Email: [email protected]
