Summary:

Professor Wanner who is an author of the EMPA-KIDNEY trial paper will delve into the results of the EMPA-KIDNEY trial, shedding light on its clinical significance and the potential it holds for the future of nephrology. He will also address the challenges faced in CKD treatment and provide insights into future prospects. This is a unique opportunity to gain first-hand knowledge from a leading expert in the field.

Summary:

In recent years, the number of options for chronic kidney disease treatments has increased. One of these is mineralocorticoid receptor antagonists. Finerenone is the only MRA that is indicated for chronic kidney disease with type 2 diabetes. In this seminar, explore the efficacy and safety of Finerenone from the perspective of its pharmacological actions in pathological conditions.

1. How Long Can Peritoneal Dialysis Be Performed Safely?

Summary:

Peritoneal dialysis (PD) varies widely around the world. The PDOPPS compares PD in the United States, United Kingdom, Australia/New Zealand, Canada, Thailand, and Japan. Japan has the longest duration of PD and the fewest deaths from peritonitis. Hybrid therapy (PD+HD) is only performed in Japan and has the fewest transplants. Therefore, Japan needs to consider how long PD can be used as renal replacement therapy. Some centers in Japan have tried planned withdrawal after EPS crisis. Considering how many years PD can be safely performed from the point of view of peritoneal membrane damage and dysfunction, there are three important issues: 1) whether peritoneal dysfunction associated with peritoneal injury can be overcome, 2) whether encapsulating peritoneal sclerosis (EPS) can be avoided, and 3) whether solute removal and decreased residual renal function associated with peritoneal dysfunction can be overcome. These issues will be discussed in this session.

2. Combined therapy with peritoneal dialysis and hemodialysis, Japanese traditional dialysis modality.

Summary:

Peritoneal dialysis (PD) is recommended as a first-line renal replacement therapy (RRT) for end-stage kidney disease because of preservation of residual kidney function (RKF) and quality of life. However, the management of PD alone becomes more difficult according to the decline of RKF and the deterioration of peritoneal function, and inadequate dialysis and/or fluid overload become clinically evident. These patients could transfer not only hemodialysis (HD) alone but also combined therapy with PD and HD, generally in the form of 5 to 6 days of PD and one or two HD session per week. The number of patients receiving combined therapy in Japan is approximately 20 percent of all PD patients. Although there are several reports showing the amelioration of dialysis efficacy, volume status and peritoneal function assessed by peritoneal equilibration test (PET), designs of these studies were retrospective or pre-post manners. We established the EARTH (Evaluation of the Adequacy of Renal replacement THerapy) Study Group to evaluate the clinical benefit of this treatment strategy. We conducted two prospective multicenter studies. First, we enrolled 176 incident PD patients as first RRT assessed patient survival prospectively. During a median follow-up period of 41 months, 47 patients transferred to combined therapy and 35 patients transferred directly to HD. We found that patients transferred to combined therapy had a significantly better survival than those transferred directly to HD. However, we could not confirm this advantage using multivariate analysis because of the low number of patient death. Second, we enrolled 40 PD patients transferring to combined therapy and prospectively investigated the changes in several clinical parameters. Body weight, urinary volume, serum creatinine and the dialysate-to-plasma creatinine ratio obtained from PET decreased, whereas hemoglobin and serum albumin increased during 6 months. Interestingly, erythropoiesis-stimulating agent (ESA) resistance index was significantly improved. Thus switching to combined therapy with PD and HD from PD alone is effective for the correction of inadequate dialysis, fluid overload, peritoneal function and ESA responsiveness. Further prospective study with a larger number of patients is needed to confirm the clinical utilities of this Japanese traditional dialysis modality.

Summary:

Aging in Japan and ERA countries has led to a rise in CKD and heart failure. Over 13 million people in Japan have CKD, a common disease like hypertension, with over 320,000 requiring renal replacement therapy. Aging primarily drives CKD increase, with renal sclerosis becoming a major cause of renal failure.
Hypertension and renal impairment are bidirectionally related. Proper blood pressure management in CKD patients is crucial to slow progression and prevent AKI. Drug selection should maximize benefits and minimize harm. RAS inhibitors are effective in DKD with proteinuria but risky for elderly patients. Sacubitril/Valsartan shows promise in improving renal function. Optimized therapy can extend healthy lifespans.

Summary:

Hypozincemia is prevalent among dialysis patients but often overlooked. It has been linked to hypogeusia and recent studies have revealed its association with anemia, tissue calcification, immune dysfunction, oxidative stress, malnutrition, and increased mortality or hospitalization. Zinc supplementation is crucial for improving the overall well-being of dialysis patients, particularly older patients, in whom malnutrition and wasting are common. However, excessive zinc supplementation can lead to hypocupremia, which may cause pancytopenia, while hypercupremia is also associated with adverse conditions. This talk will address the causes, consequences, and related conditions of hypozincemia or zinc deficiency.

Summary:

Diabetic nephropathy is a major underlying disease in new dialysis patients, and early detection, intervention, and prevention of its worsening are important issues. In this seminar, we will consider the positioning of SGLT2 inhibitors as well as changes in treatment for CKD patients with type 2 diabetes mellitus.

Early Screening as a Tool to Pre-empt the CKD Tsunami

Individualization of Therapy in CKD Clinical Management

Summary:

A number of studies have demonstrated that appropriate control s of target Hb and biomarkers for iron metabolism might be required for decrease d risks of mortality and CVD events in CKD patients. Hypoxia inducible factor prolyl hydroxylase inhibitor (HIF PHI) is a drug developed for the treatment of renal anemia in CKD patient s HIF is a transcription factor that plays a general role in the physiological response to hypoxia by regulating several gene expressions including iron mobilization as well as endogenous erythropoietin production Thus, anemia with defective iron utilization in CKD patients is thought of indication of HIF PH Is. On the other hand, it was reported that iron deficiency possibly associated with a n increased risk for thrombotic events during HIF PHIs therapy. This seminar will provide an overview of anemia of CKD and precaution of HIF-PHIs treatment.

Summary:

In this luncheon seminar, we are pleased to welcome the speaker, Professor Motoko Yanagita from the Department of Nephrology, Graduate School of Medicine, Kyoto University, and the chairperson, Professor and Head of the Division of Nephrology and Endocrinology, Masaomi Nangaku, from The University of Tokyo Graduate School of Medicine. The lecture will be on "Changing CKD practice improves renal outcomes", and includes RCT data on Dapagliflozin, an SGLT2 inhibitor. We look forward to your attendance.

Summary:

Rheocarna® - Empowering Comprehensive Strategies against CLTI -

• Some patients with chronic limb-threatening ischemia (CLTI) cannot be adequately revascularized to heal the wound, even though revascularization procedures such as distal bypass surgery or endovascular therapy have been performed. "Rheocarna" is a novel therapeutic apheresis recently developed as one of the adjunctive therapies for CLTI patients. "Rheocarna" reduces blood viscosity by adsorbing low-density lipoprotein and fibrinogen, thereby improving peripheral circulation in the lower extremities.
• This luncheon seminar will review the characteristics of CLTI patients in Japan and reporton the efficacy and safety of "Rheocarna" treatment for CLTI patients who have poor options for revascularization.

Summary:

Clinical guidelines for CKD-MBD, including the KDIGO guideline, have been based primarily on evidence from Western countries. Recently, however, randomized evidence from Japan, such as J-DAVID, VICTORY, LANDMARK, and EPISODE, as well as high-quality studies using the JSDT Renal Data Registry, have been published. Based on the accumulation of these data, the JSDT guideline is currently in the process of being updated. The guideline revision will not only help improve CKD-MBD care in Japan, but will also have important international implications. In order to properly apply Japanese evidence externally, it is important to understand the similarities and differences between Japan and other countries. This presentation will summarize the latest evidence from Japan and discuss its potential for improving CKD-MBD care worldwide.