Chih-Wei Yang

Chronic kidney disease: global dimension and perspectives

Chronic kidney disease is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and is an increasing public health issue. Prevalence is estimated to be 8-16% worldwide. Complications include increased all-cause and cardiovascular mortality, kidney-disease progression, acute kidney injury, cognitive decline, anaemia, mineral and bone disorders, and fractures. Worldwide, diabetes mellitus is the most common cause of chronic kidney disease, but in some regions other causes, such as herbal and environmental toxins, are more common. The poorest populations are at the highest risk. Screening and intervention can prevent chronic kidney disease, and where management strategies have been implemented the incidence of end-stage kidney disease has been reduced. Awareness of the disorder, however, remains low in many communities and among many physicians. Strategies to reduce burden and costs related to chronic kidney disease need to be included in national programmes for non-communicable diseases.

Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy

The global nephrology community recognises the need for a cohesive plan to address the problem of chronic kidney disease (CKD). In July, 2016, the International Society of Nephrology hosted a CKD summit of more than 85 people with diverse expertise and professional backgrounds from around the globe. The purpose was to identify and prioritise key activities for the next 5-10 years in the domains of clinical care, research, and advocacy and to create an action plan and performance framework based on ten themes: strengthen CKD surveillance; tackle major risk factors for CKD; reduce acute kidney injury-a special risk factor for CKD; enhance understanding of the genetic causes of CKD; establish better diagnostic methods in CKD; improve understanding of the natural course of CKD; assess and implement established treatment options in patients with CKD; improve management of symptoms and complications of CKD; develop novel therapeutic interventions to slow CKD progression and reduce CKD complications; and increase the quantity and quality of clinical trials in CKD. Each group produced a prioritised list of goals, activities, and a set of key deliverable objectives for each of the themes. The intended users of this action plan are clinicians, patients, scientists, industry partners, governments, and advocacy organisations. Implementation of this integrated comprehensive plan will benefit people who are at risk for or affected by CKD worldwide.

Asian chronic kidney disease best practice recommendations: Positional statements for early detection of chronic kidney disease from Asian Forum for Chronic Kidney Disease Initiatives (AFCKDI)

1.u2002Targets

Increasing home based dialysis therapies to tackle dialysis burden around the world: a position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis

PHILIP KAM-TAO LI, WAI LUN CHEUNG, SING LEUNG LUI, CHRISTOPHER BLAGG, ALAN CASS, LAI SEONG HOOI, HO YUNG LEE, FRANCESCO LOCATELLI, TAO WANG, CHIH-WEI YANG, BERNARD CANAUD, YUK LUN CHENG, HUI LIN CHOONG, ANGEL L DE FRANCISCO, VICTOR GURA, KAZO KAIZU, PETER G KERR, UN I KUOK, CHI BON LEUNG, WAI-KEI LO, MADHUKAR MISRA, CHEUK CHUN SZETO, KWOK LUNG TONG, KRIANG TUNGSANGA, ROBERT WALKER, ANDREW KUI-MAN WONG, ALEX WAI-YIN YU, on behalf of the participants of THE ROUNDTABLE DISCUSSION ON DIALYSIS ECONOMICS in the SECOND CONGRESS OF THE INTERNATIONAL SOCIETY FOR HEMODIALYSIS (ISHD 2009)*

Octreotide therapy for chylous ascites in a chronic dialysis patient

SUMMARY:u2003 Chylous ascites, a rare complication in patients receiving continuous peritoneal dialysis, often presents with turbid dialysate. This characteristic makes it frequently confused with peritonitis. Conservative treatments including bowel rest and dietary intervention with medium chain triglycerides are advised by many authors in the literature. However, this approach usually takes a long time before the lymphorrhagia are eventually resolved. Here, a case of chylous ascites that was successfully treated with subcutaneous octreotide, a somatostatin analogue, is reported. By shortening the bowel rest period, this treatment avoids the nutritional and immunological adverse effects. A series of peritoneal equilibrium tests were performed after administration of octreotide and the results showed that octreotide did not alter the peritoneal function in the short term. Therefore, subcutaneous octreotide administration is a safe and effective therapy in peritoneal dialysis patient with chylous ascites.

Vascular changes at the puncture segments of arteriovenous fistula for hemodialysis access

OBJECTIVEnRepeated puncture is a mechanical injury to the hemodialysis accesses. We systemically observed the vascular changes at the puncture segments of arteriovenous fistulas.nnnMETHODSnThe native arteriovenous fistulas in 104 patients on maintenance hemodialysis using the buttonhole technique for puncture were studied. We used the duplex scan to observe the intimal lesions, the maximal diameters at the arterial and venous puncture segments, and the references.nnnRESULTSnIntimal lesions were found in 42% and 40% of the arterial and venous puncture segments, none of which resulted in significant luminal stenosis. The differences between diameters at the arterial or venous puncture segments and the corresponding references were significant (arterial, 11.07 +/- 4.45 vs 6.85 +/- 2.35 mm, P < .001; venous, 8.82 +/- 4.13 vs 5.54 +/- 2.22 mm, P < .001). All segments, except only three arterial and four venous puncture segments, were larger than the corresponding references. The degree of vascular dilatation, defined as the diameter difference between the puncture segments and the references calibrated by the reference diameter, were 64.1 +/- 49.6% at arterial puncture segments and 59.9 +/- 42.2% at venous segments. Multivariate analysis revealed that the patient age and the puncture duration were strongly correlated with the degree of vascular dilatation at both the arterial (P = .018 and .007, respectively) and venous puncture segments (P = .020 and .011, respectively).nnnCONCLUSIONnPuncture of arteriovenous fistula using a buttonhole technique resulted in a consistent vascular dilatation and moderately high incidence of intimal thickness, but no significant luminal stenosis was found.

Increasing home-based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis.

Philip Kam-Tao LI, Wai Lun CHEUNG, Sing Leung LUI, Christopher BLAGG, Alan CASS, Lai Seong HOOI, Ho Yung LEE, Francesco LOCATELLI, Tao WANG, Chih-Wei YANG, Bernard CANAUD, Yuk Lun CHENG, Hui Lin CHOONG, Angel L. de FRANCISCO, Victor GURA, Kazo KAIZU, Peter G. KERR, Un I. KUOK, Chi Bon LEUNG, Wai-Kei LO, Madhukar MISRA, Cheuk Chun SZETO, Kwok Lung TONG, Kriang TUNGSANGA, Robert WALKER, Andrew Kui-Man WONG, Alex Wai-Yin YU, On Behalf of the participants of the Roundtable Discussion on Dialysis Economics in the 2nd Congress of the International Society for Hemodialysis held in Hong Kong in August 2009

The establishment and validation of novel therapeutic targets to retard progression of chronic kidney disease

The focus of this article is to define goals and resulting action plans that can be collectively embraced by interested stakeholders to facilitate new therapeutic approaches to mitigate chronic kidney disease progression. The specific goals include identifying druggable targets, increasing the capacity for preclinical and early clinical development, broadening the availability of new therapeutic approaches, and increasing investment in the development of new therapies to limit chronic kidney disease. Key deliverables include the establishment of new regional, national, and global consortia; development of clinical trial networks; andxa0creation of programs to support the temporary mutual movement of scientists between academia and the biotechnology and pharmaceutical sector. Other deliverables include cataloging and maintaining up-to-date records to collate progress in renal research and development, inventorying the capacity of research and clinical networks, and describing methods to ensure novel drug development.

Global overview of health systems oversight and financing for kidney care

Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the worlds population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.

Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, nxa0= 31), with the lowest figures obtained from Africa (7%, nxa0= 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, nxa0= 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, nxa0= 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (nxa0= 106) of countries and regions, and 62% (nxa0= 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (nxa0= 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.