Abstracts

In this report the effects of undernutrition on the kidney and the relationship of renal failure and undernutrition will be discussed.

Intrauterine undernutrition is one of the factors in the development of “nephron underdosing”.It has been proposed that fewer numbers of glomeruli lead to a higher single nephron glomerular filtration rate (GFR), potentially increasing the risk for progression of renal disease and the development of adult hypertension. Changes in renal function in severe childhood undernutrition were investigated in detail by Alleyne (1967). There is a reduction in GFR and renal plasma flow and evidence of impaired tubular function.

Patients with acute and chronic renal failure are at risk of developing undernutrition. Several surveys have reported undernutrition in up to 40% of this patient population. Nutritional support is important in the setting of renal failure. Providing proper levels of nutrients can both minimize the associated metabolic complications and retard the progression of renal disease.

Cardiovascular risk factors are a significant burden in end-stage renal disease patients under haemodialysis and are the leading cause of death among these patients.

Objective:

We wanted to check for a correlation between laboratory parameters and echocardiographic changes observed in chronic haemodialysis patients and to observe for an impact on mortality in these patients.

Methods:

This was retrospective study and audit. The files of the patients receiving chronic haemodialysis were reviewed. These patients were approved by the ethics committee of the hospital for haemodialysis. Data collected included age, gender, comorbidities, type of access, length of time on haemodialysis, laboratory indices, main electrocardiogram and echocardiographic findings.

Results:

There are 58 patients currently receiving chronic haemodialysis in Tobago and data was found for 52 patients. There were 9 deaths, mostly from sudden cardiac death. Significant comorbid illnesses included Hypertension. Most patients had elevated intact PTH and had proteinuria. Left ventricular hypertrophy and pulmonary hypertension, as well as valvular changes were commonly seen on echocardiogram, even in the patients who had died.

Conclusion:

There may be a correlation between non-invasive investigations and cardiovascular disease and mortality in chronic haemodialysis patients.

The increasing health and economic burdens of chronic kidney disease (CKD) are attributable to the growing prevalence of chronic non-communicable diseases, but also to infectious, post-infectious, and immune system disorders. Immune dysregulation results from chronic antigenaemia due to trans-mucosal relocation of bacterial products and chronic viral infections, having implications for susceptibility to infections and effectiveness of vaccines in this patient group. Chronic anaemia is associated with increased morbidity and mortality among patients with CKD, and recombinant human erythropoietin (EPO) improves prognosis. This presentation focuses on the immunological consequences of EPO deficiency in CKD, immunological of exogenous EPO replacement, and mechanisms of the non-haematopoietic mechanisms of EPO on the immune system.

Since the 1990s. a charcoal based drug, AST-120 (Kremezin) has been used in Japan to prevent progression of chronic kidney disease (CKD). At the time of its introduction, RAAS inhibition was not universally used in preventing progression of CKD. AST-120 was thought to prevent the intestinal absorption of indole, derived from the bacterial breakdown of tryptophan. Indole can be converted to indoxyl sulfate in the liver. Indoxyl sulfate is a toxin that can lead to glomerular and interstitial sclerosis when taken up by the kidney via stimulation of EGF. Lowering the substrate, indole, should prevent progression of CKD. After showing that AST-120 lowers indoxyl sulfate, a randomised control growth fact trial involving over 2000 patients with CKD was undertaken. Unfortunately, because the control group did not progress as expected, the null hypothesis was demonstrated. Subgroup analysis will be discussed.

BACKGROUND: This study seeks to determine the rate of change in estimated glomerular filtration rate (eGFR) in patients attending a CKD clinic and the factors affecting rate of decline.

METHODS: A retrospective observational analysis was done on the patients attending the renal outpatient clinic in South Trinidad. Demographic data, risk factors and laboratory values were documented. The patients were categorized into the stages of CKD based on the eGFR calculated from the Modification of Diet in Renal Disease equation. The glomerular filtration rates were calculated from the serial serum creatinine measurements for each patient over the follow up time in clinic. A linear mixed regression model was used to determine the mean annual rate of decline of the eGFR per patient and a multivariate analysis done to determine the factors affecting the rate of decline.

A history of diabetes, hypertension and the presence of proteinuria were found to have no impact on the rate of decline of eGFR once CKD was established. Gender and ethnicity were not associated with the rate decline in renal function in this study. Older age at presentation was associated with a slower rate of decline in renal function.