Day 2 :
Keynote Forum
Tetsuhiro Tanaka
University of Tokyo Hospital, Japan
Keynote: A role of Hypoxia-Signaling in diabetic kidney disease
Biography:
Tetsuhiro Tanaka is a currently working at the Division of Nephrology and Endocrinology, the University of Tokyo, School of Medicine. His major research interest is the role of chronic hypoxia and hypoxia-inducible gene transcription in the pathogenesis of CKD. He has completed his Graduation from the University of Tokyo, School of Medicine in 1997 and has obtained his Ph.D. degree at the University of Tokyo Graduate, School of Medicine in 2005. He has received the Young Investigator Award of the Japanese Society of Nephrology in 2014. He is currently serving as an editorial board member of Kidney International and Clinical and Experimental Nephrology.
Abstract:
Pathophysiology of Diabetic Kidney Disease (DKD) is complex. In addition to high glucose-induced inflammation, oxidative stress and activation of the renin-angiotensin system, the pathogenic role of chronic hypoxia in the tubulointerstitium is increasingly recognized. Beginning from the early stage of DKD, an increase in oxygen consumption secondary to mitochondrial uncoupling reduces local oxygenation, and together with loss of peritubular capillaries and impaired oxygen diffusion, negatively influences the balance of injury and repair in tubular epithelial cells and serves as a final common pathway leading to fibrosis. Studies on Erythropoietin (EPO) transcription led to the identification of Hypoxia Inducible Factors (HIFs) and their key regulators, Prolyl Hydroxylases (PHDs). Inhibition of Ph.D. leads to HIF stabilization irrespective of oxygen content and up-regulates EPO, as well as other 100-200 target genes involved in processes such as angiogenesis and anaerobic metabolism necessary for cellular hypoxic adaptation. Based on this, several small molecule PHD inhibitors are currently under human clinical trials for the treatment of anemia in CKD. Application of PHD inhibitors has several potential implications beyond anemia treatment. Because HIF drives the expression of genes essential to adaptation to hypoxia, there is a promising view that activation of HIF using PHD inhibitors might protect against DKD. Besides, animal and human clinical studies even suggest that PHD inhibitors may improve glucose and lipid metabolism, which may also orchestrate protection against DKD progression.
Keynote Forum
Margaret Williams
Nelson Mandela University, South Africa
Keynote: Prevention of renal pathology
Biography:
Margaret Williams is a Public Health/Primary Healthcare Specialist who coordinates, teaches and mentors post graduate students and supervises research students focusing on public health issues and participates in interfaculty and interprofessional research projects. Her passion is to improve healthcare for all communities, starting at primary healthcare level.
Abstract:
Chronic kidney disease is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and is an increasing public health issue. It is a common disorder that is associated with raised risk of cardiovascular disease, kidney failure, and other complications. In developed countries, age, hypertension, diabetes, increased body-mass index and smoking are associated consistently with chronic kidney disease. In the developing world, infectious diseases are factors, such as bacterial and viral, particularly HIV. Prevalence is estimated at 8-16% worldwide. Complications include increased cardiovascular mortality, kidney-disease progression, acute kidney injury, cognitive decline, anemia, mineral and bone disorders and fractures. Worldwide, diabetes mellitus is the most common cause of chronic kidney disease together with other causes, such as herbal and environmental toxins. Awareness of the disorder remains low in developing countries therefore strategies to reduce burden and costs related to chronic kidney disease need to be included in national programmes for non-communicable diseases. Awareness of chronic kidney disease is low among patients and health-care providers. The number of patients with chronic kidney disease is expected to grow at the fastest rate in the poorest parts of the world, but a strong association is seen between low levels of economic development and reduced availability of renal replacement therapy, thus care for advanced chronic kidney disease is associated with catastrophic health expenditure in developing countries. Early detection of chronic kidney disease requires the development of cost-effective approaches relevant to the local level of economic development and resources. Integration of screening and management strategies for chronic kidney disease into national programmes for non-communicable diseases can reduce the burden and cost of care of chronic kidney disease, particularly in developing countries. Methods should suit local needs, and factors such as health awareness and availability of human and material resources should be considered.
- Kidney Inflammation | Renal Transplantation & Multiple Organ Transplantation | Cardiovascular Nephropathy | Kidney Inflammation | Technological Advancements in Nephrology
Location: Protea Hotel Fire & Ice Cape Town
Session Introduction
Colleen Davis
Vuselela Davis, South Africa
Title: Facing burnout in nephrology - Building resilience through trust, connection and hope
Biography:
Colleen Davis started her professional journey as a registered nurse and is registered with the South African Nursing Council with quite a few qualifications including psychiatry, primary healthcare and education. Colleen has worked in different capacities within the healthcare industry, in South Africa, for the past 27 years, with extensive experience in learning and development in a private hospital setting. Colleen moved into executive coaching in 2016, her passion is the development of women in leadership, in Africa, not restricted to the healthcare industry, supporting leaders to become the powerful influencers they have the potential to become. Colleen holds a black belt in karate (JKA), is a cancer survivor, wife and mother to two teenagers. She is a dynamic speaker, influencer and motivator, encouraging hope in an uncertain world
Abstract:
Physician burnout is a well-documented phenomenon; it has been referred to as a “burnout epidemic” which cannot be ignored. The effect is on the professional and personal capability of the physician, the statistics of physician suicide are showing an upward trend. When looking at the breakdown of burnout in medical specialties’, Nephrology gets placed centrally in its percentages and severity. Burnout in Nephrologists and Nephrology nurses affects the quality of care, lower productivity, absenteeism, high turnover and ultimately burdening an already over-burdened healthcare system. The medical profession is traditionally a harsh environment in which superhuman effort is expected on the part of its practitioners and any perceived weakness is hidden, ignored or exploited. Studies in neuroscience show how the human brain responds to being threatened and how trust and hope can build resilience. The purpose of this talk is to create awareness of the impact of burnout on the individual as well as the healthcare system and encourage engagement that can bring about a significant change in the way we view the cause, the victims of, as well as the possible solutions to burnout in the discipline of Nephrology. Findings: Burnout is caused by a mixture of complex interactions resulting in exhaustion, cynicism, and inefficiency directly affecting the Nephrologist, the nephrology interdisciplinary team, the patient and the community. Conclusion and Significance: The American Society of Nephrology has recognized the importance of taking action and in 2018 called for experts to find a workable solution to address physician burnout, for measures to be taken that will improve the professional lives of Nephrologists. Solutions are available; we should be open to a new approach that will ensure that the next generations of physicians are not placed under the same pressures.
Biography:
Helena (Maria Guerreiro) José completed her PhD in Nursing by the University of Lisbon in 2009. She is the coordinator of the Multiperfil Polytechnic University, Luanda. She is a Professor at the same Institution. She has published 59 articles in scientific journals and 25 papers in events proceedings, has 3 book chapters and 5 books published. She has directed 25 master's and Doctoral thesis in Social Sciences and Health Sciences. She is researcher in Health Sciences with emphasis on Communication Sciences. In her professional activities she interacted with 156 collaborators in co-authorship of scientific works and the most frequent terms in her contextualization of scientific, technological and artistic-cultural production are: humor, nursing, health, nurses, patients, active aging, adherence, child, children, community health nursing, community nursing, content validation and elderly people.
Abstract:
Statement of the Problem: Non-communicable chronic diseases are responsible for about 60% of the causes of death worldwide and Chronic Kidney Disease (CKD) affects an estimated 14% of adults in sub-Saharan Africa, with lowers levels of therapeutic adherence. At present, non-adherence is the main cause for increased morbidity and mortality, reducing the quality of life, increasing health costs, and for overutilization of health services. Regardless of disease, treatment, and prognosis, many patients do not continue with their treatment when they return home or do not fully comply with it. The purpose of this study is to describe the relevance of communication in the therapeutic adherence of CKD patients. Methodology & Theoretical Orientation: A literature review was conducted, the therapeutic adherence models were considered and the model of Levy's cognitive hypothesis of adhesion was a reference. Findings: Therapeutic adherence can be predicted through a combination of client satisfaction with the appointment, understanding of the disease’s cause, extension and treatment, and the ability to remember information provided by health professionals. It is possible to improve adherence if the communication between patients and health professionals is also improved with a clear, simple and true message. In order to increase therapeutic adherence, health professionals should establish a relationship with the patient and the family caregiver through active listening, respect and empathic relationship. Thus, effective communication between health professionals and CKD patients is fundamental to encourage them to therapeutic adherence.
Shailesh Kumar Samal
Karolinska Institute, Sweden
Title: Low IgM antibodies levels against malondialdehyde associates with all-cause mortality in patients undergoing haemodialysis
Biography:
Shailesh Kumar Samal has his expertise in the field of Clinical Immunology. His research interests mostly focused on "Targeting extracellular vesicles for diagnosis
and treatment of vascular calcification".
Abstract:
Background: Malondialdehyde (MDA) is by-product of lipid peroxidation as in oxidized low- density lipoprotein. Antibodies against phosphorylcholine have been previously evaluated in prevalent hemodialysis dialysis patients. We here studied the association between IgM antibodies against MDA (anti- MDA) and risk of death in patients undergoing hemodialysis.
Aim: To see the association of natural IgM antibodies against MDA with all-cause mortality in prevalent hemodialysis patients.
Methods: Low levels of IgM anti-MDA conjugated with human serum albumin concentrations were measured by direct Enzyme Linked Immune-Sorbent Assay (ELISA). The association between IgM anti-MDA and five-year all-cause mortality was investigated. We performed post hoc data analyses in 210 prevalent hemodialysis patients (median age 66 years; 44% female). The patients with an anti-MDA value below cut-off value are compared with a crude hazard ratio. Cox regression analysis, after adjusted by age, gender, diabetes, cardiovascular disease, dialysis vintage and level of interleukin 6, the association between lower IgM anti-MDA level and all-cause mortality was performed.
Results: Among 210 hemodialysis patients, 137 patients (65%) had a IgM anti- MDA level >71.3 U/mL (cut-off value derived from receiver operating characteristic analysis). The patients with an anti-MDA value below cut- off value had a higher mortality rate with a crude Hazard Ratio (HR) of 1.95 (95% CI 1.33-2.88). In Cox regression analysis, after adjusted by age, gender, diabetes, cardiovascular disease, dialysis vintage and level of interleukin 6, the association between lower IgM anti- MDA level and all-cause mortality remained significant (HR 1.79; 95% CI 1.19 - 2.70).
Conclusion: Low levels of natural IgM antibodies against MDA are independently associated with all-cause mortality in prevalent hemodialysis patients.
Volene Joy Werely
Stellenbosch University, South Africa
Title: The Art and Practice of the Nephrology Nurse
Biography:
Volene Joy Werely, is the Provincial Manager Nursing in the Western Cape Government of Health, leading the Nursing Practice portfolio.
Abstract:
Renal Nursing is an advance practice nursing speciality dealing with the complexities of the nephrology health care environment. Facing the diverse challenges within the high burden of disease and nursing, the provision of a holistic, quality person-centred care is still of pivotal importance.The presenter aims to provide a broad overview into the field of renal nursing from a clinical and co-governance paradigm, emphasising the critical areas.