Day 1 :
Fu-Jen Catholic University Hospital
A graduate of the National Defense Medical Center (NDMC), Kuo-Cheng Lu joined the NDMC faculty in 1985 after having training at Internal Medicine and Clinical Nephrology. He devoted the first two decades of his career to the clinical care of dialysis patients at Tri-Service General Hospital and private Kou-Cheng clinic in Taipei, Taiwan. At the same time, he conducted bone biopsy (Histomorphometric study) research for renal patients, especially on the osteitis fibrosa cystica (SHPT) and calcitriol therapy. After managing of private dialysis clinic for ten years, he moved to the Nephrology division of Cardinal-Tien Hospital, an affiliated teaching hospital of Fu-Jen Catholic University. In 2003, he was elected as the chairman of Department of Medicine, Cardinal-Tien Hospital. Since 2003, Dr. Lu’s research has moved toward translation study in renal dystrophy focusing on SHPT treatment. The most significant contributions involved an ongoing trans-disciplinary study of renal bone diseases with a goal of identifying significant differences in renal bone diseases among the different degree of turnover status. Dr. Lu also teaches at other medical schools such as Taipei Medical University and National Defense Medical Center. Moreover, Dr. Lu supervised many PhD students who study in the field of bone cell regulation in various clinical diseases. In 2015, Dr. Lu was recruited to join Fu-Jen Catholic University as Associate Dean of College of Medicine, Fu-Jen Catholic University. Since then, Dr. Lu became more interested in potential of large observational data, biology, and pathophysiology with available renal bone disorders, both at the bedside and through translation study. In Dec 2016, this effort was rewarded when he was selected as the Present of Taiwan Society of Nephrology, devoted to improve the high quality multidisciplinary care for CKD patients in Taiwan. Currently, Dr. Lu also pays attention to study on the possible AKI in the development of CKD. This work led him to organize the faculties across many medical centers in Taiwan for the study on how AKI induces CKD, which may be used to address health care quality. Over the years, Dr. Lu has had the privilege of advocating CKD healthcare education in Tanzania, China, Japan and doing research with the professionals in these counties. Dr. Lu also published papers in the field of music therapy in dialysis patients. Currently, Dr. Lu spends much time on the strengthening international collaboration among the Taiwan Society of Nephrology (TSN) and Nephrology Society of Japan, Korea, Thailand and Malaysia to enhance the academic communicate, share the clinical experience and promote CKD education programs.
In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. For the high prevalence of vitamin-D deficiency (VDD) in hemodialysis patients, an increase in 1α-hydroxylase to 10-fold and decrease in 24-hydroxylase to 1/10-fold highlight the requirement of more 25D in the PTG of SHPT. The expression of CaSR and VDR were also decreased in the PTG cells, which is thought to be related to calcimimetics or calcitriol resistance. A higher proportion of oxyphil cells as hyperplastic parathyroid progression, lower cytosolic DBP content in oxyphil cells, and calcitriol promote vitamin D degradation by enhancing 24-hydroxylase activity all aggravate vitamin D hunger in PTG. Hence, NVD supplementation in SHPT is relative important. Clinically, NVD supplements can effectively restore serum 25D concentration, alleviate the development of SHPT in early CKD, and have benefits in further lowering PTH in moderate to severe SHPT in dialysis patients. However, these benefit of NVD supplement in SHPT need more randomized control trials to prove.
Keynote: Treatment outcomes of direct-acting antiviral (DAA) therapy among chronic kidney disease (CKD) and post kidney transplant patients with hepatitis c virus (HCV) infection: Single center experience
Time : 11:10-12:00
Dr. Shena Jo A. Capucion earned her Bachelors of Science in Biology from the University of the Philippines. Attended medical school and earned her M.D. from Remedios Trinidad Romualdez Medical Foundation, Tacloban City, Philippines. She completed then her residency in Internal Medicine at National Kidney and Transplant Institute, Philippines. She is currently a senior Adult Nephrology Fellow-in-Training in the same institution.
Hepatitis C virus (HCV) infection is common among chronic kidney disease (CKD) and kidney transplant recipients. Direct acting antiviral (DAA) regimens has been demonstrated to be effective with high sustained virological response (SVR) rates and tolerated in the general population. Data is limited and remains to be confirmed among CKD and kidney transplant recipients. The study aims to investigate treatment outcomes of DAA therapy among CKD and kidney transplant patients with hepatitis C infection. Specifically, it seeks to describe demographics, determine SVR rates, changes in laboratory values, and adverse effects with DAA therapy. Methods: The study employed a retrospective observational study design. It included all cases of CKD and kidney transplant recipients with chronic HCV infection who are >18 year old on DAA Therapy at National Kidney and Transplant Institute, Philippines from December 2015 to December 2016. Descriptive analysis of treatment outcomes, changes in laboratory values, and adverse events. Results: Twelve patients were included, 7 (58%) CKD and 5 (42%) kidney transplant recipients. All patients (100%) had SVR 12. Changes in laboratory values during treatment included; (1) mean increase in creatinine of 0.3 mg/dL vs 0.04 mg/dL, (2) mean decline in hemoglobin of 2 mg/dL vs 1.5 mg/dL, in platelet of 18 x 10^3/uL vs. 7 x 10^3/uL, in ALT levels of 31 U/L vs 27 U/L, and in bilirubin 0.5 mg/dL vs 0.12 mg/dL in CKD and post kidney transplant recipients respectively. One (8.3%) kidney transplant recipient had disorientation but did not lead to treatment discontinuation. Conclusions/Recommendations: Our study showed an SVR12 rate of 100% in both CKD and kidney transplant recipients. Majority did not experience adverse effects during treatment. Further larger studies are needed to validate our findings.