image Luxia ZhangName: Luxia Zhang

Hospital / Affiliation: Renal Division, Peking University First Hospital

Home Country: China

Host Country: China

Year: 2010

Status of your program: Completed 

 

Title of the project: 

Risk factors of CKD and collaborative management of patients with CKD in China

Topic: 

Chronic Kidney Disease 

 

Short description of the project or abstract: 

Background: Previous studies have revealed a high prevalence of chronic kidney disease (CKD) among developing countries. However, there is no national survey of CKD incorporating both estimated glomerular filtration rate (eGFR) and albuminuria in a developing country with the marked economic diversity now seen in China.

Project description: We initiated a national cross-sectional survey of CKD in China, which is partly supported by International Society of Nephrology. A multistage, stratified sampling method was used to obtain a representative sample of persons aged 18 years or older in the general population. CKD was defined as eGFR less than 60 mL/min/1.73m2 or/and the presence of albuminuria. We found that the adjusted prevalence of eGFR<60mL/min/1.73m2 and albuminuria was 1.7% (95% confidence interval [CI] 1.5%-1.9%) and 9.4% (95% CI 8.9%-10.0%), respectively.

The overall prevalence of CKD was 10.8% (95% CI 10.2%-11.3%); therefore the number of patients with CKD in China is estimated to be about 119.5 million. In rural area, an independent positive association was observed between economic development levels and the presence of albuminuria; which might be related to the increasing metabolic disorders secondary to changes of life-style, as well as suboptimal health care of metabolic disorders. Other factors independently associated with kidney damage included hypertension, diabetes, history of cardiovascular disease etc. Our study adds to the current understanding of integrated prevention and management of non-communicable diseases worldwidely, especially in the developing countries. The manuscript of main results has been published in Lancet (2012; 379: 815-822).

 

Learning or Research objectives:

  • Obtain the prevalence of CKD in China by using the eGFR and albuminuria
  • Assess the risk factors of CKD and provide preliminary evidence for CKD management and prevention

 

image adewale akinsolaName: ADEWALE AKINSOLA

Hospital / Affiliation: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State

Home Country: Nigeria

Host Country: Nigeria

Year: 2012

Status of your program: Completed 

 

 

Title of the project: 

A study on the Tolerability, Applicability and Effectiveness of sodium bicarbonate therapy in retarding
progression to End Stage Renal Disease (ESRD) in Predialytic Chronic Kidney Disease patients

Topic: 

Chronic Kidney Disease 

 

Short description of the project or abstract:

 An open label, randomised, prospective study of 75 patients with moderately severe CKD (stage 4) with established metabolic acidosis (serum bicarbonate being between 16 and 21 mmol/l, measured on 2 consecutive occasions) over a period of 24 months.
Participants were divided into 2 age - and sex-matched groups; first group received sodium bicarbonate tablets (600mg thrice daily) in addition to standard of care therapy whle the second group received standard therapy alone.
1. the progression of ckd was monitored using serial gfr (creatinine clearance) and serum creatinine levels.
2. patients' renal survival as defined by crcl <15ml/min was determined
3. impact of treatment on:
a. patients' nutritional status was evaluated with athropometric indices and serum albumin
b. renal protein excretion was determined by serial 24hr urinary protein estimation
c. calcium-phosphate metabolism and haemoglobin levels were determined by serial monitoring of serum calcium, phosphate and haemoglobin levels.
d. blood pressure and serum bicarbonate levels were also determined

These findings were compared using appropriate statistics between treated group and the controls.
Bicarbonate treatment significantly halted the progression of CKD, and also a statistically significant lower proportion of the treated patients reached end stage compared to the controls. Inspite of the observed significant rise in serum bicarbonate levels in treated patients, there was no adverse effect on blood pressure control.
There was significant increase in serum albumin in treated patients. There was no effect on mean haemoglobin levels. A higher urinary protein excretion was observed in treated patients than the controls.
No significant untowards adverse effect was observed

 

Learning or research objectives:  

  • To determine the effectiveness of sodium bicarbonate therapy in retarding progression to ESRD
  • To determine the effects of sodium bicarbonate therapy on biochemical and nutritional parameters
  • To determine the tolerability of sodium bicarbonate and adverse events that may be associated with it

 

picture PhilippinesEC Institute: Southern Philippines Medical Center - Kidney Transplant Unit

EC Liaison officer: Maria Theresa L. Bad-ang

SC Institute: University of Barcelona

SC Liaison officer: Fritz Diekmann

 

Name of STC-TTS Pair: Philippines- Spain

Pair Level: Level C

 

Learning objectives:

Objective 1: Kidney transplant unit

  • Structural: Tissue typing lab
  • Training/updates in Kidney Transplantation for surgeons/ nephrologist/transplant coordinators
  • Training of Ethics Committee
  • Information/ dissemination programs

Objective 2: Organ Procurement/cadaver unit

  • Donor detection and evaluation
  • Brain death diagnosis
  • Donor maintenance
  • Family approach
  • Organ retrieval and preservation techniques
  • Research
  • Information/dissemination programs for medical/paramedical/and lay person

picture Philippines 2

picture NigeriaEC Institute: Al Shifa Hospital, Gaza, Palestine

EC Liaison officer: Abdullah Kishawi

SC Institute: Royal Liverpool University Hospital

SC Liaison officer: Abdul Hammad

 

Name of STC-TTS Pair:  Palestine - UK

Pair Level: Level A

 

Short description of the project or abstract:

1. Delivery of integrated RRT
In order to achieve this, we need to make sure that patients with CKD are identified early, referred to nephrology services as early as possible, and measures to slow the progress of the disease are taken. Also we need to put care pathways to make sure patients are managed in a timely fashion when they reach CKD4-5, by planning their vascular access, and negate the need for neck lines with associated mortality and morbidity, and encourage pre-emptive transplantation. To achieve that we need to implement the following:

1 Renal IT system, which will connect all nephrology, centres in Gaza. All lab results, and interventions are recorded. Ultimately all patients in Gaza with CKD 3 and over will be on the system. The system will help setting up renal registry, by collecting data, which will help to standardise patient care, and plan future needs. The IT system will be a corner stone for audit and clinical governance. The same system will be used to establish kidney transplant waiting lists, and manage patients before and after kidney transplantation.
2. Introduction of eGFR into the lab system. Early identification and referral of patients with CKD is essential. Using this tool in conjunction with the IT system will help achieve this goal.
3. Vascular access team. Establishing vascular access in a timely fashion is essential to patient care. The majority of patients should start dialysis with permanent access. At least 80% of patients should dialyse through a permanent access. This will reduce considerably both mortality and morbidity, and make huge savings to the health economy by reducing the need for hospital admissions.
4. Integration of patient care between primary care and secondary care. All patients with conditions known to cause CKD, like diabetes and hypertension, should have regular screening for CKD, and proper control of their underlying disease.
5. Multi disciplinary approach. Patient care should be delivered by team approach. The input of dietary services, pathology, radiology, vascular and transplant surgeon, nephrology, virologist, and psychology, are important to deliver best outcomes.
6. Patient education. A special attention to patient and carer education is important to deliver good outcomes. Each part of the patient journey (i.e., pre dialysis, dialysis, pre-transplant, post-transplant) needs special education. Training the educators, and producing materials for patients is part of the project.

2. Establish a viable system for Kidney Transplantation
Kidney transplantation is the best treatment option for patients with kidney failure. It improves quality of life and survival. Also it is the most cost effective treatment. UK figures show that kidney transplantation is highly successful, with 5-year graft survival is 93% for live donor kidney transplants and 85% for Deceased donor kidney transplant. Kidney transplantation is highly specialised discipline, which requires multi disciplinary team approach. It is bitterly disappointing to look at kidney transplantation as a surgical procedure. To achieve best results, and to make impact on the healthcare system, kidney transplantation should be approached as a complete system.

The aim is to give every patient suitable for kidney transplantation the chance of getting one. All involved in patient care should work together to achieve this. This requires high degree of planning, discipline, and political will. Many countries in the region may perform kidney transplants, but unfortunately they lack kidney transplant system. Our aim is to establish a complete kidney transplant program similar to programs in developed countries. Teaming up with the Royal Liverpool University Hospital will help to transfer skills and technology to the proposed transplant unit at Al Shifa Hospital

 

Learning objectives:

  • Training the multi disciplinary team
  • Build infra- structure
  • Change legislation and start a cadaveric program

 

Summary Of Planned Activities For 2016

  • Training Tissue typing Technicians on Luminex technology
  • Set up the tissue typing lab in Gaza
  • Training Recipient transplant coordinator
  • Train surgeons on techniques of lap donor nephrectomy

image MasnicName of Fellow: Fahrudin Masnic

Home Centre: Clinic for Hemodialysis, Clinical Center University of Sarajevo, Bosnia and Herzegovina

Host Centre: Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK

Mentor: Arif Khwaja 

Training Duration: 3 months as from 04/07/2016

 

Learning objectives:

  • AKI training
  • CKD diagnosis, management and quality improvement methods
  • Vascular Access for Dialysis
  • Kidney transplantation
  • Clinical Governance and Audit

 

Profile Description and Training plan:

  • To gain hands-on clinical experience of investigation and management of AKI and learn about the practical implementation of AKI e-alerts and AKI care bundles.
  • Better understanding of all aspects of CKD (from diagnosis to management) to help improve crash lander rates in home center,
  • Understanding the roles of specialist nurses in CKD education and management, firsthand experience of the specialist pre-dialysis (low clearance) clinic in Sheffield to help facilitate smooth transition to RRT,
  • Improve knowledge in the investigation and management of CKD and all its complications including bone disease and anemia,
  • Learn how to set up a specialist palliative-renal clinic.
  • To gain experience in delivering effective vascular access. In particular the role of the interventional nephrologists and specialist nurse in helping maintain good vascular access.
  • Learn and develop ideas from transplant co-ordinators, surgeons and nephrologists as to what practical steps can be taken to improve transplantation rate in Sarajevo as well as gaining an insight into the short and long-term management of such patients. Also, learning from Sheffield experience in clinical governance meetings and audits on how to improve patient safety.

 

 

image RazeenName: Mogamat Razeen Davids

Hospital / Affiliation: Stellenbosch University and Tygerberg Hospital

Home Country: South Africa

Host Country: Toronto (2000-2001)

Year: Started in 2010 

Status of your program: COMPLETED

 

 Title of the project:

Prevalence of chronic kidney disease and association with cardiovascular risk factors
among teachers in the Western Cape, South Africa

Topic: 

Chronic Kidney Disease 

 

Short description of the project or abstract:

In a cross-sectional survey of teachers we captured data on demographics, CVD risk factors, anthropometry and blood pressure. Serum glucose, creatinine, cholesterol, and urine protein/creatinine ratio was measured.
The prevalence of CKD was 6.1% using the CKD-EPI equation and 10.0% with the MDRD equation. CKD was associated with the presence of diabetes and higher diastolic blood pressures.

 

Learning or Research objectives:

In this study which involved a population of young, working individuals CKD was common, clinically silent, and associated with cardiovascular risk factors. There is thus a substantial burden of disease from CKD in South Africa which will require considerable resources to manage.

 

picture Nepal AustraliaEC Institute: Tribhuwan University Teaching Hospital,Institute of Medicine

EC Liaison officer: Dibya Singh Shah

SC Institute: Monash Medical Center

SC Liaison officer: John Kanellis

 

Name of STC-TTS Pair: Nepal - Australia

Pair Level: level C

 

Short description of the project or abstract

Prior to 2008, hemodialysis was the only form of renal replacement therapy available in Nepal. The availability was limited to only a few major cities. For a country like Nepal, renal transplantation was seen as a much better modality of renal replacement therapy as it promised to be more economical and give a better quality of life while also saving lives. The first renal transplantation program in Nepal was started in Tribhuwan University Teaching hospital in 2008 which has so far, performed more than 370 renal transplant procedures. As it is a strictly living related donor transplant program, there is a significant shortage of donors. Recipients who do not have relatives as donors are deprived of having renal transplantation in Nepal as the law strictly prohibits unrelated donations.

In order to improve this situation it is time to upgrade and expand the National renal transplantation service by including ABO incompatible transplantation, paired kidney exchange donation, domino exchange and finally starting a deceased donor transplant program in Nepal. As the educational support and contact with Monash Medical center has been of great help in establishing renal transplantation in Nepal, further collaboration through the ISN renal sister program would provide a substantial opportunity for Tribhuwan University teaching hospital in achieving these goals. Further collaboration and support would not only improve the service in our own hospital but would provide a further stimulus to improve transplant services in Nepal as whole.

 

Learning objectives:

  • To establish an ABO incompatible renal transplant service in Nepal.
  • To identify and start assembling the human and physical resources required to establish a deceased donor transplant service in Nepal
  • To facilitate the achievement of these objectives, collaboration with Monash Medical Centre is seen as essential. The exchange of medical staff between the two institutes for teaching and learning activities as well as for research projects would significantly enhance the ability to achieve these objectives.

 

Summary of Planned Activities For 2016:

  • The Department of Nephrology Tribhuvan University teaching hospital has already organized a kidney disease awareness and free health camp. This was held at the Bhanu Bhakta secondary school on the 10th March 2016 on the occasion of World Kidney day. 890 students, teachers and other staff members were screened for kidney disease.
  • Visit by medical staff from Monash to Nepal in September 2016 for an opportunity to critically assess, advise and help plan for Nepal’s future transplant program requirements.
  • To organize a seminar aiming to increase awareness regarding the value of deceased donation. Invitees and participants would include doctors, other medical staff, bureaucrats, politicians, media personnel and civilians. 
  • The preparation of protocols for ABO incompatible transplantation and deceased donor transplantation in Nepal.
  • Further training of transplant coordinators in Nepal.

 

picture Nepal Australia 2picture Nepal Australia 3

image drapeau MAEC Institute: Kuala Lumpur Hospital

EC Liaison officer: Dr Rosnawati Yahya

SC Institute: Royal prince Alfred, Sydney, Australia

SC Liaison officer: Dr Steve Chadban

 

Name of STC-TTS Pair: Malaysia - Australia

Pair Level: Level B

 

Learning objectives:  

  • To improve short and long term outcome of renal transplantation
  • To improve local practices
  • To increase the number of renal transplantation

 

Summary Of Planned Activities For 2016

  • Planned Visit from Emerging Centre in Jul 2016: a) provide active input in areas that require improvement (donor evaluation, recipient evaluation), b) discussion on research, c) input for setting up Kidney paired exchange program, d) Discussions on cases, e) Input for improvement of organ allocation system, f)  Local CME program
  • Visit to the supporting center – need to be postponed due to lack of funding

 

picture india italy 1EC Institute: St John’s Medical College Hospital, Bangalore
EC Liaison officer: Arpana Iyengar
SC Institute: Bambino Gesu Children’s Hospital, Rome
SC Liaison officer: Francesco Emma
Name of STC-TTS Pair: India-Italy

Pair Level: Level B

Learning objectives:

  • To strengthen the transition from pediatric ESRD care to Transplantation in a resource limited nation
  • To discuss on skype /tele-meetings the clinical challenges and issues related to the children undergoing or undergone renal transplantation in the EC
  • To ensure that the EC benefits with educational resources from the SC 
  • To organize for the SC transplant team to facilitate and guide the EC towards undertaking transplantation in young children-The Young Transplant Program Initiative.
  • To pursue with training programs and capacity building towards optimizing multidisciplinary care of pediatric transplantation in the EC

Summary of Program

  • The Young Transplant Program (YTP) Initiative: This program aims at undertaking renal transplantation for the first time in the EC in young and small children weighing 9-10 kgs. The SC is supporting the visit of their transplant physician and surgeon to the EC to facilitate this initiative in May 2016.
  • Meetings between SC and EC: To have discussions on further plans for 2017 at two meetings with the director of SC (April 2016 at the IPNA Junior master class meeting in Delhi and September 2016 at the IPNA Congress in Brazil).
  • Initiatives of EC: • Participation of the faculty of the EC as invited speakers for National meetings on transplantation in India. • The EC has taken majors steps forward to employ and create positions for a transplant coordinator, a CKD coordinator and an ESRD Nurse in the EC. • The EC has taken up focused clinical research projects in the area of Nutrition in CKD and ESRD that would optimize the pre -transplant care in children.

 

picture india italy 2 picture india italy 3

picture colombia 1EC Institute: Fundación Valle del Líli - Cali Colombia

EC Liaison officer: Jaime M Restrepo

SC Institute: Boston Childrens Hospital

SC Liaison officer: Nancy Rodig

 

Name of STC-TTS Pair: Colombia - USA

Pair Level:  level C

 

Short description of the project or abstract:

We have previous experience with the SRC program 2007-2013. We have been working since the beginning of the SRC program 2008 with many groups of patients and health related population outside of the FVL center, especially in renal units (Dietitians, Nurses, Psychologists, Social workers, Pediatricians),who have required support and preparation for children and their families in the pre-transplant protocol.
Looking for rise the donation rates and better knowledge of the course and risks in transplantation have been necessary to improve the acceptance and adherence to the complex transplant regimes in children . During that period of time we were promoting and stimulating the preemptive and related kidney transplantation through educational activities, which are not enough to get the proposals in our region.

We have had an excellent Supporting Center -BCH - which have supported our activities all the time in the previous SRC, and through the BCH Tx group to our Pediatric activity. As we are responsible for the "renal health" of the south west of our country, and also during these past 7 years we have been building a network with the Children Hospitals from the South west, we are convinced about the need to work joined with the ADULT NEPHROLOGY AND TX TEAM in order to get the aims for this task in the Pediatric population. The grand round, renal pathology and Transplant weekly ´s meetings are in conjunction with the adult group, and permanently they are given support for special cases.

In summary we have a very good reputation as a group, and a strong compromise and ethical relationship among other groups in Colombia. The challenge is now to give a whole attention to renal diseases in ESRD in the South of the country

 

Learning objectives:

  • To improve the internal organization in the Transplant group in order to get a better support for the activities with the families and children who come from cities very far from our State
  • To set up an effective and stable program to promote organ donation among our community where donation rates are low.
  • To provide orientation and integrate the patients refered from the neighboring states, which are permanently referng patients to FVL pre-transplant program. The total population in the southwest is almost 10 million inhabitants who are at present underserved
  • To introduce and strengthen a "transition program" from adolescents to Adulthood , trying to attain better adherence to the Transplant treatment regimes
  • One aim is to improve post surgical care avoiding graft´s acute rejection and ATN with the introduction of new protocols, and take care of infection diseases in pre and post transplant patients
  • To Improve the care of metabolic bone disease in the pre and post-transplant period
  • Take the leadership in our country in order to support the network in solid organ transplantation with the best opportunity and quality as be possible .

 

Activities:

  • To include a social worker required by this group
  • We are working in two projects focused in the Donation and Transition 
  • To explore the feasibility to design a new protocol without steroids in a collaborative way with Boston Children´s Hospital
  • Participate in the introduction of a better immunoassay as a marker of acute rejection
  • Prepare local practice protocols and educational material pertaining to improve the growth and decrease the metabolic bone disease.
  • To follow up our post transplant infectious diseases and kidney Tx with bladder abnormalities in our pediatric population. ( Two abstract sent to International Congress of Pediatric Nephrology Association 2016 in Brasil)
  • We finished 3 abstracts to send to IPNA Congress Sept 2016 : - Infections of clinical importance after Pediatric Renal Transplantation at a tertiary health center in Colombia. - Experience in Renal Transplantation of Pediatric Patients with Bladder Dysfunction: Series of Cases. - Pediatric Renal Transplantation, a 20 year experience in a tertiary health center from Colombian Southwest
  • We have scheduled 3 activities for this year : a. Meeting with pediatric nephrologist from the south west, the proposal is to recreate the flowsheet to detect the patients with ESRD and the proper and right administrative way to refer them and to be involved in the PRETRASPLANT PROTOCOL. b. Workshop sept 2016 : Donor laparoscopy worshop by Dr Thayyab Diwan. He´ll spend a whole week as a Ambassador visiting . c. Symposium about RESEARCH AND ETHICS IN TRASPLANTATION , in association with Colombian Association of Trasplantation + Colombian Association of Pediatric Nephrology . Beginning October 2016 . Guest speakers from CME program : David Cooper from Pittsburgh University, and David Sacks from Boston Harvard University .
  • A FVL – ICESI University Transplant program´s fellowship is ready to apply to ISN fellowship program this year 1 May 2016. Her name is Liliana Caicedo, she is an Adult surgeon from Popayan who just finished her two year of fellowship. She will back to her University Hospital at Popayan, where she hopes to set up a Kidney Trasplant program supported by FVL Trasplant team.

 

picture colombia USA 3 picture colombia USApicture colombia USA 2

Global Operations Center

Avenue des Arts 1-2
1210 Brussels, Belgium
Tel: +32 2 808 04 20
Fax: +32 2 808 4454
Email contact

               

Americas Operations Center

340 North Avenue 3rd Floor
Cranford, NJ 07016-2496, United States
Tel: +1 567 248 9703
Fax: +1 908 272 7101
Email contact