Dialysis, Renal Transplantation, Clinical Engineering, and Diet Therapy for Diabetes Mellitus and Chronic Kidney Disease

August 22 ~ 23, 2019 Phnom Penh, Cambodia

Japanese Assistance Council of Establishing Dialysis Specialists System in Cambodia (JAC-DSC)

International University (IU), Phnom Penh, Cambodia

Supported by

Cambodian Association of Nephrology (CAN)

NGO Ubiquitous Blood Purification International (NGO UBPI)

Japanese Society for Technology of Blood Purification (JSTB)

⁓ intensive seminar ⁓

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President of the Japanese Assistance Council of Establishing Dialysis Specialist System in Cambodia (JAC-DSC)

Vice President, Kidney Center and Surgery, Tsuchiya General Hospital, Hiroshima, JapanClinical Professor, Faculty of Medicine, Hiroshima University, Hiroshima, Japan

President-elect, International Society of Blood Purification (ISBP) / Congress President of ISBP 2016President, Japanese Society for Hemodiafiltration

Council Member, Japanese Society for Peritoneal DialysisCouncil Member, Japanese Society for Dialysis Access

Council Member, Japanese Society for Blood Purification in Critical CarePresident, NGO Ubiquitous Blood Purification International (NGO UBPI), Yokohama, Japan

Guest Professor, International University, Phnom Penh, Cambodia

Hideki Kawanishi, M.D., Ph.D.

Dear Participants.Congratulation for “the intensive seminar of Dialysis, Renal Transplantation, Clinical Engineering, and Diet Therapy for Diabetes Mellitus and Chronic Kidney Disease in Cambodia 2019”. This seminar will be informed the important message for ESRD/CKD field in Cambodia and South East Asian countries.The number of patients being treated for ESRD globally was estimated to be 3,200,000 at the end of 2013 and, with a 6% growth rate, continues to increase at a significantly higher rate than the world population. In particular, the remarkable increasing rate was shown in Asian countries. However, the access to treatment is still limited in many developing countries and a number of patients with terminal renal failure do not receive treatment. In order to save these patients, it is necessary to enhance the dialysis system, the educated staff and association of each countries.Japanese Assistance Council of Establishing Dialysis Specialist System in Cambodia (JAC-DSC) was organized the several education programs from 2015. Moreover, the Cambodia Association of Nephrology was stated at 2016 and approval by International Society of Nephrology (ISN). This is a great opportunity recognized worldwide for the Cambodian Nephrology Society. I hope that everyone will grow in the renal area with this educational program. We will expect to be built the cooperation between JAC-DSC and Cambodian Nephrology Team and younger generation.

Messages

Introduction of General Chairpersons

Adviser of the JAC-DSC Vice President of the JAC-DSCAkihiro C. Yamashita, Ph.D. Toru Hyodo, M.D., Ph.D.

Professor and Head, Department of Chemical Science and Technology, Faculty of Bioscience and Applied Chemistry, Hosei University, Tokyo, JapanVice President and Executive Director, NGO UBPI, Yokohama, Japan

Director, Eijin Clinic and Kurata Hospital Dialysis Center, Hiratsuka, JapanInvited Associate Professor, Department of Urology, Kitasato University School of Medicine, Sagamihara, JapanExecutive Director and Secretary General, NGO UBPI, Yokohama, JapanVice President, JAC-DSC, Tokyo, JapanCouncil Member, Japanese Society for Dialysis Therapy (JSDT)Guest Professor, International University, Phnom Penh, Cambodia Honorary President of the Ho Chi Min City Society of the Dialysis Therapy, VietnamHonorary President, CAN, CambodiaISN Oceania South East Asia Regional Board Member

Vice President of the JAC-DSC Secretary General of the JAC-DSCKenichi Kokubo, Ph.D. Haruki Wakai, M.D.

Associate Professor, Kitasato University School of Allied Health Sciences, Sagamihara, Japan Auditor-secretary, NGO UBPI, Yokohama, Japan Chairman, Committee on International Affairs, Japanese Society for Technology of Blood Purification, Tokyo, Japan Member, JSDT Committee to Support Young Doctors and Co-medical Staffs in Dialysis Fields in Developing Countries, Tokyo, Japan Member, Committee on International Affairs, Japanese Society for Artificial OrgansGuest Professor, International University, Phnom Penh, CambodiaVice President of the JAC-DSC

President, Reiseikai Medical Corporation, Tokyo, JapanDirector, Shinagawa Garden Clinic, Tokyo, JapanAssistant Director, Gotanda Garden Clinic, Tokyo, JapanCouncil Member and Secretary, Japanese Society for Home HemodialysisAuditor Secretary, Japanese Society for Renal NutritionDirector and Vice Secretary General, NGO UBPI, Yokohama, JapanGuest Professor, International University, Phnom Penh, Cambodia

Introduction of ChairpersonsYim Sovannbophea, M.D. Kenji Sakurai, M.D., Ph.D.

General Physician and Dialysis Specialist, Cambo-dia-Japan Freiendship Blood purification center of sen sok international university hospital, Cambodia

Director, Hashimoto Clinic, Kanagawa, Japan

Svay Kamol, M.D. Ken Tsuchiya, M.D., Ph.D.Assistant Professor and Lecturer at Health Science Institute of RCAF, Cambodia

Department of Blood Purification, Tokyo Women’s Medical University, Shinjuku, Tokyo, JapanProfessor, Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan

Chan Sovandy, M.D. Junji Uchida, M.D., Ph.D.Vice President, CAN, CambodiaAdviser, Cambodia-Japan Friendship Blood Purification Center, International University, Phnom Penh, CambodiaChief, Emergency room Kossamak Hospital, Phnom Penh, CambodiaDirector, Sovandy Clinic, Phnom Penh, Cambodia

Associate Professor, Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.Council Member, Japanese Society for Dialysis Therapy (JSDT)Council Member, Japanese Society of Endourology (JSE)Council Member, Japanese Society for Transplantation (JST)Council Member, Osaka Medical Association.Academic Chairman, Osaka Society of Clinical Urology.Member of directors, Osaka Society of Clinical Urology.Guest Professor, International University, Phnom Penh, Cambodia

Chin Samnang, M.D., IMPH. Norio Hanafusa, M.D., Ph.D.President of People’s Health Consulting Associa-tion.Director of QH Medicare Dialysis center.Executive committee technical member of Cambodia Association of Nephrology.

Associate Professor, Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, JapanVice Chair, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan

Nov Tam, M.D., SCHP, B.A. Atsushi Ueda, M.D., Ph.D.General Medicine DepartmentInternational Tutor, Sydney Child Health Program (SCHP)International Insurance Assistance CoordinatorSonja Kill Memorial Hospital

Associate Professor, University of Tsukuba Hospital, Hitachi Social Cooperation Education Research Center Manager, Nephrology, Hitachi General HospitalManager, Kidney & Lifestyle-related Disease Center, Hitachi General Hospital

KIM Sam Oudum, BEd, LLB, BMedSci, M.D. Minoru Ito, M.D., Ph.D.Internal Medicine Resident (DES) 2nd Batch of International University (IU)Resident Internist at Emergency Department of Khmer Soviet Friendship Hospital

Assistant Director, Department of Nephrology and Dialysis Center, Yabuki Hospital, Yamagata, JapanGuest Professor, International University, Phnom Penh, Cambodia

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Introduction of lecturers (Alphabetical order by last name)

Natsumi Abe, C.E., M.T. Akira Kato, C.E.Director, Reiseikai Medical Corporation, Tokyo, Ja-panChief Clinical Engineer, Reiseikai Medical Corpora-tion, Tokyo, Japan

Medical Technologist

Clinical Engineer, Eijin Clinic and Kurata Hospital Dialysis Center, Hiratsuka, Japan

Takayuki Abe, C.E. Yukie Kitajima, R.D., Ph.D.Tokyo Women’s Medical University, Department of Clinical Engineering, Tokyo, Japan

Associate Professor, Department of Medical Nutrition, Tokyo Healthcare University, Setagaya, JapanDietitian of Reiseikai medical corporation shinagawa gardenclin-ic, Tokyo, Japan Dietitian of Eijin Clinic, Hiratsuka, Japan2017 Congress President of Japanese Society for Renal NutritionCouncil Member, Japanese Society for Renal NutritionCouncil Member, Japanese Society of Metabolism and Clinical NutritionCouncil Member, Japanese Society of Nutrition and Dietetics

Satoshi Ebihara, R.N., C.E., B.N. Yoshitaka Kurihara, C.E., Ph.D.Chief Registered Nurse, Reiseikai Medical Corpora-tion, Tokyo, Japan

Clinical Engineer, Bachelor of Nursing Science

Hashimoto Clinic, Kanagawa, Japan

Norio Hanafusa, M.D., Ph.D. Kanenori Maeda, M.D., Ph.D.Associate Professor, Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, JapanVice Chair, Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan

The Department of Urology, Nephrology and Dermatology Maeda Clinic, Nagasaki, Japan

Masaru Imai, C.E. Toshihide Naganuma, M.D., Ph.D.Manager Department of Research and Development, Education Adviser Department of Clinical Engineering, Reiseikai Medical Corporation, Tokyo, Japan

Lecturer, Department of Urology, Osaka City University Graduate School of Medicine, Osaka, JapanGuest Professor, International University, Phnom Penh, Cambodia

Minoru Ito, M.D., Ph.D. Hyogo Nakakura, M.D., Ph.D.Assistant Director, Department of Nephrology and Dialysis Center, Yabuki Hospital, Yamagata, JapanGuest Professor, International University, Phnom Penh, Cambodia

Chief Director of Department of Hemodialysis and Apheresis of Arisawa General Hospital, Osaka, Japan

Shunji Nishide, M.D. Thim Pichthida, M.D. Postgraduate student and Medical Doctor, Osaka City University Graduate School of Medicine, Department of Urology

Medical Doctor, Angkor Hospital for Children, Siem Reap, CambodiaMember, CAN

Phon Elin, M.D. Ken Tsuchiya, M.D., Ph.D.Resident, Department of Pediatric, Sonja Kill Memorial Hospital, Kampot, Cambodia

Member, CAN

Department of Blood Purification, Tokyo Women’s Medical University, Shinjuku, Tokyo, JapanProfessor, Department of Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan

Ryoichi Sakiyama, Ph.D. Junji Uchida, M.D., Ph.D.Associate Professor, Bioartificial Organs Lab, Department of Biomedical Engineering, Osaka Institute of Technology, Osaka, Japan

Associate Professor, Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.Council Member, Japanese Society for Dialysis Therapy (JSDT)Council Member, Japanese Society of Endourology (JSE)Council Member, Japanese Society for Transplantation (JST)Council Member, Osaka Medical Association.Academic Chairman, Osaka Society of Clinical Urology.Member of directors, Osaka Society of Clinical Urology.Guest Professor, International University, Phnom Penh, Cambodia

Kenji Sakurai, M.D., Ph.D. Atsushi Ueda, M.D., Ph.D.Director, Hashimoto Clinic, Kanagawa, Japan Associate Professor, University of Tsukuba Hospital,

Hitachi Social Cooperation Education Research Center Manager, Nephrology, Hitachi General HospitalManager, Kidney & Lifestyle-related Disease Center, Hitachi General Hospital

Ayumi Takizawa, C.E., M.T. Kazuyuki Yamaguchi, M.D.Tokyo Women’s Medical University, Department of Clinical Engineering, Tokyo, JapanMedical Technologist

Postgraduate student and Medical Doctor, Osaka City University Graduate School of Medicine, Department of Urology, Osaka, Japan

Ema MaedaDepartment of Urology, Nephrology and Dermatology Maeda clinic, Nagasaki

Program Announcer

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Program

The intensive seminar of Dialysis, Renal Transplantation, Clinical Engineering, and Diet Therapy for Diabetes Mellitus and Chronic Kidney Disease in Cambodia 2019

Preliminary ProgramVenue: International University, No. 35-41, Street 582, Boeung Kak II, Khan Toulkok,

Phnom Penh, CambodiaMaster of Ceremonies: Phisith Vouch, M.P.A.

Day-1: August 22, Thu., 2019

Opening Ceremony (Conference Hall, 9th Floor, NTV Building,)

8:00- 8:30 Participants Gathering and Registration 8:30- 8:40 Distinguished Guests Arrival 8:40- 8:50 National Anthems 8:50- 9:00 Welcome Speech by Prof. Sabo Ojano, M.D., Ph.D., President of International University (IU)

and Dr. Neth Barom, Vice President IR, Post Graduate Affairs of IU 9:00- 9:10 Remarks by IU Guest Prof. Hideki Kawanishi, M.D., Ph.D., President of Japanese Assistance

Council of Establishing Dialysis Specialist System in Cambodia (JAC-DSC) 9:10- 9:30 Interest Speech by Svay Kamol, M.D. and Chan Sovandy, M.D., Vice Presidents of the Cambodian

Association of Nephrology (CAN) 9:30- 9:40 Opening Speech by Kenji Sakurai, M.D., Ph.D. 9:40- 9:50 Group Photos and Ceremony Ending

Seminar (Day-1)General Chairpersons of the day-1: Kenichi Kokubo, Ph.D. and Haruki Wakai, M.D.

Session 1Chairpersons: Svay Kamol, M.D. and Minoru Ito, M.D., Ph.D.

10:20-10:40 【01】Introduction of the Seminar and Overview of Kidney Disease by Haruki Wakai, M.D.10:40-11:00 【02】Basics of Hemodialysis and Hemodiafiltration by Kenichi Kokubo, Ph.D.11:00-11:20 【03】Dialysis History by Hideki Kawanishi, M.D., Ph.D.11:20-11:40 【04】The Current Status of ESRD and Nephrology in Cambodia by Thim Pichthida, M.D.11:40-12:10 【05】Membranes and Kinetics of Dialysis Therapy by Akihiro C. Yamashita, Ph.D.12:10-12:40 【06】�Biocompatibility of Dialysis Membrane from the Clinical Aspect

by Kenji Sakurai, M.D., Ph.D.

12:40-14:00 Lunch

Session 2Chairpersons: Chan Sovandy, M.D. and Kenji Sakurai, M.D., Ph.D.

14:00-14:15 【07】Quality Management of Dialysis Fluid by Ayumi Takizawa, C.E., M.T.14:15-14:20 【08】Result of the Water Quality Testing in Cambodia by Satoshi Ebihara, R.N., C.E., B.N.14:20-14:45 【09】Clearance (HD, HDF) and Internal Filtration of HD by Ryoichi Sakiyama, Ph.D.14:45-15:00 【10】�The Practical Working Flow in Dialysis Room by Natsumi Abe, C.E., M.T.

and Masaru Imai, C.E.15:00-15:20 【11】�Blood Pressure Control and Water and Sodium Restriction in Dialysis Patients

by Akira Kato, C.E.15:20-15:40 【12】Blood Volume Monitoring during Dialysis Therapy by Takayuki Abe, C.E.

15:40-16:10 Break

Session 3Chairpersons: Nov Tam, M.D. and Ken Tsuchiya, M.D., Ph.D.

16:10-16:30 【13】Safety Management in Dialysis Room by Yoshitaka Kurihara, C.E., Ph.D.16:30-17:00 【14】Clinical Benefits of On-line Hemodiafiltration by Kenji Sakurai, M.D., Ph.D.17:00-17:30 【15】�Long-Hour Hemodialysis, Long-Hour Hemodiafiltration by Kanenori Maeda, M.D., Ph.D.17:30-17:45 【16】Home Hemodialysis by Haruki Wakai, M.D.17:45-18:15 【17】�Peritoneal Dialysis as Renal Replacement Therapy by Hideki Kawanishi, M.D., Ph.D.

Seminar (Day-2)General Chairpersons of Day-2: Hideki Kawanishi, M.D., Ph.D. and Toru Hyodo, M.D. Ph.D.

Session4Chairpersons: Chin Samnang, M.D., IMPH. and Atsushi Ueda, M.D., Ph.D.

8:00- 8:30 【18】�Diagnosis and treatment of CKD ~Usefulness of early diagnosis by kidney(Renal) biopsy~ by Atsushi Ueda, M.D., Ph.D.

8:30- 8:50 【19】�Acute Kidney Insufficiency by Hideki Kawanishi, M.D., Ph.D. 8:50- 9:20 【20】�CKD and Dialysis Treatment in Children by Hyogo Nakakura, M.D.Ph.D. 9:20- 9:50 【21】�Kidney Transplantation as Renal Replacement Therapy by Junji Uchida, M.D., Ph.D. 9:50-10:20 【22】�CKD-MBD by Ken Tsuchiya, M.D., Ph.D.10:20-10:35 【23】�Cerebral Vascular Disease by Toshihide Naganuma, M.D., Ph.D.10:35-10:50 【24】�Infection of Dialysis Patients by Toshihide Naganuma, M.D., Ph.D.

10:50-11:10 Break

Session 5Chairpersons: Yim Sovannbophea, M.D. and Junji Uchida, M.D., Ph.D.

11:10-11:25 【25】�Malignant Tumors in Hemodialysis Patients by Shunji Nishide, M.D.11:25-11:40 【26】�Standard Procedure for Arteriovenus Fistula and Superficilization

by Toshihide Naganuma, M.D., Ph.D.11:40-11:55 【27】�Daily Management of Vascular Access by Kazuyuki Yamaguchi, M.D.11:55-12:10 【28】�Peripheral Artery Disease of Dialysis Patients by Toshihide Naganuma, M.D., Ph.D.12:10-12:40 【29】�Management Against Renal Anemia by Norio Hanafusa, M.D., Ph.D.12:40-13:10 【30】�JRDR, the Japanese Society for Dialysis Therapy Renal Data Registry, Its History,

Significance in Dialysis Practice, and Future Collaboration with CAN by Norio Hanafusa, M.D., Ph.D.

13:10-14:30 Lunch

Session 6Chairpersons: Kim Sam Oudum, M.D. and Norio Hanafusa, M.D.,Ph.D

14:30-14:50 【31】�Nutrition in CKD Patients by Minoru Ito, M.D., Ph.D.14:50-15:10 【32】�Diet Therapy for Dialysis Patients by Yukie Kitajima, R.D., Ph.D.15:10-15:20 【33】�Pre-Dialysis Diabetic CKD Diet Therapy by Toru Hyodo, M.D., Ph.D. 15:20-15:40 【34】�Basic Carbohydrate Counting for CKD Diabetic Patients by Phon Elin, M.D.15:40-16:00 【35】�What is Advanced Carbohydrate Counting? by Phon Elin, M.D.

16:00-16:20 Break

ExaminationOrganizer: Kenichi Kokubo, Ph.D. and Haruki Wakai, M.D.

16:20-16:30 Examination notes16:30-17:30 Comprehensive Examination17:30-18:00 Scoring and Introduction of Dialysis Products from Japan by Kaname Sadahiro and

Yuki Tanaka of Nipro Ltd.

Closing Ceremony18:00-18:20 Awarding Ceremony18:20-18:30 Closing Remarks by Akihiro Yamashita, Ph.D., Adviser of JAC-DSC and IU Guest Prof.

Hideki Kawanishi, M.D., Ph.D., President of JAC-DSC18:30-18:40 Presentation of the Certification of Attendance

Day-2: August 23, Fri., 2019

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Introduction of lectures

[01] Overview of Kidney DiseaseHaruki Wakai, M.D.

The kidney is a vital organ that performs many important functions to support life. Decreased kidney function can lead to various symptoms such as reduced urinary volume, edema, anemia, loss of appetite,and general malaise, which gradually affect other organs.In this lecture, I will cover the symptoms and pathology of renal diseases and provide an overview ofrepresentative renal diseases such as chronic glomerulonephritis, diabetic nephropathy, nephrosclerosis, chronic pyelonephritis, cystic renal disease, and nephrotic syndrome.

[02] Basics of Hemodialysis and HemodiafiltrationKenichi Kokubo, Ph.D.

Hemodialysis (HD) is a therapy which replace some kidney functions by the use of advanced membrane separation technique in an extracorporeal system to remove metabolic wastes such as urea, creatinine, uric acid and excess fluid in the body and to control ion balance and pH of the blood. Hemodiafiltration (HDF) is also a therapy which replace some kidney functions and characterized by enhanced solute removal of larger molecules by convection (filtration) compared to HD. This lecture will cover the basics of HD and HDF including their principles, techniques and procedures.

[04] The Current Status of ESRD and Nephrology in CambodiaThim Pichthida, M.D.

Hemodialysis (HD), acting as an artificial kidney, is one of the treatment options for end stage renal disease (ESRD). In Cambodia, the burdens of ESRD and hemodialysis have been increasing yet there is no national registry currently. Cambodia has its own obstacles to promote a better hemodialysis. In this session, the history, present condition, and issues of hemodialysis and nephrology in Cambodia will be discussed.

[03] Dialysis HistoryHideki Kawanishi, M.D., Ph.D.

Modern dialysis therapy started in the 1960s. Since then, several new developments in dialysis machines and systems have occurred and have made dialysis a life-saving treatment for patients with CKD.

[05] Membranes and Kinetics of Dialysis TherapyAkihiro C. Yamashita, Ph.D.

The most important device of the dialysis therapy is a dialyzer, among which membrane is the crucial part of the device. Since there are many kinds of dialysis membrane, we should first learn their physicochemical properties including solute removal performance as well as biocompatibility. Since dialysis dose is usually represented by KT/V, we should learn how we compute the value and how we utilize the value for prescription, although it is not a universal index to evaluate the treatment.

[06] Biocompatibility of Dialysis Membrane from the Clinical AspectKenji Sakurai, M.D., Ph.D.

IntroductionIf a membrane with high biocompatibility is used for dialysis, progression of inflammatory processes during dialysis may be suppressed and the oxidative stress may be reduced, allowing the patient to receive dialysis more easily and comfortably.During the early days after hemodialysis therapy began to be used clinically, the evaluation of biocompatibility focused on uncomfortable reactions associated with the residual level of formalin used for disinfection of the dialyzer, uncomfortable reactions caused by EOG sterilization of the dialyzer, abnormal reactions arising from the -OH group freed from the cellulose membrane, and so on. Through accumulation of data collected by these evaluations, synthetic polymer dialysis membranes with high biocompatibility came to be developed and have been advancing year after year. At present, the PS membrane is used most frequently across the world, but polyvinylpyrrolidone (PVP) is needed during its manufacture to make the membrane hydrophilic and porous, and abnormal reactions due to this substance arise although rarely. Thus, there are still cases of PS membrane intolerance.For evaluation of biocompatibility of dialysis membranes, it is required to evaluate various host reactions, including reactions arising from contact with the synthetic material during extracorporeal circulation of blood, reactions arising from the dialysis fluid coming into contact with blood via the dialysis membrane, reactions arising from increased blood flow within the filters in pre-dilution HDF, and reactions arising from concentration of blood within the filters in post-dilution HDF.1) Changes in C3a during use of PS membraneAs stated above, PS membranes characterized by high performance and favorable biocompatibility are now pre-dominant as dialysis membranes. However, it is almost sure that the PVP used for manufacture of PS mem-branes activate the complement. 2) Evaluation of recent hemodiafilters manufactured in JapanBiocompatibility was evaluated on five Japanese products, i.e., GDF (Nikkiso), ABH-22PA (AsahiKASEI Med.), NVF-21P (Toray Med.), MFX-U (Nipro), and FIX-210U (Nipro). Results: There was no significant difference between them. Conclusions: The five Japanese hemodiafilters evaluated had their unique characteristics and were excellent in biocompatibility on the whole.3) Experience with use of European hemodiafiltersFX-HDF (a PS membrane manufactured by Fresenius) was evaluated as to biocompatibility in comparison with Japanese products (ABH-PA, NVF-H, and FIX-S). Percent changes in D-dimer, IL-6, and PRX-3 levels after dialysis with each membrane from their pre-dialysis levels were analyzed.Polyflux-H is a hemodiafilter made of sulfonated poly aryl ether membrane (PAES membrane, Baxter). Its biocompatibility and removing performance were compared with GDF-M (PEPA membrane).These two European hemodiafilters were low in removing performance and not excellent in terms of biocompatibility.4) Is there a difference in biocompatibility between pre-HDF and post-HDF ?There is no difference in biocompatibility between them if setting conditions are appropriate.

ConclusionsIn dialysis treatment, it is essential to combine good removal performance and good biocompatibility. Even if the filter has excellent removal performance, it can not be used for a long time unless it is in excellent in biocompatibility.

[07] Quality Management of Dialysis FluidAyumi Takizawa, C.E., M.T.

Quality assurance of dialysis fluid purification is a vital component of dialysis treatment. Toll-like receptor mediated cytokine production can result from bacterial endotoxin contamination of dialysis fluid during dialysis treatment. Both scheduled and random water quality testing need to be performed in conjunction with equipment maintenance. The cleanliness of water used for dialysis is confirmed by measuring endotoxin and viable bacteria count. This lecture will cover quality assurance methods and problems faced during the dialysis fluid production process.

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Introduction of lectures

[15] Long-Hour Hemodialysis, Long-Hour HemodiafiltrationKanenori Maeda, M.D., Ph.D.

BackgroundConventional hemodialysis (HD) / Hemodiafiltration (HDF) around the world may be four hours a session, 3 times a week. Long-hour HD/HDF around the world may be 8 hours a session, 3 times a week. Long-hour HD/HDF in Japan are 6 hours or more a session, 3 times a week.

How long hours are conventional HD/HDF in Cambodia ?

The functions of the kidneys are ”filtration”, “re-absorption” and ”endocrine.” The functions of HD/HDF are ”diffusion”, “convection” and ”adsorption.” HD/HDF are not as adequate as healthy kidneys. Our healthy kidneys work 24 hours a day. On the other side, conventional HD/HDF are performed only 12 hours a week. So, intermittent HD/HDF are insufficient renal replacement therapies !!!ContentsI will show data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). A huge observational cross-sectional study from JRDR was conducted to determine the relationship between the treatment time and some objectives. In this study, as the treatment time becomes longer per one session, Kt /V urea, the control of serum phosphate levels and nPCR (normalized protein catabolic rate) were improving. As the treatment time becomes longer, the serum albumin levels, blood hemoglobin levels and the reduction rate of serum β2MG levels increased.Additionally, I will introduce data from DOPPS that is the Dialysis Outcomes and Practice Patterns Study from 11 countries and areas. DOPPS is a prospective cohort study of in–center hemodialysis patients. In this study, when treatment time is 30 minutes longer per one session, we recognized the improvement in all-cause mortality, the rate of sudden death, risk of any hospitalization, risk of cardiovascular hospitalization and the risk of hospitalization due to chronic heart failure or fluid overload.ConclusionLong-hour HD and long-hour HDF are very effective methods for end-stage renal failure patients.

[12] Blood Volume Monitoring during Dialysis TherapyTakayuki Abe, C.E.

Extracorporeal blood circulation and water removal during dialysis therapy greatly affects the hemodynamics of the patient during hemodialysis treatment. Hemodynamics is important for the safety of the treatment and the monitoring of hemodynamics by a blood volume measurement is effective to know the patient’s condition during hemodialysis. In this lecture, the principle and clinical usefulness of blood volume monitoring during treatment will be discussed.

[13] Safety Management in Dialysis RoomYoshitaka Kurihara, C.E., Ph.D. / Kenichi Kokubo, Ph.D.

Safety management in dialysis room is important to prevent mistakes in clinical situation which may result in serious medical accidents. In order to confirm the safety, several concept applied in dialysis device, such as such as interlock, foolproof and fail safe. In addition, staff always use check sheets as a tool of safety management. In this lecture, the concept and methodology of safety management used in the dialysis room will be explained.

[10] The Practical Working Flow in Dialysis RoomNatsumi Abe, C.E., M.T. / Masaru Imai,C.E.

Dialysis therapy requires the cooperation of many medical professionals. Nurses and clinical engineers perform most of the daily practical work. In this lecture, the practical working flow at a standard dialysis room in Japan will be explained through the use of video footage. This virtual experience will allow you to familiarize yourself with dialysis treatment.

[11] Blood Pressure Control and Water and Sodium Restriction in Dialysis PatientsAkira Kato, C.E.

Dialysis patients cannot excrete urine if the residual renal function is completely diminished.Therefore, the amount of drinking water is equal to all weight gain.Since the weight gain is a factor related to life prognosis, it must be properly managed.For this reason, we must know the relationship between the weight gain and salt intake.The salt intake between the inter-dialysis can be calculated by using the following formula based on the serum salt concentration in HD patients (approximately 140 mEq/L): The increase in the body weight (Kg) x 140 x molecular weight of salt (58.5)/1,000 = The increase in the body weight (Kg) x approximately 8 g.In other words, the formula means the consumption of salt at approximately 8 g per 1.0 kg weight gain (water retention of 1.0 L).Please introduce this formula to patients and utilize it.

[14] Clinical Benefits of On-line HemodiafiltrationKenji Sakurai, M.D., Ph.D.

The number of dialysis patients in Japan was 334,505 at the end of 2017. Of these, 21.1% were receiving on-line hemodiafiltration (HDF), and 84.4% of the on-line HDF were performed with pre-dilution mode. The number of HDF patients is increasing year by year. In Europe, post-dilution HDF has been widely used. The main purpose of HDF is to remove middle- and large-molecular uremic toxins effectively in order to prevent and treat complications of dialysis patients. Therefore, it is very important to set the appropriate conditions of HDF. When HDF is performed under suitable conditions, good therapeutic effects can be obtained against various complications (i.e. Dialysis Amyloidosis, Restless Legs Syndrome, Pruritus). However if the condition for performing HDF are inappropriate, the removal efficiency of HDF is almost as same as the performance of hemodialysis with a supper high-flux dialyzer and there is no positive impact on patients conditions. Therefore, it is very important to evaluate the removal efficiency of HDF. β2-Microglobulin (MG) (MW:11.8 kDa) is an important marker of dialysis removal efficiency. However, β2-MG is a little small as a marker for evaluation of the removal efficiency of HDF. α1-MG (MW: 33 kDa), which is removed by convection, should be used as a marker to assess the removal efficiency of HDF. The α1-MG reduction rate of 35% or more is the target number in HDF.I will give a presentation about clinical benefits of on-line HDF on dialysis-related symptoms and the dif-ference in biocompatibility between pre-dilution on-line HDF and post-dilution on-line HDF.

[09] Clearance (HD, HDF) and Internal Filtration of HDRyoichi Sakiyama, Ph.D.

1) The clearance is introduced as an index representing the function of the living kidney and is used as a performance evaluation of the artificial kidney. The clearance is affected by various conditions when the clearance measured.2) Internal filtration is filtration caused by pressure loss in the dialyzer in hemodialysis. Purification of the dialysate is very important since the dialysate flows into the living body side by internal filtration.

[08] Result of the Water Quality Testing in CambodiaSatoshi Ebihara, R.N., C.E., B.N.

For dialysis treatment, high quality dialysis fluid is required. And, original water (tap water or water from wells) is important to make good dialysis fluid.This time, we tested the water quality of original water in Phnom Penh and several rural areas. Each result of water quality was almost good. However, there are some problems in details.This result indicates that we need to perform water quality test of original water in the area when we make dialysis fluid and It is necessary to take action for improvement when any problems are detected.

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[20] CKD and Dialysis Treatment in Children Hyogo Nakakura, M.D., Ph.D.

The time has passed where the only goal is to prolong the life of pediatric patients with chronic renal failure. The present goal is to nurture the physical and mental health of these children to a level equal to that of healthy children.Children with chronic renal failure need to reliably assess renal function. In children, Schwartz formula is often used to calculate kidney function. This formula is clinically useful as it allows estimation of the normal serum Cr level from the patient’s body.Unlike adults, many of the causes of childhood kidney failure are congenital and hereditary diseases.In children with CKD, most complications are similar to adults. But one of the child-specific complications is poor growth. Sufficient medical care is required to prevent poor growth.PD is often the first choice for kidney replacement therapy in children with chronic renal failure. For chil-dren, PD is chosen because of its many advantages over HD.As renal replacement therapy for children with chronic renal failure, HD is also selected, but we need to be careful enough to do it.I would like to talk about the CKD and dialysis treatment in children.

[18] Diagnosis and Treatment of CKD ⁓Usefulness of early diagnosis by kidney (renal) biopsy⁓Atsushi Ueda, M.D., Ph.D.

In 2018, the International Society of Nephrology reported that the world's number of CKD patients have reached about 850 million. The number of CKD patients is twice that of diabetes (422 million) and more than 20 times that of cancer (42 million) and HIV / AIDS (36.7 million). The increasing numbers of CKD patients could be caused mainly by the increase in patients with lifestyle-related diseases. As a result of the progression of CKD, it is estimated that 5.3 to 10.5 million people have needed dialysis therapy and kidney transplantation in the world. In this regard, early diagnosis and treatment are needed to inhibit the progression of CKD. In Japan, kidney biopsies are currently actively performed, because they have been proven to be very useful for early diagnosis of the kidney disease. In this lecture, I will explain 1) the concept of CKD, 2) indications for kidney biopsy, 3) the method of kidney biopsy, 4) the diagnosis and treatment of IgA nephropathy, and 5) one of the new therapeutic agents for diabetic nephropathy.

[16] Home HemodialysisHaruki Wakai, M.D.

HHD is a treatment option that allows patients to perform hemodialysis at home under the supervision of physicians. A hemodialysis machine is installed in the home, and the patient performs hemodialysis by manually assembling the circuit, performing shunt puncture, monitoring his/her condition during dialysis, and retransfusion. HHD has various benefits. It allows dialysis to be performed at home at any time, and the biggest benefi t is that it is possible to dialyze a large volume of blood, which is known to yield a good prognosis. Dialysis should be performed gradually over time. It can loosen food restriction, improve nutrition, and help physical conditioning. Since it can be performed at home at any time, it allows a large volume of blood to be dialyzed more easily. Outpatient dialysis is provided up to fourteen times a month in principle, while HHD can be performed every day or every other day. When the number of dialysis days is increased, adequate dialysiscan be provided “more frequently”, which helps in stabilizing the physical condition of the patient. In this lecture, we introduce general matters of HHD, examples of present HHD and examples of HHD introduction in foreign countries.

[17] Peritoneal Dialysis as Renal Replacement TherapyHideki Kawanishi, M.D., Ph.D.

Peritoneal dialysis has been applied as a self-care and home-based procedure for patients with ESRD and has contributed to restoring and maintaining patients’ social and family lives. In this lecture, peritoneal dialysis theory, devices, systems, and use in the clinical setting will be discussed.

[19] Acute Kidney InsufficiencyHideki Kawanishi, M.D., Ph.D.

Acute kidney injury (AKI) is an abrupt loss of kidney function that develops within 7 days. Generally it occurs because of damage to the kidney tissue caused by decreased kidney blood flow from any cause, exposure to substances harmful to the kidney, an infl ammatory process in the kidney, or an obstruction of the urinary tract. In this lecture, we will discuss the mechanism and management of AKI.

[21] Kidney Transplantation as Renal Replacement TherapyJunji Uchida, M.D., Ph.D.

Kidney transplantation is the optimal renal replacement therapy for patients with End-stage kidney disease (ESKD) because of greater longevity and better quality of life compared to dialysis therapy. Due to the scarcity of deceased donor and constantly growing kidney transplant waiting lists, living donor kidney transplantation accounts for approximately 90% of all kidney transplants in the Japan. The strategies have developed to overcome the problem of shortage of deceased donors. A kidney transplant candidate with an ABO-incompatible living donor has options to proceed with desensitization for ABO-incompatible transplantation. ABO-incompatible living donor kidney transplantation has been performed since the late 1980s in Japan. In this lecture, I would like to discuss significance of kidney transplantation as renal replacement therapy and ABO-incompatible kidney transplantation.

[22] CKD-MBD : What are they? Klotho and FGF23. Ken Tsuchiya, M.D., Ph.D.

It was reported by Kuro-o et al. in 1997 that insertion mutant mice of Klotho gene showed early senescence traits, but remarkably, the gene expression was strongly recognized in the kidney. After this report, it has conjugated that FGF23 which is one type of bone-derived fibroblast growth factor (FGF), has a phosphorus diuretic action in the kidney, forms a series of FGF23-Klotho-axis and regulates calcium /phosphorus metabolism. Under these circumstances, the link between them is speculated that they are involved in the development of chronic kidney disease (CKD), resulting in the establishing pathophysiology of CKD-MBD.

[23] Cerebral Vascular DiseaseToshihide Naganuma, M.D., Ph.D.

Growing evidence suggests that CKD is a significant risk factor for stroke, subclinical cerebrovascular abnormalities, and decreased physical and cognitive function independent of known cardiovascular risk factors. Moreover, the prevalence of cerebrovascular disease is higher in patients with more advanced stages of CKD. Cerebrovascular disease is reported to be one of the major causes of death in dialysis patients. Furthermore, the incidence of stroke is higher in dialysis patients than in the normal population.In this lecture, cerebrovascular disease in dialysis patients will be explained.

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[27] Daily Management of Vascular AccessKazuyuki Yamaguchi, M.D.

Vascular access (VA) is created in the patient’s body to allow large volumes of blood to circulate between the patient and dialysis machine. VA is an essential component in dialysis therapy. Therefore, daily management of VA is very important, due to its frequent use and changing the state of VA stenosis and the state of puncture and hemostasis at the previous treatment. Regarding other problems, VA recirculation is that the dialyzed blood returned from the V side of the dialysis circuit is not returned to the heart but removed again from the A side and re-dialyzed. In this lecture, we will discuss about VA management including VA puncture method, monitoring and surveillance of VA stenosis and VA recirculation.

[24] Infection of Dialysis PatientsToshihide Naganuma, M.D., Ph.D.

In general, dialysis is known to impair immune function and increase the susceptibility to infection. Dialysis has also been reported to reduce cell-mediated and humoral immunity. Uremic substances, malnutrition, acidosis, and renal anemia have been identified as potential contributing factors to immunosuppression. According to a nationwide statistical survey by the Japanese Society for Dialysis Therapy (as of December 31, 2013), infectious disease is the second-leading cause of death in dialysis patients (20.8%). Thus, infection is a serious concern in management of dialysis patients. In this lecture, the characteristics and management of infectious diseases in dialysis patients will be explained

[26] Standard Procedure for Arteriovenous Fistula and SuperficializationToshihide Naganuma, M.D., Ph.D.

Vascular access is an essential component of hemodialysis treatment. I would like show you a video of the typical arteriovenous fistula (AVF) and superficialization creation procedure at our hospital. The video of vascular access will be distributed after my lecture.

[28] Periferal Artery Disease of Dialysis PatientsToshihide Naganuma, M.D., Ph.D.

Diabetes is a well-known risk factor for peripheral arterial disease (PAD) of the legs. CKD has also been reported to be an independent risk factor for PAD of the legs. It is known that PAD incidence is high among dialysis patients with stage 5D CKD and is associated with very poor prognosis. In the Dialysis Outcomes and Practice Patterns study (DOPPS), the worldwide and Japanese prevalence rates of PAD in dialysis patients are reported to be 25.3% and 11.5%, respectively. In this lecture, PAD treatment will be explained from a perspective of blood purification therapy including LDL apheresis.

[25] Malignant Tumors in Hemodialysis PatientsShunji Nishide, M.D.

IntroductionThe overall incidence of cancer is reported to be higher in patients with end-stage renal disease (ESRD) than in the general population. Dialysis patients, for example, were more likely to develop cancer of the bladder (standardized incidence ratio), kidney, liver, thyroid, tongue, and cervix, as well as multiple myeloma and non-Hodgkin lymphoma.Risk factorAcquired renal cystic disease increases the risk of renal cell carcinoma.Prolonged analgesic abuse is a risk factor for transitional cell carcinoma of the bladder, ureter, and renal pelvis and for renal cell carcinoma.Some reports suggest that reduced immune function among chronic dialysis patients contributes to the enhanced incidence of malignancy.Cancer ScreeningMammography, Papanicolaou tests, Flexible sigmoidoscopy, and Serum prostate-specific antigen (PSA) levels etc. are recommended.Treatment of cancer in Dialysis PatientsOnce diagnosed, cancer in a dialysis patient is generally treated as in the nondialysis patient with appropriate consideration of the renal clearance, dosing, and dialyzability of chemotherapeutic agents. Future story ⁓Tumor immunity⁓Recently, development of tumor immunology has been remarkable, including PD-1 antibody. Macrophage are very important immune cell for tumor immunity. Macrophage-abundant tumors are highly malignant and are the cause of poor prognosis and therapeutic resistance. In this lecture, I show that the prolyl hydroxylase (PHD) inhibitor FG-4592 inhibits tumor growth of macrophage-abundant tumors and prolongs mouse survival. FG not only normalizes tumor vessels and improves tumor oxygenation but also directly affects macrophages and activates phagocytosis through the PHD-hypoxia-inducible factor (HIF) axis. Remarkably, FG can promote phagocytic ability of tumor-infiltrating macrophages, leading to tumor growth inhibition. I suggest that the PHD inhibitor can promote the anti-tumor potential of macrophages to improve cancer therapy.

[29] Management Against Renal AnemiaNorio Hanafusa, M.D., Ph.D.

The chronic kidney disease (CKD) patients, including on hemodialysis, often experience anemia due to the decreased activity of erythropoietin because this hormone is produced in the kidneys. Although anemia is associated with worse outcomes, the normal hemoglobin levels have been shown not to improve outcomes or even to be associated with worse outcomes as well. Therefore, many guidelines recommend the target hemoglobin levels to be lower in CKD patients than the general population. Many hemodialysis patients also experience iron deficiency. The strategies against renal anemia include the administration of erythropoiesis-stimulating agents (ESAs) and/or iron. Transferrin saturation (TSAT) calculated from serum iron levels and total iron binding capacity (TIBC), and serum ferritin are two markers to be investigated in dialysis patients as iron indices. The target levels of these indices are quite different between the Japanese Society for Dialysis Therapy (JSDT) guideline and other guidelines. In Japan, conservative use of iron is recommended; the upper limit of serum ferritin allowed is 300ng/ml, while the Kidney Disease Improving Global Outcomes (KDIGO) guideline allows up to 500ng/ml. ESA hyporesponsiveness can occur in many conditions such as inflammation or wasting. This condition, which requires a high dose of ESA but cannot attain adequate hemoglobin levels, is shown to be associated with poor clinical outcomes of the patients. In this lecture, these topics will be discussed.

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[34] Basic Carbohydrate Counting for CKD Diabetic PatientsPhon Elin, M.D.

Diabetes is the main cause leading CKD and dialysis induction in many countries as well as in Cambodia. Blood sugar control is important in diabetes patient, as it helps to prevent the complications. Basic carbohydrate counting is the basic meal planning option for managing blood glucose levels. Recently, carbohydrate counting has been shown to be a powerful method to control blood sugar in diabetic dialysis patients. In this lecture, the basic carbohydrate counting will be described as the diet therapy for CKD diabetic patients.

[30] JRDR, the Japanese Society for Dialysis Therapy Renal Data Registry, Its History, Significance in Dialysis Practice, and Future Collaboration with CAN

Norio Hanafusa, M.D., Ph.D.

The history of Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) went back to the year 1968, which is the only several years after the first hemodialysis treatment was performed in the patients with chronic renal failure. At first, the surveys were being performed as facility surveys. In 1983, the survey was changed into the combination of facility survey and patient survey, in which individualized patient data is collected. The system itself has not changed during the past 35 years.Questionnaires are sent to all facilities which offer dialysis treatment in Japan every year at the end of November. The facilities were asked to fill them with the facility and patient data as of the end of the year. The deadline of the collecting data is usually April to May of the next year. Very high response rates were observed every year more than 95%, even though the survey is performed entirely voluntary basis.The questionnaire consists of facility survey and patient survey. The facility survey includes basic char-acteristics of the facility, numbers of patients and staffs, and dialysis fluid quality management practice. The patient survey includes patient demographics, outcomes of the patient, clinical indices potentially relating to outcomes, and other clinical parameters to be investigated by studies.Registries have huge impacts on actual clinical practice. First, JRDR provides the entire picture of dialysis therapy in Japan both cross-sectionally and longitudinally. For example, we can recognize the actual numbers of the dialysis patients or the age distribution of the population. Second, JRDR provides many evidences. The Japanese Society for Dialysis Therapy (JSDT) have publicized guidelines for dialysis therapy. Among them, JRDR has been used for providing the evidence on which the guidelines based. Third, fundamental data can be provided by JRDR for policy making for health care planning and for deploying the clinical resources in the right place. The government also uses the data obtained from JRDR to make the future planning in the field of kidney diseases. Last, the benchmark of the health care policies also can be obtained from the registry. For example, we can assess the effect of intervention such as renin-angiotensin inhibitors on chronic kidney diseases patients by the changes in the numbers of the patients or the characteristics of the population.As such, JRDR has many strong points in the field of dialysis clinical practice and provides the basement on which the Japanese dialysis community relies. However, skills as well as efforts are required for collecting data, cleaning data, and linking data of a facility with ones of other facilities. In this sense, JRDR has a long history in which such skills or experience have accumulated. We, the members of JRDR, believe in the significance of JRDR and hope to help the Cambodian Association of Nephrology to develop a registry in the field of kidney disease in the future.

[33] Pre-Dialysis Diabetic CKD Diet TherapyToru Hyodo, M.D., Ph.D.

Diabetes is the main cause of dialysis induction in many countries. There are no dietitians who deal with CKD patients in Cambodia. Nephrologists must know how to treat with such diabetic and non-diabetic CKD patients by diet therapy. In this lecture the basic concept of diet therapy for these patients is explained.

[35] What is Advanced Carbohydrate Counting?Phon Elin, M.D.

According to the fact that only carbohydrate raises blood sugar, not fat, not protein, the advanced carbohydrate counting is practiced for insulin therapy patients. Every diabetic patient learns the insulin dose for 1 Carbohydrate Unit (10 g of carbohydrate) to keep good blood sugar level. Every patient injects insulin according to the amount of carbohydrate which he or she eats. However, they have already learned the basic carbohydrate counting. As the result, they inject almost the same dose of insulin at every meal. Only when the patients face the situations that they eat more or less carbohydrate than as usual, they change the insulin dose. They can get the flexibility of eating by the advanced carbohydrate counting.

[31] Nutrition in CKD PatientsMinoru Ito, M.D., Ph.D.

Nutritional problems in CKD patients are complicated, and its causes are multifactorial. Malnutrition, Inflammation, and Atherosclerosis affect the nutrition of CKD patients strongly. In this lecture, we will focus on the special features of the nutrition of CKD and discuss the management of malnutrition for the patients.

[32] Diet Therapy for Dialysis PatientsYukie Kitajima, R.D., Ph.D.

The purpose of diet therapy is to avoid malnutrition and prevent the progression of various hemodialysis related complications. The basics of the dialysis diet are as follows:

1. Control of salt and water intake2. Appropriate energy intake3. Control of potassium intake4. Appropriate protein intake5. Control of phosphorus intake

It is most important for dialysis patients to restrict salt. This lecture will focus on ways to control water intake, ensure adequate energy and potassium intake in dialysis patients. Increased concentration of potassium in the blood can strain on the heart. This lecture will cover foods high in potassium and cooking methods to reduce potassium content with specific examples. In addition, I will lecture how to intake protein and phosphorus. Hyperphosphatemia is a risk factor for cardiovascular disease and is associated with the development of secondary hyperparathyroidism and ectopic calcification. Potassium and Phosphorus is a nutrient contained in many foods. It is important for CKD patients to monitor their daily dietary phosphorus intake. Dietary habit in Japan is different from that in Cambodia. Together let's think about what foods and dishes in Cambodia have high and low contents of potassium and phosphorus.

Nipro Corporation Sponsor Speech 1 We introduce Nipro Corporation Company Profile and Nipro’s corporate policy Nipro Medical Training Facility “IMEP”. We will give an overview of the high quality dialysis products manufactured by Nipro.

Nipro Corporation Sponsor Speech 2 We will introduce Nipro’s new dialysis machines, portable echo devices and endotoxin testing machines.

Kaname SadahiroYuki Tanaka

Nipro Corporation

Introduction of devices related to dialysis

Intercultural “media” for all people concerned in healthcare and for all children

18/F Canadia Tower, No.315, Ang Doung St, Corner Monivong Blvd, Phnom Penh, Cambodiahttp://www.reiseikai-media.org/index-e.html

Publication of books and magazines

Planning, creation, and renewal of websites.

Translation services between Khmer, English, and Japanese languages.

Support in planning and organizing various academic meetings and training events.

Import, export and sale of healthcare items.

Nutritional Business Center

1918

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August 22 ~ 23, 2019

International University (IU): Building 89-91-93 & 95, St.1011-1984, Sangkat Phnom Penh Thmey, Khan Sen Sok, Phnom Penh, Cambodia

Tel: (855) 23 881-623, H/P: 099 899 069, 016 203 040 Email: info@iu.edu.kh Website: www.iu.edu.kh

JAC-DSC will issue a certificate of seminar completion to participants with an attendance rate of 70% or higher who achieve the specified score or higher on the final test.

An English textbook on dialysis etc. will be given to participants with an attendance rate of 70% or higher who rank among the top 4th - 6th based on the final test score.

Three particularly excellent participants who satisfy all of the following criteria will be invited to attend a training course (7 to 10 days) in Japan.

1. A participant with an attendance rate of 70% or higher and an excellent final test score. 2. A participant who is highly motivated and qualified to become a dialysis healthcare professional. 3. A participant with a certain level or higher English skills. 4. A participant who is courteous and follows the rules. 5. A participant who is in good health and without infectious disease. 6. A participant who wishes to participate in the training in Japan and can obtain family consent. 7. A participant who can obtain a passport. 8. A participant who is less than 40 yeras old. 9. A participant who have never been to Japan by support of Japanese organization (JAC-DSC, JSTB,

JSDT, etc.).

* Selection will be made by the JAC-DSC. Objections to the selection results will not be allowed.* The training will take place in near Tokyo and Yokohama, Japan, in Feburaly or October 2020. The participants will receive practical training at several medical institutions and universities. They can join a tour of Tokyo or Osaka as an extracurricular activity.* The JAC-DSC, JSTB, cooperative organizations, cooperative medical institutes, or cooperative campanies will pay for the following training expenses: airfare, hotel, travel insurance, transfer fee, Cambodia International Airport tax, and reference materials.

Please make contact with “International University, Cambodia” directly or e-mail your information to info@ubpi.orgPlease write, your name, age, female/male, e-mail address, phone number, occupation, institute and de-partment that you belong to (university, school, hospital, clinic, corporation, etc.), in your e-mail.Your e-mail will be forwarded to both of JAC-DSC staff and IU staff automatically.*Participants need to pay “10 USD” to cover venue preparation costs.*All Japanese chairpersons and lecturers are volunteer.

Schedule

Place

Privilege for partic-ipants

How to apply

©2019 Japanese Assistance Council of establishing Dialysis Specialists system in CambodiaAll rights reserved.No part of this publication may be reproduced,stored in a retrieval system,or transmitted in any form or by any means,electronic,

mechanical,photocopying,recording,or otherwise,without the prior permission of publisher.Printed in Japan