14^th World Nephrology Conference July 23-24, 2018 Melbourne, Australia

Biography:

DR. Vijitha Burra currently doing DM cardiac anesthesia in Sri jayadeva institute of cardiovascular sciences and research, Bangalore. Awarded best outgoing student in MBBS with a gold medal. Qualifications are MBBS, DIPLOMA IN ANESTHESIA, DNB Anesthesia. Presented various free paper presentations at both state and national conferences. Paper entitled “A Comparative study on Granisetron and Palonosetron for prevention of Postoperative Nausea and Vomiting in  Laproscopic Surgery and Anesthesia”-got selected for international conference in United kingdom on 2015.Did fellowship in Difficult Airway under AIDAA in 2016 for four months at Kailash cancer hospital and research center,Vadodara . Areas of interest were airway management, cardiac anesthesia, pediatric critical care.

Abstract:

BACKGROUND

   Acute kidney injury (AKI) is a strong predictor of morbidity and mortality after cardiac surgery. Lack of valid early biomarkers for predicting AKI has hampered the ability to take therapeutic measures for preventive cause. Hyperphosphatemia that occurs in AKI due to renal excretion defect was not studied in this context and could be simple marker of AKI . Therefore, we tested role of serum phosphorus in prediction of AKI as a biomarker after cardiac surgery in children.

METHODOLOGY

We prospectively evaluated 51 children aged between 3mo-12yrs undergoing elective cardiac surgery. Serum creatinine and phosphorus were measured preoperatively and postoperatively at 24,48hrs. As per KDIGO (Kidney Disease Improving Global Outcome) criteria ,patients were grouped into AKI and NON AKI on basis of development of AKI within 48hrs postsurgery .The postoperative diagnostic performance of phosphorus thresholds were analysed by the area under receiver operating characteristic curves (AUC-ROC).

RESULTS

From 51 children included, 10 developed AKI. In AKI group, serum phosphorus increased significantly from 4.47±1.36 baseline to 6.29±1.01 at 24hrs postsurgery (p=0.003).While serum creatinine increased from baseline 0.36±0.19 to 0.74±0.90 at 24hrs which is insignificant (p=0.14).Receiver Operating Characteristic Curve analysis showed that serum phosphorus at 24hrs, the area under the curve was 0.84 with sensitivity 0.75, specificity 0.93 for a cut off value of 6.4mg/dl. Whereas serum phosphorus at 48hrs, the area under the curve was 0.86 with sensitivity 66.67% and specificity 97.62% for a cut off value of 5.4 mg/dl.

CONCLUSION

Serum phosphorus can be an alternative biomarker as early as 24hrs for early prediction of AKI in paediatric cardiac surgery.

Biography:

Punit Gupta, was Profossser in Government medical college hospital (consider to be the tribal of india), raipur, India. He have done bachelor degree in 2000 I.e MBBS, than master degree in General Medicine in 2003 I.e MD, than Superspeciality in Nephrology I.e DM , With PHD DEGREE . He also awarded the prestigious ISPD SCHOLARSHIP and ASN fellowship. He have awarded with APCN developmental award in Malaysia. And also awarded with many oral n poster presentation National and International. He have presented highest number of papers I.e 31 abstract in single conference under his name till date around 175 paper and abstract is presented by him in different conferences

Abstract:

Aims :  this study was done to know the  incidence of infections and sepsis in hemodialysis patients,  also the risk factors and bacteria, commonly associated with CVC infection in hemodialysis patients.

Methods : We conducted a prospective study in (Nephrology unit) at Dr. B.R.A.M. Hospital  Raipur in a total 100 patients.  Prospective surveillance for hemodialysis catheter related blood stream infections (CRBSI) was performed in all hundred patients in whom CVC was the access. Blood culture and Maki’s semi‐quantitative method for catheter tip were used for processing.

Results : In the study group of a total of 100 patients, 35 patients suffered from septicemia whose blood culture was found to be positive for gram positive cocci and gram negative bacilli and they had signs and symptoms of sepsis. All patients had sepsis secondary to catheter related blood stream infection. Out of 35 patients, 34 patients were chronic kidney disease and one suffered from Acute Kidney Injury. The maximum number of patients were in age group more than 45 years with male preponderance.  (11%) patients suffered from urinary tract infection, 35 patients (15%) had CRBSI (Catheter related Blood Stream Infection) and 2 (2%) had pneumonia. 40% patients were diabetic. 92% cases in our study group with sepsis had moderate anemia (<11gm%). Gram positive cocci (Staphylococcus aureus) was most common organism found in blood of 80% patients of renal failure on haemodialysis with sepsis and E.coli, Acinectobacter and Candida was found  6.66%, 6.67%, 6.67% respectively. Incidence of sepsis was high with femoral vein (66.67%) usage and prolonged hemodialysis. Serum Phosphorus level was high in 73.33% patients and CRP was raised in all 15 patients with sepsis. Hypoalbuminemia (Serum Albumin level < 3.4 gm/dl) was associated with sepsis in 60% cases. Most of the patients were euthyroid.

Conclusion: As incidence of renal failure requiring hemodialysis increases and accordingly use of vascular access to deliver haemodialysis therapy has increased. The patient requiring haemodialysis are prone to infections because of risk factors like advanced age, male sex, diabetes, anemia, hypoalbuminemia, hyperphosphatemia and prolonged duration of hemodialysis.The site of vascular access is an important risk factor for development of sepsis. Gram positive cocci(S. aureus) is the commonest cause of sepsis. Prevention of CRBSI by encouraging AV Fistula, minimizing the use of CVCs, use of preventive measures for s. aureus cariers and aggressive management of hyperphosphatemia with phosphate binding agents can reduce incidence of CRBSI.

Biography:

Professor EL-Attar HA has completed MBBch in 11/1979 from Faculty of Medicine ,University of Alexandria ,MS in Chemical Pathology in 4/1987  and MD in Chemical Pathology in 4/2001 from Medical Research Institute. Assistant Professor in Chemical Pathology in 28/8/2006 and Professor in Chemical Pathology since30/8/2011 in Medical Research Institute. Alexandria University . Egypt.

Abstract:

The human kidney releases a monoamine oxidase ,Renalase ,which was discovered in 2005, to the blood stream to regulate the blood pressure .Renalase decreases systemic pressure by metabolizing the circulating catecholamines. Hypertension is highly prevalent in patients with diabetic nephropathy which is one of the leading causes (about 80%) of chronic kidney disease and end-stage –kidney disease .

When considered in isolation, hypertension and diabetes are associated with increased risk of the development of cardiovascular and renal complications . It is recognized that sympathetic nervous activation and stimulation of the rennin –angiotensin-aldosterone are involved .The dopaminergic and rennin-angiotensin systems interact to regulate the blood pressure.The vasodilator , Dopamine , counteracts angiotensin receptors in the paracrine regulation of renal sodium transport .

 Levels of Renalase that metabolize catecholamines are decreased in chronic kidney disease and the plasma concentration of Renalase is markadely reduced in patients with ESRD. Chronic kidney disease is often characterized by the presence of sympathetic hyperactivity , which contribute to the development of other forms of organ damage independent of its effect on blood pressure .It is associated with heart failure , arrhythmias and atherogenesis .

 Decrease Renalase level plays an important role in cardiovascular pathology. Chronic kidney disease  lead to an 18-fold increase in cardiovascular complications not fully explained by traditional risk factors .  Preventing the progression of renal failure and reducing cardiovascular risk of uraemic patients are major challenges for nephrologists. Interference with sympathetic overactivity may provide a new therapeutic avenue to follow in clinical medicine.

Biography:

Abstract:

Background: Survival analysis of patients on maintenance hemodialysis (HD) has been the subject of many studies. No study evaluated the effect of different factors on the survival time of these patients. We aimed to find factors affecting survival by using parametric survival models and the effect of them on the survival time. Methods: As a retrospective cohort study, we evaluated the data of 1408 HD patients and considered the data of patients who had at least 3 months of HD and started HD from December 2011 to February 2016. The data were extracted from Shiraz University of Medical Sciences (SUMS) Special Diseases database. Primary event was death. We applied Cox-adjusted PH to find the variables with significant effect on hazards of death. The effect of various factors on the survival time was evaluated by a parametric event-time model, the one found to have the best fit by Akaike Information Criterion (AIC). Results: Of 428 HD patients eligible for the analysis, 221 (52%) experienced death. With the mean ±SD age of 60±16 years and BMI of 23±4.6 Kg/m2, they composed of 250 men (58%). The median of the survival time (95% CI) was 624 days (550 to 716). The overall 1, 2, 3, and 4 year survival rates for the patients undergoing HD were 74 %, 42 %, 25 %, and 17 %; respectively. By using AIC, AFT log-normal model was recognized as the best functional form of the survival time. Cox-adjusted PH results showed that the amount of ultrafiltration volume (UF) (HR=1.146, P=0.049), WBC count (HR=1.039, P=0.001), RBC count (HR=0.817, P=0.044), MCHC (HR=0.887, P=0.001), and serum albumin (HR=0.616, P<0.001) had significant effect on mortality. AFT log-normal model indicated that WBC (ETR=0.982, P=0.018), RBC (ETR=1.131, P=0.023), MCHC (ETR=1.067, P=0.001), and serum albumin (ETR=1.232, 0.002) had significant influence on the survival time. Conclusions: Considering Cox-adjusted PH and three parametric event-time models, the parametric AFT log-normal had the best efficiency in determining factors influencing HD patients survival. Resulted from this model, WBC and RBC count, MCHC and serum albumin are factors significantly affecting survival time of HD patients.

Key Words: Body Mass Index, erythrocyte count, leukocyte count, renal dialysis, serum albumin, survival analysis, ultrafiltration

Biography:

Miguel is a final year medical student at King’s College London, with a First Class Honours BSc in Anatomy, Developmental and Human Biology. He has authored a book on medical history-taking, published research, presented internationally and taught hundreds of individuals including young offenders from disadvantaged backgrounds and other medical students.

Abstract:

Background/introduction:

The improper management of Acute Kidney Injury (AKI) is a leading cause of preventable morbidity and mor-tality, which costs NHS England an estimated £1.02bn per year. At our hospital a preliminary analysis revealed that only 41.1% of patients identified to have AKI on admission were managed in full accordance with the hospital-specific care bundle.

Aim(s)/objectives:

This project set out to improve complete compliance with the local AKI care bundle, within 24 hours of admission. We targeted three wards and aimed to increase overall compliance by 20% over a three-month period.

Methods:

Data was collected from 68 patients over 14 weeks (5/10/17–11/01/18) during which changes were implemented in the form of Plan-Do-Study-Act (PDSA) cycles, according to the Quality Improvement methodology. Two weeks of preliminary data collection were followed by three four-week cycles. These consisted of: alterations to the hospital’s medical admission pro forma, a hospital-wide screensaver and posters on target wards (PDSA1); a care bundle sticker (PDSA2); and consultant-led teaching aimed at junior doctors (PDSA3).

Results:

Complete compliance with the hospital AKI care bundle rose to 62% (PDSA1), 83.5% (PDSA2) and 87.5% (PDSA3) – a total increase of 46.4% on baseline. Failure to complete urinalysis accounted for 83.3% of cases in which management was sub-optimal. Following its introduction, the sticker was used in just 6.25% of patients (n=2), but led to full compliance with the care bundle in both cases.

Discussion/conclusion:

This project far surpassed our initial target, demonstrating that the cumulative effect of several simple interventions can make a significant contribution to the optimal management of AKI.

Biography:

Professor EL-Attar HA has completed MBBch in 11/1979 from Faculty of Medicine ,University of Alexandria ,MS in Chemical Pathology in 4/1987  and MD in Chemical Pathology in 4/2001 from Medical Research Institute. Assistant Professor in Chemical Pathology in 28/8/2006 and Professor in Chemical Pathology since30/8/2011 in Medical Research Institute. Alexandria University . Egypt.

Abstract:

Background: Human Kidney Injury Molecule-1 (KIM-1) is produced in the affected segments of the proximal renal tubule whenever there is a pathophysiological state resulting in dedifferentiation of the epithelium. The kidney injury molecule-1 is a type 1 transmembrane glycoprotein (339 aa). KIM-1 ectodomain is cleaved and shed in a metalloproteinase-dependent fashion. The soluble KIM-1 protein that appears in the urine of humans is about 90 KDa. All forms of chronic kidney disease, including diabetes, are associated with tubulo-interstitial injury. Aim: The current study was performed try to assess use of urinary KIM-1/Creatinine ratio as a sensitive diagnostic tool for renal injury in the urine of patients with type 2 diabetic Egyptian patients. Methods: Eighty subjects were subjected to clinical examination included and subdivided as 20 apparently healthy control volunteers (group I) and 60 diabetic patients which were divided into 3 subgroups (Group II, Group III and Group IV) of 20 patients each: according to ACR: (ACR<30 mg/g, 30 – 299 mg/g and ≥ 300 mg/g respectively). All were subjected to laboratory investigations which included: Morning mid-stream urine sample for: 1) Complete urine analysis. 2) Quantitative measurement of urinary albumin. 3) Urinary creatinine. 4) Calculation of urinary albumin to creatinine ratio. 5) Measurement of KIM-1 (ELISA) 6) Calculation of KIM-1 to creatinine ratio. Calculation of estimated glomerular filtration rate (eGFR). Estimation of: fasting and post prandial glucose, urea and creatinine serum levels and blood level of glyclated hemoglobin (HbA1c). Results: Urinary KIM-1 levels were increased with the progression of nephropathy. Urinary KIM-1 levels were independent risk factor of (eGFR) and albuminuria in diabetic patients. Urinary KIM-1/Cr ratio was more sensitive than KIM-1. There was no correlation between urinary KIM-1/Cr ratio and GFR in all studied groups. Conclusion: Urinary KIM-1/Cr ratio is a sensitive, noninvasive diagnostic tool for kidney affection in Type 2 diabetic Egyptian patients that seem to predict renal injury in early period independent of albuminuria. Due to lack of correlation, both KIM-1/Cr and Alb/Cr ratios are required to be calculated for Type 2 diabetic patients. Recommendations: The use of KIM-1/Cr ratio as a diagnostic tool for kidney affection by measuring it in urine of Type 2 diabetic patients at risk of chronic kidney disease

Biography:

Abstract:

Background: Survival analysis of patients on maintenance hemodialysis (HD) has been the subject of many studies. No study evaluated the effect of different factors on the survival time of these patients. We aimed to find factors affecting survival by using parametric survival models and the effect of them on the survival time. Methods: As a retrospective cohort study, we evaluated the data of 1408 HD patients and considered the data of patients who had at least 3 months of HD and started HD from December 2011 to February 2016. The data were extracted from Shiraz University of Medical Sciences (SUMS) Special Diseases database. Primary event was death. We applied Cox-adjusted PH to find the variables with significant effect on hazards of death. The effect of various factors on the survival time was evaluated by a parametric event-time model, the one found to have the best fit by Akaike Information Criterion (AIC). Results: Of 428 HD patients eligible for the analysis, 221 (52%) experienced death. With the mean ±SD age of 60±16 years and BMI of 23±4.6 Kg/m2, they composed of 250 men (58%). The median of the survival time (95% CI) was 624 days (550 to 716). The overall 1, 2, 3, and 4 year survival rates for the patients undergoing HD were 74 %, 42 %, 25 %, and 17 %; respectively. By using AIC, AFT log-normal model was recognized as the best functional form of the survival time. Cox-adjusted PH results showed that the amount of ultrafiltration volume (UF) (HR=1.146, P=0.049), WBC count (HR=1.039, P=0.001), RBC count (HR=0.817, P=0.044), MCHC (HR=0.887, P=0.001), and serum albumin (HR=0.616, P<0.001) had significant effect on mortality. AFT log-normal model indicated that WBC (ETR=0.982, P=0.018), RBC (ETR=1.131, P=0.023), MCHC (ETR=1.067, P=0.001), and serum albumin (ETR=1.232, 0.002) had significant influence on the survival time. Conclusions: Considering Cox-adjusted PH and three parametric event-time models, the parametric AFT log-normal had the best efficiency in determining factors influencing HD patients survival. Resulted from this model, WBC and RBC count, MCHC and serum albumin are factors significantly affecting survival time of HD patients.

Key Words: Body Mass Index, erythrocyte count, leukocyte count, renal dialysis, serum albumin, survival analysis, ultrafiltration