KIDNEY HEART CROSSTALK DELEGATE PAGE

Head to the exhibition area to visit the sponsor stands as well as the Renal Association Desk.

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Abstract
The link between cardiovascular and renal disease has been recognised for many years, and has an important adverse impact on population health. Not only does impaired renal function associate with cardiovascular events, but renal impairment is also linked to poor outcomes after myocardial infarction.  Increasingly, type 2 diabetes and a result of a worldwide increase in obesity levels, links the development of both conditions and leads to significant reduction in life expectancy. Excitingly, two new classes of drugs, the GLP-1 receptor agonists and SGLT2 inhibitors, both developed for treatment of diabetes, result in significant reduction of cardiovascular morbidity and mortality and slows decline in renal function.  The benefit results from different mechanism and the two classes may be combined to supplement existing evidence based treatments such as statins.   Ongoing trials are examining the impact of these two classes of drugs on cardiovascular and renal outcomes in patients with and without diabetes. In addition to improved treatment, prevention of type 2 diabetes, cardiovascular and renal clinical problems by early management including targeting obesity, is now an essential approach for public health maintenance.

Speaker details

John Deanfield CBE is Professor of Cardiology at University College London (UCL) and Director of National Institute for Cardiovascular Outcomes Research (NICOR) which incorporates the national databases for cardiovascular outcomes. Deanfield undertook his training at Churchill College, Cambridge, the Middlesex, Hammersmith and Great Ormond Street Hospitals, London. His principal interests are vascular medicine, opportunities for lifetime management of cardiovascular risk and large scale cardiovascular outcomes research. He has been at the forefront in describing the impact of obesity, cholesterol, diabetes, smoking and other risk factors on health in later life, through coordination of multiple large longitudinal cardiovascular studies in population throughout lifetime   He Chaired the Joint British Societies (JBS3) National Guidelines for Cardiovascular Disease Prevention (2014) and led the development of the public facing Heart Age Tool (2015). He was awarded the British Cardiac Society McKenzie Award, the John Hopkins All Children’s Hospital Decades of Service Award in 2017 and was made Commander of the Order of the British Empire (CBE) in 2021. He Chaired the UK’s National Health Check Programme Review (2021) and is Chief Medical Advisor to the new national Our Future Health programme (2020). He is currently Chairing the development of the new JBS4 Consensus Guidelines. Professor Deanfield serves on many international advisory boards and is a member of the editorial boards of several major CV journals. He has published numerous articles in leading medical and scientific journals.

Abstract
The fact that advanced kidney disease is more dangerous than most cancers is not widely appreciated beyond the sphere of those who study and care for these patients. The risk of death faced by a young adult dialysis patient is 50-100 fold greater than that of a person of similar age without kidney disease, making dialysis far more dangerous than most cancers. The impact of kidney disease on survival exhibits a dose-response effect, with increasingly powerful negative effects seen as the level of kidney function falls. Most of the deaths are cardiac and the effect is seen regardless of the cause of the kidney disease, though may be amplified by some, for example diabetes. Successful transplantation dramatically reduces this hazard, though does not eliminate it. Diverse biomechanical and metabolic disturbances, increasingly florid as the level of kidney function falls, are the main drivers but drilling down reveals daunting complexity such that this remains “a work in progress”. Mitigation centres around prevention of the primary kidney disease (often not possible), slowing its progression, or substitution by transplantation (hindered by inadequate organ supply and loss of some grafts from rejection and other causes). Dialysis is both the least effective and the most expensive treatment option for ‘end stage’ kidney disease, being much inferior to transplantation which provides a rare example of “cheap is best’ in the healthcare setting.

Speaker Details


John Cunningham is a clinician-scientist holding positions as Professor of Nephrology at University College London Medical School and The Royal Free Hospital and an Honorary Fellowship at Trinity Hall, University of Cambridge. He is a graduate of the universities of Cambridge and Oxford followed by postgraduate training in London and Washington University School of Medicine, St Louis, under Drs Louis V Avioli and Eduardo Slatopolsky. He is an active clinician and researcher with contributions to the understanding of the effect of acidosis on the bioactivation of vitamin D, the influence of simulated uraemia and vitamin D on the release of cytokines by bone cells, factors mediating bone loss following renal transplantation and the control of parathyroid function by structurally modified vitamin D metabolites and calcimimetics. He has also focussed increasingly on the links between mineral metabolism and cardiovascular disease in CKD and the reasons for the high cardiovascular morbidity and mortality is these individuals. He serves on various grant giving bodies, guideline groups and charities, lectures nationally and internationally and is co-chairman of the ‘Cardiology, Diabetes and Nephrology At The Limits’ series held under the auspices of University College London, The University of Cape Town, The Brigham and Women’s Hospital and The Lancet.

Abstract
Dual-antiplatelet therapy with aspirin combined with a P2Y12 receptor inhibitor is recommended for use as first-line therapy in patients with acute coronary syndromes (ACS) who have undergone high-risk percutaneous coronary intervention. ACS. The drug class continues to evolve as novel agents with increasingly efficacious antiplatelet actions. This talk shall be about the antiplatelet agents such as the P2Y12 receptor inhibitors that are currently used to treat patients in ACS, focusing on their pharmacological properties along with the clinical evidence to support its use. While aspirin has been recognised as having antithrombotic effects since the sixties, it is still being prescribed almost ubiquitously for patients with ACS, and P2Y12 inhibitors are added in; such dual antiplatelet therapy provides greater antithrombotic efficacy. Over the recent years, it has become apparent that these drugs confer powerful anti-inflammatory effects thus leading to additional benefits in the management of ACS. This talk shall be about how antiplatelet agents are currently being used in the management of ACS cases.

Speaker details


Dr. Jeilan trained as a physician and cardiologist in the UK before moving to Kenya in 2012 to join the newly formed Aga Khan University Hospital Heart and Cancer Center. He was appointed Director of Cardiac Services shortly after. Over the last 10 years, he and his team have pioneered the development of Interventional cardiology in the region with introductions of new techniques and treatments performed through minimally invasive procedures. These include Intravascular ultrasound, renal denervation, rotational atherectomy, and transcatheter aortic valve implantation. As a device and interventional proctor he has helped developed the skills of experienced cardiologists in newer techniques within Nairobi and across Africa and overseen the introduction of the first cardiac centers in Mombasa and Dar es Salaam. He is the current chairman of the Panafrican Association of Coronary and Structural Intervention (PASCI), and the current General Secretary of the African Heart Rhythm Association (AFHRA). His biggest passion is capacity building, in particular to improve access to heart attack management across Kenya, and he has worked within organizations like Heart Attack Concern Kenya and the Kenya Cardiac Society to advocate for better treatments of heart disease for Kenyans.

Head to the exhibition area for tea and snacks. Visit the stands of our sponsors as well as the Renal Association Desk.

Abstract
The diagnosis and management of atherosclerotic renovascular disease (ARVD) is still an area of contention. The large randomised controlled trials from around a decade ago, ASTRAL (2009) and CORAL (2013), showed that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone in the majority of patients with significant renal artery stenosis. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin blockers even in bilateral RAS or RAS affecting a solitary kidney is now considered standard treatment. However, several areas of uncertainty remain, and developments are still in progress, including how to identify kidneys with RAS that have potentially salvageable function. Importantly, it is recognised that certain high-risk populations with RAS and specific clinical manifestations may benefit from revascularization, and greater effort should be directed to identifying such individuals.

Speaker details

Professor Philip Kalra, Professor of Nephrology at the University of Manchester, graduated from Cambridge University and St Thomas’s Hospital Medical School and has been a consultant at Salford since 1995. He is Director of Research and Innovation in the Northern Care Alliance, the trust encompassing Salford Royal where he has been consultant nephrologist since 1995. He was Academic Vice President of the UK Renal Association 2016-19, Chair of the UK Kidney Research Consortium during this time and was Chair of the NIHR CRN Renal Disorders group from 2010 until 2018. He is the lead of the Donal O’Donoghue Renal Research Centre, the local research centre named in honour of his late great colleague and friend, and he has been involved in the development of several large UK clinical trials in nephrology and cardiology, including the ASTRAL, PIVOTAL and IRONMAN trials and the NURTuRE cohort. He has a long history of involvement in preparing candidates for the MRCP UK, and has played a role in improving collaboration between Nephrology and Cardiology in both scientific and educational endeavours.

Abstract
Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. It implies a failure to increase fluid and sodium (Na+) output sufficiently to relieve volume overload, edema, or congestion, despite escalating doses of a loop diuretic to a ceiling level (80 mg of furosemide once or twice daily or greater in those with reduced glomerular filtration rate or heart failure). The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. Pathophysiological mechanisms of diuretic resistance include an inappropriately high daily salt intake that exceeds the acute diuretic-induced salt loss, hyponatraemia or hypokalaemic, hypochloraemic metabolic alkalosis, and reflex activation of the renal nerves. Resistance to diuretics is a frequent, but a sometimes preventable or reversible, cause of hospitalization for congestion, and worsening symptoms. Unfortunately, clinical signs and symptoms are often unreliable to detect diuretic resistance. The development of new diuretics, strategies, or combinations is important to overcome diuretic resistance. Many factors can contribute to diuretic resistance that provide rationales for the use of specific interventions.

Speaker details


Cardiologist at Ministry of Health and Quality of Life, A.G.Jeetoo Hospital Masters in Cardiology, with interest in Interventional Cardiology, Huazhong University of Science and Technology, Wuhan, China Elective Placement at St Peters and Ashford Hospital, Surrey, UK in June 2004, January 2005, July 2006 Member of the Expert Committee of the Health Strategic Plan 2020-2024, MOHW National Coordinator for the first National Research (Registry) on Cardiovascular Diseases in Mauritius , in collaboration with the MOHW and WHO Gold Award Winners at Team Leader at the Public Service Excellence Award 2017 and National Productivity and Competitiveness Council 2019 Secretary Treasurer, Cardiovascular Society Mauritius 2017,2018,2019 Lecturer in Cardiovascular Diseases at the Mauritius Institute of Health Trained in Interventional Cardiology in Mauritius Lecturer for NCD nurses at MOHW

Abstract
Contrast-associated acute kidney injury (AKI) features a decrease in kidney function within days after the intravascular administration of iodinated contrast material. In the 1950s, a high incidence of AKI was initially reported in patients with pre-existing kidney disease who undergoing intravenous pyelography with contrast agents. Over time, development of new contrast agents, recognition of risk factors, and implementation of preventive care have reduced AKI rates to the point that recent studies now suggests that the AKI risk is exaggerated. Does it now mean that potentially life-changing angiographic procedures may be denied to patients with chronic kidney disease because of concern about precipitating AKI? This presentation summarizes the pathophysiology of contrast-associated AKI, the diagnostic criteria, and risk stratification; discusses current controversies regarding the incidence of this condition and preventive care.

Speaker details


Dr Ougrashan Bheekharry works at the Victoria hospital in Quatre Bornes as Nephrologist since 2019. After his studies at the Royal college of Port Louis, he studied General Medicine at the University of Medicine and Pharmacy of Cluj Napoca in Romania (where he has been a scholarship holder). He trained in internal medicine and nephrology at the Cluj County university hospitals in Romania during which he was also involved in teaching medical students in nephrology. He is one of the founding members of the Renal Association of Mauritius.

Abstract
A patient-centred approach should be used to guide the choice of pharmacologic agents in type 2 diabetes mellitus. Considerations include cardiovascular comorbid conditions, hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences. Current guidelines of managing type 2 diabetes recommend metformin and comprehensive lifestyle modification as first line treatment. Additional agents, including GLP-1 receptor agonists and SGLT2 inhibitors are currently second line Metformin is the preferred initial pharmacologic agent. Early combination therapy can be considered in some patients at treatment initiation to extend the time to treatment failure. The early introduction of insulin should be considered if there is evidence of ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when hemoglobin A 1c  (HbA 1c ) or blood glucose levels are very high (HbA 1c >10% ,blood glucose ≥16.7 mmol/L). In patients with type 2 diabetes with established ASCVD or indicators of high risk, established kidney disease, or heart failure, a SGLT2 inhibitor or GLP-1 RA with demonstrated cardiovascular disease benefit is recommended. In patients with type 2 diabetes who need greater glucose lowering than can be obtained with oral agents, GLP-1 RAs are preferred to insulin when possible. The medication regimen and medication-taking behaviour should be reevaluated at regular intervals (every 3 to 6 months) and adjusted as needed to incorporate specific factors that affect choice of treatment.

Speaker details
Professor Stephanie Baldeweg works as a Consultant Physician in Diabetes and Endocrinology at University College London Hospital and as Honorary Professor at UCL. She is Clinical Lead of the Department of Diabetes & Endocrinology at UCLH. She graduated from Humboldt University Berlin in 1990 and received her MD on Endothelial function and insulin resistance in 2002 in London. In 2009 she was elected Fellow of the Royal College of Physicians of Ireland and of the Royal College of Physicians in London (FRCP). She has held a number of National Roles including Associate Academic Dean, Health Education England and Associate Director for Higher Specialties Training, UCL Partners. She is chair of the Clinical Committee, UK Society for Endocrinology and chair of the Joint Specialty Committee for Endocrinology and Diabetes at the Royal College of Physicians. Professor Baldeweg is interested in all aspects of diabetes and endocrinology, weight management and cardiovascular risk reduction. Her main academic interest aims to improve patient care through systematic clinical research with a focus on cross-specialty working and comorbidities. Her research expertise spans from fundamental basic science through to clinical trials, real word studies and influencing policy/guidelines. Professor Baldeweg has published extensively in high impact journals and textbooks. During Covid-19 pandemic Professor Baldeweg led the Society for Endocrinology response across the UK on managing diabetes and endocrine conditions in patients with Covid-19 infections as well as those affected by reduced access to healthcare during the pandemic. This was endorsed and distributed by many other professional societies and patient groups. Prof Baldeweg is a keen medical educator, having received the UCLH Chairman’s medal for excellence in clinical education and regularly lectures at national and international meetings as well as Patient days for UK charities

Abstract
With the introduction of the SGLT2 inhibitors, the landscape of medical care for diabetic and non diabetic patients with cardiovascular disease has drastically changed. I aim to revisit the major players in the SGLT2 inbitors arena and then present new evidence of their effectiveness in cardiovascular disease and also their safety in CKD patients.

Speaker details

I am an interventional cardiologist currently working at The Trust Fund for Specialised Medical Care in Pamplemousses. I currently undertake interventional procedures and train my colleagues in advanced/complex techniques such as tackling difficult, tortuous, calcified and chronically occluded arteries. These new and advanced methods allow me to treat and stent previously untreatable patients and also gives an alternative to Bypass/Open Heart Surgery. I also implant pacemakers using the latest techniques. After being awarded a national scholarship (1st Laureate College du St Esprit – 2001 batch), I went on to complete my undergraduate medical education at the University of Manchester and my general medical training in the North West Deanery before proceeding to interventional cardiology and General Internal Medical training in the same region. I have presented numerous posters at international and European conferences. I am heavily involved in undergraduate and postgraduate medical education and I have completed a Post Graduate Diploma in Medical Education from the University of Manchester. I have also gained recognition as a Fellow of the Higher Education Academy in the UK for my role as a postgraduate trainer and lecturer. I have also published PubMed listed papers in the field of cardiology and medical education. I have now returned to my country under the national diaspora scheme to share my expertise and help improve cardiac services for my fellow citizens.

Abstract
A positive family history is a frequent feature in hypertensive patients with the heritability estimated to vary between 35 and 50%. Several genome wide association studies (GWAS) and their meta- analyses have identified 120 loci that are associated with blood pressure (BP) regulation, but together these only explain about 3.5% of the trait variance. Commentators have suggested that these studies will not clarify the genetic architecture of hypertension nor lead to a personalised approach to treatment of hypertension. The ESH/ESC Hypertension guidelines does not recommend routine genetic testing and reserves it for highly specialised clinics where monogenic disorders like Liddle syndrome are suspected. The whole debate regarding the genetic architecture of hypertension relates to whether hypertension is a polygenic disorder with several single nucleoside polymorphisms (SNPs) each making a small contribution to BP or more dominant variants with a lower frequency causing a more marked effect on BP. GWAS is much less likely to detect lower frequency dominant variants. In people of African descent there is a more distinctive phenotype associated with hypertension with low renin hypertension and salt sensitivity more frequently observed. This is linked to enhanced Na retention by the kidney due to overactivity of the Epithelial Na Channel (ENaC). We hypothesised that common variants in the SCNN1B chain of the (ENaC) may in part explain this. The entire SCNN1B was sequenced, and a novel variant (R563Q) was found in the active region 3 base pairs from the original Liddle mutation. It was associated with low renin-low aldosterone hypertension, pre-eclampsia, and clinically significant hypertension in families. It was present in 5-8% of Black and Mixed ancestry (but not Whites) hypertensives in Cape Town and Johannesburg (but not in West Africa) and 20% of unselected Khoi-San people (the likely origin of the SNP). Treatment with amiloride resulted in a highly significant reduction in BP in those resistant to traditional antihypertensives. Routine screening is currently done in our clinic to detect this mutation in those with resistant hypertension. A similar approach was adopted in young hypertensives with low renin levels in China where Liddle syndrome was detected in 1.72%. Further research has demonstrated that variants in the ENaC and other Na channels in the kidney are linked to both hypertension (and hypotension). This potentially could lead to targeted approach to selecting a particular diuretic depending on which channel is affected. More recent refinement of GWAS and use of Mendelian randomisation has assisted in better defining the genetic architecture of hypertension with detection of more loci linked to hypertension and discovery of rare variants with a more dominant effect on BP. In addition, environmental factors may have a more pronounced effect on BP in people with a high polygenic risk score. Thus, the future may allow improved risk stratification, a personalised approach, detection of novel biomarkers, targeted drug design and novel therapeutics. However, many remain sceptical that a pharmacogenomic approach will advance the treatment of hypertension.

Speaker details

Brian Rayner is an emeritus Professor and Senior Scholar of the University of Cape Town (UCT). He is past Head of the Division of Nephrology and Hypertension at the Groote Schuur Hospital and University of Cape Town (UCT) and established the Kidney and Hypertension Research Unit in 2016. He is a past President of the Southern African Hypertension Society and is an executive member of the African Regional Advisory Group of the International Society of Hypertension. He graduated M.B.Ch.B. from UCT in 1978, and FCP in 1986, and has a MMed and PhD from UCT. His doctoral thesis studied salt sensitivity and salt sensitive hypertension in indigenous South African people. He received the World Hypertension League Award for Notable Achievement in Hypertension in 2014 in his work related to his doctorate. The Division of Nephrology and Hypertension and the Kidney and Hypertension Research Unit is an active training and research centre training Nephrologists from Sub-Saharan Africa, and has active Masters and Doctoral programmes. In 2016 the International Society of Nephrology endorsed the Division as a Regional Training Centre of Excellence. Brian Rayner’s active research interests are therapy of hypertension, mutations in the ENaC, genetic determinants of salt sensitivity, primary aldosteronism, assessing adherence in hypertensive patients, physiological treatment of resistant hypertension and genetics of severe hypertension in blacks. Together with Profs Seedat and Veriava wrote the 2014 South African Hypertension Practice Guideline. He has 165 publications in peer reviewed journals. has made over 120 presentations at local and international congresses and has written 6 chapters in books. He was a principal investigator in the Altitude, Coral, Award 7, Accelerate, Duration 8, Reprise, Carmelina, Tecos, Signify, Fidelio, Figaro, Delight, Protect2, ASCEND-ND, and many other major international research studies.

STARTERS
Mixed Salads
Crudités: lettuce, tomato, watercress, cabbage, cucumber
Shrimp salad sweet chili sauce
Cucumber, olive and coriander
German potato salad
Eggplant caviar with crispy bread fruit chips
Tofu pineapple salad
Broccoli and green apple salad
Fish vindaye
Greek salad
Verrines
Melon gazpacho with fresh basil
Smoked Merlin tartare with pineapple salsa
Assorted hummus: beetroot,plain
Tomato basket of garlic crouton

MAIN COURSE
Lamb roghan josh
Filet of dorado with grilled, tomato salsa
Butter chicken
Calamari black bean
Sautéed spaghetti & seafood bisque
Pumpkin gratin with truffle oil
Butter garlic steam vegetables
Farata & condiments

DESSERT
Lemon grass crème brulée
Puit d’amour
Banana tart
Red velvet cake
Cheese cake
Creme caramel
Apricot poach tart
Biackberry chocolate mousse
Fruit cuts
Ice cream

Head to the exhibition area to visit the sponsor stands as well as the Renal Association Desk.

Keynote speech from the Minister of Health and Wellness

Abstract
Although the great majority of kidney disease in Mauritius is due to diabetes and vascular disease, other glomerulopathies do exist. However, they are often diagnosed late or not at all. With the help of a couple of cases, the clinical presentation and investigations of glomerulopathies will be reviewed. Local data will be presented and finally a discussion on how to eliminate the formidable barriers to timely diagnosis of glomerular diseases in Mauritius.

Speaker details

Dr Davy Ip Min Wan won a national scholarship (Collège du Saint Esprit laureate) in 1988 to study at the University of Edinburgh Medical School. After graduating in 1993, he did an internship in the Edinburgh area and then went into general professional training in Internal Medicine specialties in Edinburgh and Sheffield. On obtaining his MRCP(UK) in 1997, he joined the West Midlands Specialist Training Programme in Internal Medicine and Renal Medicine. He became a consultant physician and nephrologist in 2002 at the University Hospital Coventry and Warwickshire. He was involved in medical student, postgraduate and paramedical teaching for Warwick Medical School and University of Coventry. In 2012, he returned to Mauritius and joined SSRN Hospital as a Physician then as a Nephrologist. He is one of the founder members, and President since 2021, of the Renal Association. He became acting Consultant in Charge for Nephrology in 2021.

Head to the exhibition area for tea and snacks. Visit the stands of our sponsors as well as the Renal Association Desk.

Abstract
The identification of various cardiomyopathy phenotypes relies primarily upon echocardiographic evaluation. Two-dimensional and doppler echocardiography can, in most cases, define the anatomic and functional characteristics of the heart that are diagnostic.In this local case series , we will review a variety of pathologies , which, in the absence of cardiac MRI , can prove to be challenging.

Speaker details

Dr Timol graduated from the Royal College of Surgeons in Ireland, Dublin in 2003 & undertook Higher Speciality Training in Cardiology , which included positions in St James’s , St Vincents’ & Cork University Hospitals followed by a Fellowship in Coronary Intervention at the Belfast Health & Social Care Trust in Northern Ireland & was awarded Specialist Registration in Cardiology in 2015. His field of expertise includes General & Interventional Cardiology, Including complex intervention/chronic total occlusions.

Abstract
Despite evidence of myocardial infarct size reduction in both preclinical and small “proof of concept” clinical studies, the phenomenon of Remote Ischaemic Conditioning (RIC) has failed to improve clinical outcomes in the recent large CONDI-2/ERIC-PPCI outcome trial. We believe the main reason for this is the predominantly low-risk study participants who all received timely optimal reperfusion therapy by means of primary percutaneous coronary intervention (PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to early reperfusion or indeed PPCI, is being investigated in the RIC-AFRICA trial. This study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI patients, without access to PPCI, and receiving reperfusion therapy via thrombolysis. Participants will receive either RIC (four 5-minute cycles of inflation [20mmHg above systolic blood pressure] and deflation of an automated blood- pressure cuff placed on the upper arm) or sham-control (similar protocol but with low-pressure inflation of 20mmHg and deflation) within 1 hour of thrombolysis and applied daily for the next 2 days. It is hoped that the RIC-AFRICA trial will determine whether this intervention can reduce rates of death and heart failure in higher-risk, sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.

Speaker Details


Derek M Yellon PhD, DSc (UK), DSc (UCT), FRCP, FACC, FESC, FBCS, FAHA, is Professor of Molecular & Cellular Cardiology at University College London (UCL) & Director of the Hatter Cardiovascular Institute at UCL and University College London Hospital (UCLH). Professor Yellon has held a number of National & International roles including Vice-President of the British Cardiovascular Society; Chairman of the Cellular Biology Working Group of the European Society of Cardiology; Member of the World Council of the International Society for Heart Research, Programme Director (Cardiology & Diabetes) for the NIHR-UCLH Biomedical Research Centre and a Senior Investigator and member of the College of Senior Investigators. In 1994, he was awarded a DSc from the University of Bath (UK) for his “substantial contribution to the knowledge of cardiovascular disease and treatment” and in 2013 he was been awarded a second Doctor of Science (honorius causa) degree from the University of Cape Town, in recognition of “his distinguished basic and clinical research in the mechanisms underlying myocardial protection”. Due to his significant involvement with the Medical School at the University of Cape Town (UCT) he was, in 1997, made an Honorary Professor in the Department of Medicine at UCT. He also holds Honorary Professorships at the University of South Alabama in the USA, and the North China Coal Medical University in China. He is a Fellow of the Royal College of Physicians; the American College of Cardiology; the European Society of Cardiology; the International Society for Heart Research, The British Cardiovascular Society, and the American Heart Association. He sits on the editorial board of several major Cardiovascular Journals and has himself published in excess of 600 papers and edited 23 books. He has an H factor of 113 (Web of Science). Prof Yellon runs a translational research Institute at UCL/UCLH with his main area of interest including myocardial, neuro and renal protection, and the pathophysiology of cellular protection in the setting of diabetes, ischaemia/reperfusion injury, molecular aspects of adaptation to ischaemic injury and ischaemic conditioning in both the basic and clinical arena.

Abstract
Metformin remains the cornerstone in the management of Type2 diabetes due to its efficacy , accessibility and cost effectiveness. However, the use of metformin in advanced kidney disease remain controversial due to the fear of developing lactic acidosis. Metformin has been shown to reduce the all cause mortality and progression to ESKD in patients with advanced diabetic kidney disease. Suprisingly, more and more studies have shown that metformin may not increase the risk of lactic and metabolic acidosis and the drug is quite safe for patients with CKD stage 3B  I would be reviewing the literature for and against the use of metformin in this subgroup of patients.

Speaker details

Dr Mehjabeen Beebeejaun is a Consultant Physician, Diabetologist and Endocrinologist who completed her undergraduate training from the University of Cape Town in 2004 and completed her specialist training at St George’s and King’s College in London. She currently practices privately in Mauritius, she is the founder of the Curis clinic. She is also the Vice President of EDA Mauritius

Abstract not available

Speaker details

Qualified in Medicine from the University of Birmingham, with clinical training in cardiology at St Thomas’ Hospital London and Oxford. Appointed as Consultant Cardiologist and Physician at University College Hospital London (UCLH) in 1987 and Professor of Cardiology in 2019. In 1990 co-founded the Hatter Cardiovascular Institute (HCI) with Prof Derek Yellon. The HCI has an international reputation in laboratory and translational research, focusing on myocardial protection and producing >800 publications and over 70 MD and PhDs. In 1990, in response to perceived clinical need a dedicated cardiology clinic for patients with disorders of haemoglobin, such as thalassaemia (TM) and sickle cell disease, was established at UCLH. The MRI T2* for non-invasive tissue iron measurement was developed in collaboration with Prof Dudley Pennell. Clinical use of T2* has been credited with a >70% reduction in mortality in Thalassaemia and has been adopted world-wide. In recent years research has focused on the application of novel, abbreviated cardiac MRI sequences (rCMR), with trials of rCMR protocols completed in Thailand, India, and Peru. In 2016 Prof Walker initiated the Cardio-oncology clinical service at UCLH. This is an expanding clinical service serving cancer patients with cardiovascular complications and now deals with >700 out-patient consultations per annum, in addition to acute in-patient support. Cardio-oncology has been linked to a growing research effort established within the HCI. Prof Walker whilst primarily a clinician, has published over 120 articles & has a Scopus H-index of~40.

Abstract
Not available

Speaker details


John Cunningham is a clinician-scientist holding positions as Professor of Nephrology at University College London Medical School and The Royal Free Hospital and an Honorary Fellowship at Trinity Hall, University of Cambridge. He is a graduate of the universities of Cambridge and Oxford followed by postgraduate training in London and Washington University School of Medicine, St Louis, under Drs Louis V Avioli and Eduardo Slatopolsky. He is an active clinician and researcher with contributions to the understanding of the effect of acidosis on the bioactivation of vitamin D, the influence of simulated uraemia and vitamin D on the release of cytokines by bone cells, factors mediating bone loss following renal transplantation and the control of parathyroid function by structurally modified vitamin D metabolites and calcimimetics. He has also focussed increasingly on the links between mineral metabolism and cardiovascular disease in CKD and the reasons for the high cardiovascular morbidity and mortality is these individuals. He serves on various grant giving bodies, guideline groups and charities, lectures nationally and internationally and is co-chairman of the ‘Cardiology, Diabetes and Nephrology At The Limits’ series held under the auspices of University College London, The University of Cape Town, The Brigham and Women’s Hospital and The Lancet.

Head to the exhibition area for tea and snacks. Visit the stands of our sponsors as well as the Renal Association Desk.

Abstract
Mauritius is a small island of limited gene pool with numerous risk factors for ishaemic heart disease. Many patients present each day with acute myocardial infarction. Are we In line with the current mode of treatment as outlined by international guidelines…Let’s discuss.

Speaker details

Dr Shamloll Oomesh, MBBS/AFS/FESC/FAPSIC, is a consultant interventional cardiologist and head of the Cardiology Unit at Dr A G Jeetoo Hospital.

Abstract
CKD the 12th leading cause of death globally in 2017, an increase from 17th in 1990, set to become the fifth global cause of death by 2040. The proportion of people with ESRD not receiving RRT is much higher in low (96%) and lower-middle (90%) income countries than in upper-middle (70%) and high (40%) income countries. Over 2 million people worldwide currently receive treatment with dialysis or a kidney transplant to stay alive, yet this number may only represent 10% of people who actually need treatment to live.  Although CKD is generally progressive and irreversible, there are steps providers and patients can take to slow progression, enabling patients to live longer without complications or the need for renal replacement therapy.  Number 1 cause of morbidity & mortality in CKD is CVD.
Treatment strategies to slow progression and reduce cardiovascular risk are similar, which includes nutritional interventions. Dietary components such as excess sodium, protein, phosphate may accelerate the progression of CKD More recently, awareness has emerged that the diet feeds both the human body and its gut microbiota. Thus diet may influence kidney disease not only through a direct impact of specific nutrients on the human body, but also through modulation of the gut microbiota composition or through metabolites generated by the gut microbiota from ingested nutrients. Intestinal microflora consist of 1014 microorganisms of 500 different species known as gut microbiota. The gut microbiota has beneficial coexistence with host and plays an important role in health and disease by contributing to its Nutrition, Metabolism, Physiology & Immune function.
Uremic retention solutes ( URS ) disturbs microbiota which is known as dysbiota. Dysbiota is responsible for production of toxins from food which get absorbed and leads to further accumulation URS / inflammation. Probiotics defined as live organism when ingested in adequate quantity confer health benefits. Specific combination of live safe bacteria have been tried in CKD patients which helps to normalise dysbiota / reduces URS / slows progression of CKD.

Speaker details


Dr. Atul Ingale is a Consultant Nephrologist. He has more than 20 years of experience. He has completed his Master Degree from GMC (Aurangabad) and trained in Nephrology in Michigan (USA). He is a fellow of the Royal College of Physicians. He has started his carrier as Jr. Consultant Nephrologist & Transplant Physician in 1991 and is also attached to University of Mumbai as Professor of Medicine. Dr. Ingale has participated as a panellist for the KDOQI & KDIGO guidelines and for the American Society of Hypertension. He has been awarded with Health Icon Award by UP Govt and Abdul Kalam excellence award by Government of India.He is the author of worlds first data on parentral omega 3 fatty acid as immunomodulator in renal failure with sepsis.

Abstract

Would you entrust your heart to a nephrologist?
Patients with kidney disease are prone to developing cardiovascular complications and likewise cardiac conditions often lead to renal complications. With developments in medical therapies, such as use of SGLT-2 inhibitors for heart failure as well as progressive CKD, and mineralocorticoid antagonists for cardio-renal disease, Nephrologists are increasingly finding themselves managing cardiac conditions. Although the return to the days of the generic and toti-potential ‘general’ physician is unlikely to occur in larger centres there maybe opportunities for greater development of Cardio-renal medicine with specific training for individuals following this career path. In this session a range of topics will be covered including the Nephrologist’s understanding of the pathogenesis of structural heart disease in CKD, including HFpEF, vascular calcification, arrhythmia and sudden cardiac death, coronary artery disease, renovascular disease and heart failure.

Would you entrust your kidneys to a cardiologist?
The treatment for many patients has become increasingly complex and many healthcare professionals more and more specialised. There is a real danger that when a patient is seen by a healthcare professional, management focuses on a particular organ system as opposed to a more holistic, patient-centred approach. This is no more apparent than when considering patients with co-existent chronic kidney and cardiovascular disease. Non-specialists, patients and carers may receive mixed messages. Co- ordinated cross specialty working is required, to achieve best outcomes for patients. This debate will highlight some of the challenges encountered in clinical practice, with a focus on patients presenting with heart failure, and discuss strategies of how we might improve care provision.

Speakers details


Professor Philip Kalra, Professor of Nephrology at the University of Manchester, graduated from Cambridge University and St Thomas’s Hospital Medical School and has been a consultant at Salford since 1995. He is Director of Research and Innovation in the Northern Care Alliance, the trust encompassing Salford Royal where he has been consultant nephrologist since 1995. He was Academic Vice President of the UK Renal Association 2016-19, Chair of the UK Kidney Research Consortium during this time and was Chair of the NIHR CRN Renal Disorders group from 2010 until 2018. He is the lead of the Donal O’Donoghue Renal Research Centre, the local research centre named in honour of his late great colleague and friend, and he has been involved in the development of several large UK clinical trials in nephrology and cardiology, including the ASTRAL, PIVOTAL and IRONMAN trials and the NURTuRE cohort. He has a long history of involvement in preparing candidates for the MRCP UK, and has played a role in improving collaboration between Nephrology and Cardiology in both scientific and educational endeavours.

Prof Paul Kalra is a Consultant Cardiologist with specialist interest in heart failure at Portsmouth Hospitals University NHS Trust, UK. Paul served on the British Society for Heart Failure Board from 2009 until 2019 (Chair 2017-2019). During his role as Chair he was instrumental in getting heart failure recognised as a national priority and incorporated into the NHS Long Term Plan. He is currently helping to drive implementation of the plan, contributing to NHS England’s ‘NHS Long Term Plan Heart Failure and Heart Valve Disease Expert Advisory Group’. He co-founded the UK Cardiorenal Forum, which will hold its 17 th  annual meeting in 2022. He has been involved in question writing and exam setting for the European Exam in General Cardiology for over 5 years and in 2020 was appointed Chair of the UK standard setting group for this exam.  He has set up and leads a cardiovascular research programme in Portsmouth. He is chief investigator for the British Heart Foundation funded IRONMAN study (outcome study of intravenous iron in patients with chronic heart failure), which is due to report in late 2022.

Starters
Tandoori chicken salad with mint chutney
Tofu salad with with marinated pineapple bean sprouts
Fish carpaccio, shallots, sweet melon, grissini nature
German potato salad with mustard and peppers
Assorted salad bar, dressing & condiments, pickles
Assorted bread rolls

Main Course
Steamed basmati rice
Sautéed tagliatelle with basil and tomato
Lamb navarin, glazed vegetables
Pan seared tuna in a bruised julienne vegetables -lemon butter sauce
BBQ chicken leg, caramelised onions
Paneer makhani cooked in spicy tomato and cream
Alloo matar
Chunky vegetable ratatouille

Dessert
Chocolate opera
Vanilla crème brulée
Apricot and blueberry tart
Indian sweet (ladoo/barfi)
Fresh fruit salad & ice cream