It is my pleasure to announce you the very upcoming EURECA-m CME Course* to be held during the ERA-EDTA annual congress of Amsterdam (May 31, 2014 from 9:00 until 13:00): to download the program, please click here. We expect you to be numerous!

*CME Courses on May 31, 2014 are reserved to regularly registered congress members and are included in the registration fee. In order to participate in the CME Courses, all regularly registered congress members must go to the session halls and have their badge scanned by the hostesses at the entrance (at participant’s own responsibility). Please note that the seat capacity of the conference rooms is limited, therefore participation in these courses will be on a “first come first served” basis. For all info concerning the registrations, please click here.

In addition, I am also pleased to welcome the two new elected EURECA-m Board Members: Professors Heine Gunnar and Francesca Mallamaci as well as to thank Professors Adrian Covic, David Goldsmith and Danilo Fliser who left the Board after 5 years of fruitful collaboration.

At the end of the above mentioned CME Course of Amsterdam the new Members will be officially welcomed and special Board membership Certificates will be given to the outgoing Board members (2009-2014).

Through our newsletter and blasts, we will continue to keep you updated on all our future initiatives.

Enjoy this newsletter reading!

In previous  EURECA-m newsletters   I illustrated into detail  the scope  and the  design of the LUST   study, a randomized  trial testing whether a treatment policy guided by systematic monitoring of lung water   as measured by chest ultrasound (US) may reduce mortality, heart failure, coronary heart disease and/or heart failure in dialysis patients.   I  also  remarked  that lung water assessment by chest US is a quick, reliable, and easy to learn technique that requires just a 2-hours training session.  

LUST  study is one of the main investments and undertakings of EURECA-m  and  for this reason I  believe  that all EURECA-m members  need  periodical   news  about the progress of the trial.    I am happy to inform you that the trial   has  already garnered a  superb result, i.e.   we   successfully  completed  the training  and the  certification  of all  nephrologists-sonographers and the  vast majority of cardiologists of participating  centers by an original, almost cost-less approach  consisting in WEB-based   training sessions with individual centers .  The  success of  the training-phase is mainly due   to the talent and dedication of Luna Gargani ,  Rosa  Sicari and  Eugenio Picano, all investigators  at the  LUST-cardiovascular imaging Unit at CNR-Clinical Physiology Institute in Pisa.  Luna  has  given  an outstanding  educational  performance. The very high degree of agreement between US lung  readings  by her  and by nephrologists-sonographers, the  very basis  for  lung-US certification of LUST centers,  stands  as  a   proof  that in LUST all  sonographers have reached a  high level of competence   with the technique.  To my knowledge this experience is  unique  and as  such it deserves  to be described into a   specific methodological paper.

The  coordinating center in Reggio Cal  has  already enrolled  27 patients. The  study  proceeds smoothly at this Unit  and  all patients  have already completed the first echocardiography follow-up study (6 months).   Some interesting observations  are emerging  in the preliminary analysis of  data at this Unit.   First, the reduction in US-B lines (the experimental  manoeuver  in LUST)  can be  achieved   with  just relatively  small changes in dry body  weight.  Second,  we  note  that when the number of US-B lines  re-enters or approaches the normal range  the pre-post dialysis difference in US-B lines  markedly attenuates.   If confirmed   across the  whole study, this phenomenon  may  be used  as  a novel clue for assessing the “dry weight” of  dialysis patients.  Centers in Iasi  (over  30 patients), Wroclaw  (31 patients), Maribor  (28 patients), Ioannina (19 patients),  Homburg  (14 patients), Parma (12 patients)  have  already randomized  and  actually entered  into the  study several patients.  Centers in France had   problems of various kind  with their demanding ethical committees  but the  French coordinator of the study, Patrick Rossignol,  has now  sorted  these problems  and I remain positive that these  centers  may eventually join LUST.  After the dropping out of the  British center  we have now invited  an additional center in Viareggio (Vincenzo Panichi) and this center has  enthusiastically accepted the invitation to join.  Centers in Madrid, Barcelona, Hannover, Kallithea,  Jerusalem  and  Imola are  progressing at  slow  pace  but I am sure they  will  eventually be  able to successfully participate into LUST.

I hope to meet   all LUST investigators in  Amsterdam at the ERA EDTA Congress!

REVIEW FOCUSED ON THE UNACCEPTABLY HIHG MORTALITY RATES OF PATIENTS WITH CHRONIC RENAL FAILURE

The EURECA-m working group writing committee has authored a review focused on the unacceptably high mortality rates of patients with chronic renal failure, i.e., those with estimated glomerular filtration rates below 15 ml/min/1.72 m2, which will be published in The Lancet and presented during the 51st ERA-EDTA Congress (May 31st - June 3rd in Amsterdam).
Be prepared to read a carefully researched and crafted update on the global epidemiology, causes, pathophysiology, risk factors and staging of mortality risk. To learn what evidence is available from randomized clinical trials testing interventions to decrease mortality and what additional hypothesis derived from observational studies merit to be formally tested. To join in the brainstorming on what logistical, educational, political, scientific, technical and clinical approaches may best tackle this serious issue.

Prof. Alberto Ortiz Arduan

CARDIOVASCULAR OUTCOMES IN CKD: PROBLEMS AND SOLUTIONS

EURECA-m collaborated in the successful innovative 2 days CME Course held in Antalya last April 4th-5th, 2014: CardiovaScular outcomes in CKD: problems and solutions, organized by Professors Gultekin Suleymanlar and Mahmut Ilker Yilmaz.
The CME discussed cardiovascular outcome in chronic kidney disease (CKD) in all aspects: 11 talks by experts in the field grouped into four sessions were held:

The discussion about cardio-renal link is very complex: there is a bi-directionality link, loss of kidney function may trigger cardiovascular disease and cardiovascular diseases may also engender kidney damage. The experts also discussed that hyperuricemia should be a target for treatment as well as about the aldosteron and its therapeutic targeting in CKD progression and hypertension; they also provided an update on vascular calcification (including phosphate, FGF-23, klotho and sclerostin) and pointed out the importance of salt restriction and volume control in CKD as well as the importance of controlling and monitoring hypertension in general population and in CKD population.

Prof. Mehmet Kanbay