Etiology Of ESRD Research Articles

Effect of Incremental Hemodialysis on Residual Kidney Function and Other Laboratory Parameters in End Stage Renal Disease Patients Starting Dialysis

Abstract Background Residual kidney function (RKF) in patients with end-stage renal disease plays a critical role in dialysis adequacy, quality of life, and survival by maintaining fluid and metabolic homeostasis, mitigating mineral abnormalities, optimizing uremic toxin clearance, and sustaining higher production of endogenous vitamin D and erythropoietin. Endogenous clearance conferred by RKF is associated with greater survival than dialysis clearance per se, and at a certain RKF level, higher dialysis dose may not influence clinical outcomes in both peritoneal and hemodialysis patients. Furthermore, randomized controlled trials (RCTs) have shown inconsistent results in terms of clinical benefit of higher dialysis dose or frequency, and they may accelerate RKF decline. Aim of the Work To detect the effect of twice – weekly HD on patients starting dialysis regarding laboratory parameters and preservation of kidney function. Patients and Methods This prospective cohort study included 30 patients from multiple convienant dialysis units in 10th of Ramadan and Mushtoul Elsouq city to initiate twice-weekly hemodialysis, the patient should meet the first (urine output >600 ml/day) and the last criteria (KRU > 3 ml/minute/1.73 m2)d, plus most (five out of nine). Patients were examined for these criteria every month for 3 months. Regarding baseline data, this study patients had a mean age of 49.6 ± 8.7 years old, with a range from 32 to 65 years old, with male predominance (70 %), the mean weight of the studied patients was 79.9± 10.31 kg, with a range from 55 to 105 Kg, and their height ranged from 160 to 185 cm, the main etiology of ESRD was hypertension in 46.7 % of the studied patients, followed by DM in 30% then DM with hypertension in 16.7%. Results The study shows that there's highly significant increase in serum PTH and bicarbonate all over the study period, there's significant increase in serum phosphorus level, there's highly significant increase in serum albumin, there's highly significant increase in Hemoglobin all over the study period. There's highly significant increase in serum calcium, there's highly significant increase in Serum Potassium, there's highly significant decrease in Serum Creatinine, Urea before and urea after dialysis all over the study period. This study showed that there's highly significant increase in renal KT/V, there's highly significant increase in RKF, there's highly significant decrease in urine Urea and there's no statistically change in dry weight of patients all over the study. Conclusion In conclusion, in our selected cohort of incident hemodialysis patients with measured RKF, the incremental hemodialysis regimen that starts with twice-weekly schedule upon transition to dialysis is associated with greater preservation of the RKF in the first 3 months and may be safely implemented among incident hemodialysis patients with substantial RKF.

Comparing Hemodialysis and Peritoneal Dialysis Patients for Gastrointestinal Symptoms

Objective: The purpose of this research was to compare gastrointestinal (GI) symptoms in ESRD patients receiving PD and HD to see whether there were any significant changes. Methods: After the ethical approval from the institute review board, this crossectional study was conducted at shahida Islam medical complex ,lodhran. From 01/01/22 to 30/06/22. A modified 15-item gastrointestinal symptom rating scale (GSRS) questionnaire was used to assess GI symptoms; this questionnaire included questions on eating dysfunction. Age, a etiology of ESRD, and most recent adequacy evaluation of dialysis were collected through the follow-up database, patient interviews, and chart reviews. Results: Total seventy patients were included in the present study, N=35 was on hemodialysis and N=35 on peritoneal dialysis. HD and PD patients were similar with respect to age, sex, the occurrence of diabetes mellitus, and average dialysis duration. In ESRD patients’ overall prevalence of GI symptoms (GSRS >1) was 68.5% (48/70 patients). Patients with a GSRS > 1 were more common among those with HD group (28/35; 80%) than those with PD (57%; 20/35) (P 0.058*). In the HD group, more patients suffered from abdominal pain, constipation, and diarrhea (74%, 60% and 68.5%, respectively), compared with those in the PD group (34%, 28.5% and 32%, respectively; P value is 0.003, 0.001, and 0.008 respectively) Conclusion: Gastrointestinal (GI) symptoms vary in frequency, intensity, and variety across HD and PD individuals. Keywords: Gastrointestinal symptom, Hemodialysis, Peritoneal dialysis, End-stage renal disease

243.2: Pediatric Kidney Transplantation in Argentina: Is Delayed Graft Function a Problem? Results of a Multicenter Study

Introduction: Delayed graft function (DGF) is a manifestation of acute kidney injury occurring after kidney transplantation (KTx). Incidence of DGF in pediatric KTx recipients is variable (10% to 25%) due to different definitions of DGF and different subgroups of kidney donors. It is associated with an increased risk of graft loss in adult KTx. Several factors related to donor, recipient, and organ procurement/transplantation procedures may increase the risk of DGF. The aim of our study was to evaluate the cumulative incidence of DGF in a children who received a kidney graft from a brain-dead donor, its impact on patient and graft survival, and to identify predictive risk factors of DGF. Methods: A retrospective multicenter study was conducted including recipients under 18 years of age who underwent KTx from a brain-dead donor between January 1, 2015 and December 31, 2017. DGF was defined as the need for dialysis within the first week after KTx. Data were obtained from the clinical records of the patients and from the Registry and Management System of Argentina (SINTRA) and were analyzed using MedCalc® Statistical Software version 20.014; 2021. Results: We analyzed 239 KTx performed at 17 centers. Of the recipients 54.4% were male, median age at Tx was 13.7 yr (r: 2.8 -17.9), weight 30 kg (r: 7 - 82), BMI 17 Kg/m2 (r: 11 - 36). Etiology of ESRD: CAKUT 30%, glomerular diseases with risk of recurrence 24.3%, typical HUS 3.8%, others 29.7%, and unknown 12.2%. Pre-emptive KTx was performed in 18.8% of patients, 39.7% were receiving hemodialysis, and 41.5% peritoneal dialysis. Median of time on dialysis was 2.62 yr (r: 0.12 - 9.8). Of the donors 70.7% were male, median age was 17.6 yr (r: 2.8 - 55), BMI 23 Kg/m2 (r: 17 - 35), BMI ratio donor/recipient 1.35, and pre-ablation serum creatinine 0.82 mg/dl (r: 0.6 - 2.6). Cause of death was trauma in 57%, vascular in 24%, and others in 19%. Cold ischemia time was 16.6 hours (r: 4.2 - 42), HLA mismatches ≼ 3: 54% and > 3: 46 %. Multiple-organ donor in 84.5%. Overall, 59 patients (24.7%) developed DGF. Patients without DGF had better graft survival at 1 (96% vs 78%) and 3 yrs of follow-up (89% vs 73%) p= 0.001. There were no significant differences in patient survival between both groups at the 3-year follow-up (95% vs 91%). Incidence of early AR (90 days post Tx) was higher in patients with DGF (34.5% vs 10.6%) p= 0.0001. In univariate analysis risk factors for DGF were: age at Tx > 13.7 yr, male gender, glomerular disease with risk of recurrence, hemodialysis as prior to KTx, and time on dialysis > 1 yr. In multivariate analysis independent risk factors for DGF were: time on dialysis > 1 yr (OR 9.2 - 95% CI 2.1 - 39) and age at KTx > 13.7 yr (OR 1.09 - 95% CI 1.01 - 1.18). Conclusion: In our cohort, cumulative incidence of DGF was higher than that reported by other authors. Patients with DGF had worse graft survival than those without DGF. Shortening the time on dialysis seems to be a modifiable factor to reduce DGF.

Analysis of risk factors influencing the BK polyomavirus replication in patients with ESRD waiting for kidney transplantation

BackgroundSince the pre-transplant status affects the renal transplantation success and ultimately the survival rate, identifying the probable risk factors that increase the chance of BK virus replication in end-stage renal disease patients can be included in proposing proper surveillance guidelines during pre and post-transplantation. MethodsA descriptive cross-sectional study was performed by collecting plasma samples from 192 ESRD patients undergoing hemodialysis for at least 3 months. Quantitative Real-time PCR assay was used to detect and measure the BK viral load. Demographic and clinical characteristics of the patients who had BK viremia were documented. Results14 (7.3%) out of our 192 participants had BK virus viremia (95%CI 4.2%–11.6%). Demographic characteristics including etiology of ESRD and underlying diseases, mean duration and frequency of dialysis, co-infection with HBV and HCV did not affect the virus replication, since the difference between patients with BK virus viremia and BK virus negative individuals was not statistically significant. However, the statistical significance of the mean age of men with BKV and without BK virus viremia was found (OR: 3.42, P = 0.02 95%CI 0.86–13.61). Also, multiple regression analyses of some other parameters revealed that old age, high body mass index and male gender can be predictive factors of BK virus viremia in ESRD patients. ConclusionBased on our findings, elderly male had higher chance of being exposed to BK virus viremia. Some other demographic characteristics such as a high BMI, old age and gender (male) can increase the risk of BK viremia in patients with ESRD prior to kidney transplantation.

CLINICAL SIGNIFICANCE OF PRETRANSPLANT DONOR-SPECIFIC HLA ANTIBODIES IN KIDNEY TRANSPLANT RECIPIENTS OF HISPANIC POPULATION

Introduction: Donor-specific HLA antibodies (DSA) before kidney transplantation (KT) is one of the major risk factors for humoral rejection and lower graft survival (1-2). In order to identify prognostic factors and develop follow up strategies in this high risk population, it is required for transplant center to share their outcome data (3-4). In addition, in most previous studies the Hispanic population is poorly represented. Materials and Methods: Retrospective cohort and comparative study in KT recipients with pretransplant DSA measured by Luminex, negative AHG-CDC-XM (living and deceased donor) and negative flow cross match (living donor). Our main objective was to determine graft survival and describe the incidence of acute rejection (AR) and renal function (eGFR by CKD-EPI). Results: Between September 2006 and March 2017, 411 patients received KT in the INCMNSZ, 60 were identified with pretransplant DSA and compared with 60 KT recipients without pretransplant DSA, paired by donor type, induction and maintenance immunosuppression. Median age was 33 (range 27-44) years, 55 (45%) were women, 55 (45.8%) had unknown etiology of ESRD, months on dialysis [24 (range 12-48)], 10.7% received second KT, 63.3% were living donor receptor, 75% had thymoglobulin induction, 96% were with tacrolimus, mycofenolate mofetil and steroids as maintenance immunosupression. The incidence of AR was increased in the pretransplant DSA group (35.5% vs. 15.2%, p=0.011) and the median time between KT and AR episodes was lower in the pretransplant DSA group [12.8 (8.3-23.6) vs 32.1 (25.9-40.6), (p<0.0001)] months.In the pretransplant DSA group 52.4% of the biopsies with AR were protocol biopsies and 29% were secondary to graft disfunction.Incidence of De Novo DSA were similar between groups [30 (53.6%) vs 29 (56.8%), (p=0.732)].After 37.4 (range 29.2-52.3) months of follow up, eGFR was similar between groups 65.0 ± 22.0 vs 69.8 ± 21.4 ml/min/1.73m2 (p=0.19) and there were no difference in graft survival (87.7% vs 96.7% p=0.240) between pretransplant DSA and without pretransplant DSA groups, respectively.Discussion and conclusions: Although there is a higher incidence of rejection, KT recipients with pretransplant DSA could be considered candidates for KT. One limitation of this study is the small sample size and short follow-up time. However, we acknowledge that in this population of high immunological risk, induction therapy with lymphocyte depletors and powerful maintenance immunosuppression, combined with follow-up strategies as protocol biopsies with early treatment of subclinical rejection could provide similar graft survival compared to KT receptors without pretransplant DSA.

P1272ECFECT OF MELATONIN ON DYSLIPIDEMIA IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease is one of the major causes of death in hemodialysis patients. Lipid metabolism abnormalities and increased inflammatory factors are related factors. In recent studies melatonin inhibits dyslipidemia and reduces inflammatory factors by inhibiting LDL-c oxidation. The purpose of this study was to evaluate the effect of melatonin supplement on hyperlipidemia and c reactive protein (CRP ) level in hemodialysis patients. Method In this clinical trial ,the inclusion criteria were as follows:age older than 18 years, undergoing dialysis for at least 3 months,triglyceride &amp;gt;150mg/dL,HDL-c&amp;lt;40 mg/dL in males, HDL-c&amp;lt;50 mg/dL in females and serum CRP&amp;gt;5 mg/l Exclusion criteria were: Patients with a history of stroke, myocardial infarction, peripheral vascular disease, malignancy, heart failure, liver cirrhosis, active liver disease, history of infection, hospitalization one month ago, hepatitis B and C.HIV, and taking corticosteroid, statin, Non-steroidal anti-inflammatory drugs. Among 200 hemodialysis patients,only 28 patients fulfilled the inclusion criteria.. Patients were treated with Melatonin supplements 3 mg per day at bedtime during 12 weeks. Serum lipid profile and CRP level were measured after 12 weeks. Five patients were excluded, 2 patients underwent kidney transplantation, and three patients did not cooperate. Data were analyzed by SPSS 20 software. Normal distributed quantitative data were expressed as the mean ± SD and qualitative data was expressed as frequency and percentage. Wilcoxon matched pairs test was used to compare the two groups according to the type of study that had no normal distribution and the number of participants (less than 30) and study type (pre-test and post-test). P &amp;lt;0.05 was considered as the level of significance. Results A total of 23 patients completed the treatment protocol.Baseline demographic characteristics of patient are shown in Table 1.Parcipitant was composed of 13 male and 10female .The participants’ mean age was 30.6± 11.6.Etiology of ESRD was diabetes in 13(56/5%)and hypertension in5(21.7%)patients and other causes was 5(21/7%). After treatment mean total cholesterol levels decreased from 139.95 ± 35.49 mg/dL to 131.13 ± 34.96 mg/dL (p value =0.194 ) which was not statistically significant. But the decrease in serum triglyceride level was statistically significant ,from 242.08 ± 101.05 mg/dL decreased to 178.00 ± 48.02 mg/dL (pvalue = 0.004).HDL-c increased significantly after treatment from 36.20 ±7.08 mg/dL to 40.16 ±4.35mg/dL (pvalue =0.032). Serum CRP levels did not decreased.The limitations of our study were the small sample size and short duration of the investigation. Conclusion Melatonin supplement improves triglyceride and HDL-c in hemodialysis patients but has no effect on total cholesterol-c and CRP in hemodialysis patients.

SUN-212 PRELIMINARY RESULTS OF SECONDARY HYPERPARATHYROIDISM BY ETELCALCETIDE IN A SPECIAL COHORT OF HOME HEMODIALYSIS PATIENTS

Secondary hyperparathyroidism (SHP) is a major complication in chronic kidney disease (CKD), in particular CKD5 on hemodialysis. It carries both high co-morbidity and mortality. In patients with CKD G5D, the KDIGO guidelines 2017, recommended to maintain the intact PTH levels in the range of approximately 2 to 9 times the upper normal limit for the assay (2C). We are reporting in this study our experience in treating SHP by Etelcalcetide, in a very special cohort of sick, highly co-morbid, bed, and home bound, hemodialysis patients, treated at home with the assistance of a hemodialysis nurse, we called the program as Nurse Assisted Home Hemodialysis (NAHHD). This is a prospective observational three month study. Twenty seven home HD patients, managed by NAHHD program, were included in this study, average age 58.4 (26-87) year, 61.5% female. Etiology of ESRD was DM in 70%, 54% of them have hypertension. Vascular access AVF & AVG 16 (60%), CVC 11(40%). Average comorbidities 9.4 (6-16). Indications for Etelcalcetide were 50% non compliance, 31% PTH resistance, and 19% bad tolerance of Cinacalcet Three month results are illustrated in the table:Tabled 1M0M1M2M3pPTH (pg/ml)1003882877631<0.01Corrected Ca (mmol/l)2.242.142.162.1NSEtelcalcetide Dose (mg/week)141418.416.4NSOne Alpha Vit.D3 Dose (mcg/week)11.1511.3NSThe medication was well tolerated, only two patients had GI side effects (7%), led to holding the drug in one patient, and the other one was managed by re-adjusting the dose. Open table in a new tab The medication was well tolerated, only two patients had GI side effects (7%), led to holding the drug in one patient, and the other one was managed by re-adjusting the dose. This preliminary and short study showed, Etelcalcetide is efficient and well tolerated in this special group of sick, highly co-morbid, bed and home bound home hemodialysis patients. The drug was well tolerated with minimal GI side effects.

Skin manifestations in end stage renal disease patients on hemodialysis.

Chronic kidney disease (CKD) is a world public health problem that is related with high morbidity and mortality. CKD patients can present with different skin manifestations, often benign with much impact on quality of patients life. Study Design: Case-series study. Setting: Nephrology Unit Civil Hospital Larkana. Period: From 1st January 2018 to 30th June 2018. Material and methods: 141 patients of ESRD on regular HD for at least 1 month. Patients were chosen randomly for evaluation of cutaneous changes regardless of their gender, age, sex and etiology of ESRD. General and dermatological examination of the skin, hair, nails, and oral mucosa was performed by consultant dermatologist. Data were analyzed by using IBM SPSS version 23.0. Descriptive analyses performed using mean with standard deviation and median with inter quartile ranges of quantitative data set. Count and percentages were reported for categorical data set. Results: In the present study there were one hundred and forty one patients. Out of them skin manifestations of patients, 87.9% had Xerosis, 31.9% found with skin hyper pigmentation, 9.2% had Subungal Hyperkeratosis, 24.1% had Uremic Pruirtis, 45.4% had Pallor, and 6.4% found with Bruises. There were 9.9% cases of Alopecia, 17.7% cases of half n half nail, 1.4% cases of half n half nail with alopecia, 9.2% cases of Koilionychia, 0.7% cases of Koilionychia with alopecia, 2.8% found with koilonychias and half n half nail, 2.1% with leuconycia and koilionychia, 15.5% with Leuconychia, 2.1% found with Leuconychia and alopecia, and 0.7% found with Leuconychia, koilonychia &amp; alopecia in Hair and Nail changes. Conclusion: The range of skin manifestations vary in different studies. Although often benign with much impact on quality of patient’s life and life can be threatening. Early treatment of skin disorders can improve the quality of life.

Results of a Pediatric Transplant Program in a Low Income Country

Background Since the middle of the last decade, the incidence of ESRD has been relatively stable for many affluent countries such as USA and Western European countries. However, rates appear to be increasing for many developing countries, becoming more challenging to get access to Renal Replacement Therapy (RRT), and transplant in particular. As an example, Guatemala has a kidney transplant rate of 6.9 per million population (pmp) per year, including children and adults, compare to Spain where it is more than 34 pmp. Guatemala, situated in Central America, with 16 million populations has an incidence of ESRD in children of 4.6 per million age-related population (pmarp). FUNDANIER (Foundation for Children with Kidney Diseases) has become the only center that provides free access to comprehensive RRT to Guatemalan Children, including transplantation and immunosuppression. As the national referral center for pediatric RRT, FUNDANIER provides peritoneal dialysis (40.4% of patients), hemodialysis (26.4%), transplant, (12.4%), and conservative management (no RRT) in 17.6%. The transplant program was founded in 2007, and has performed and follow more than eighty transplants. With the goal of presenting the results of this experience, we analyzed the pediatric transplant program database. Methods Data from recipients and donors were described as qualitative (Sex, etiology of ESRD, RRT before transplant, type of donors, type of induction, immunosuppression protocol, reasons for discharge of the program, causes of graft loss and acute and relevant complications) and quantitative variables (number of transplant and number. of rejections) using proportions. Mean and standard deviation were used for quantitative variables such as age, follow up time and eGFR. We retrospectively described the results of all transplanted patients between 2007 and 2017. Results Eighty three patients were followed. 78 were transplanted at our center and five were referred for follow up. The mean age was 12.49 years (SD 3.28), 53% were male and the etiology of ESRD was unknown in 63%, followed by CAKUT in 23% of patients. Most of the donations were from living donors (88%). Infections were the most common acute complication after transplant (n=16/80, 20%). In total 25% of patients (18/73) experience at least 1 episode of rejection during 12 months post transplant. Of 47 episodes of rejection reported, 49% (23/47) were after 1 year post transplant. 8/37 (22%) patients discharged from the program were moved to other type of RRT due to graft loss. The patient and graft survival at 1 year was 90% and 88%. When divided by type of donation, the 1 year graft survival for living and deceased donor was 90% and 70%. Conclusion Our graft survival is comparable from pediatric kidney transplant program in low-middle income countries. Increasing the number of deceased donor is mandatory in order to improve the transplant rate in a country with a high rate of ESRD with unknown etiology.

Outcome and complications of living donor pediatric renal transplantation: Experience from a tertiary care center.

Introduction:We retrospectively reviewed the patient characteristics, outcome, and complications of renal transplantation in pediatric age group performed at our center and compared the results with various centers in India and other developed countries.Materials and Methods:Patients younger than eighteen years of age who underwent renal transplantation from 2003 to 2014 at our institute were reviewed. Demographic data of the transplant recipients and donors, etiology of ESRD, mode of dialysis, surgical details of renal transplantation, immunosuppression, medical and surgical complications, and post-transplant follow-up were assessed. Graft survival was determined at 1, 3 and 5 years post-transplant. All data collected were entered into Microsoft excel program and analyzed using SPSS 20. Kaplan–Meier method was applied to determine the graft survival at 1, 3, and 5 years. The log-rank test was applied to test the statistical significance of the difference in survival between groups.Results:Thirty-two children underwent transplantation comprising of 18 females and 14 males. The mean age was 14.5 years (range 10–17 years). The primary cause of renal failure was glomerular diseases in 53% (17/32) of patients. Seventeen postsurgical complications were noted in our series. Two grafts were lost over a follow-up of 5 years. The 1, 3, and 5 year graft survival rates were 96.7%, 92.9%, and 85%, respectively. There was no mortality.Conclusion:The etiology of ESRD in our region is different from that of developed countries. The mean age at which children undergo renal transplantation is higher. Graft survival at our center is comparable to that of developed nations. Renal transplantation can be safely performed in children with ESRD.

Immune-mediated nephropathies in kidney transplants: recurrent or de novo diseases.

IMN contribute to ESRD in 13% children with renal transplant (txp). Recurrent or de novo IMN can cause graft dysfunction and/or failure, but the details regarding incidence, therapy, and outcome remain poorly understood. Retrospective single-center study of all pediatric kidney txp was carried out since 1998. Clinical presentation, pathology, therapy, and graft outcomes of children with recurrent or de novo IMN were reviewed. IMN was the primary etiology of ESRD in 28 of the 149 txp recipients. Eleven children had biopsy-proven post-txp IMN-six were recurrent and five had de novo. Presentation varied with changes in SCr and/or proteinuria. Initial therapy included higher doses of steroids, MMF, and tacrolimus. Outcome was excellent with only one late graft loss. Full remission was achieved in all other patients, but some had re-recurrence of the IMN. Median follow-up time was 11.8years. IMN (recurrent or de novo) occurred in 7.4% (11 of 149) of all kidney txp performed at our center. IMN post-txp was often seen late post-txp, usually asymptomatic and noted to have relapsing pattern. Early diagnosis and prompt therapy resulted in excellent long-term outcome in children diagnosed with post-txp IMN.

Carotid Intima-Media Thickness and Incident ESRD: The Atherosclerosis Risk in Communities (ARIC) Study.

Carotid intima-media thickness has been reported to predict kidney function decline. However, whether carotid intima-media thickness is associated with a hard kidney end point, ESRD, has not been investigated. We studied 13,197 Atherosclerosis Risk in Communities participants at visit 1 (1987-1989) without history of cardiovascular disease, including coronary heart disease, stroke, and heart failure, at baseline and assessed whether carotid intima-media thickness measured by B-mode ultrasound is associated with ESRD risk using Cox proportional hazards models. Regarding carotid intima-media thickness parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation, and internal carotid arteries) measurements. Mean age was 54.0 (SD=5.7) years old, and there were 3373 (25.6%) blacks and 7370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid intima-media thickness was significantly associated with ESRD risk (hazard ratio [HR] between quartiles 4 and 1, 1.46; 95% confidence interval [95% CI], 1.02 to 2.08 for overall mean intima-media thickness and HR between quartiles 4 and 1, 1.75; 95% CI, 1.24 to 2.48 for overall maximum intima-media thickness). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific intima-media thicknesses, the associations with ESRD were most robust for bifurcation carotid (e.g., adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.49; 95% CI, 1.04 to 2.13 for bifurcation; adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.36; 95% CI, 0.94 to 1.97 for common; and adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 0.93; 95% CI, 0.67 to 1.29 for internal). Carotid intima-media thickness was independently associated with incident ESRD in the general population, suggesting the shared etiology of atherosclerosis and ESRD.

Impact of ESRD Diagnosis On Graft Survival of Kidney Transplant Recipients of Small Pediatric Kidneys.

Outcomes of kidneys from small pediatric donors may be improved by optimal recipient selection. Etiology of ESRD may be a discerning risk factor for poor outcomes. SRTR data from 1995-2010 of adult deceased-donor KTXs were assessed for recipients of pediatric kidneys from donors <6 years of age compared to KTX from donors 17-34 years of age. Exclusions were multiorgan transplants, donor ≤10 kg, and recipient HCV/HIV seropositivity. Only those with ESRD due to diabetes mellitus (DM), hypertension (HTN) and immune-mediated disease (IMD, at least 1 of the following: SLE, MGN, FSGS) were included in the cohort. Other etiologies of ESRD were not assessed due to low sample size. On univariate analysis, death-censored graft survival (DCGS) time to event curves were significantly different between PEDS-donor single (SK), en bloc (EB), and ADULT-donor groups within each disease etiology.Figure: No Caption available.On multivariate Cox regression analyses (adjusted for donor and recipient risk factors) transplantation from a PEDS-donor with a single kidney was associated with a significantly increased risk of DCGS in recipients with DM (aHR 2.41, 95%CI 1.79-3.26), HTN (aHR 2.38, 95%CI 1.84-3.09), and IMD (aHR 2.46, 95%CI 1.74-3.46) compared to receiving an ADULT-donor kidney. Transplantation with an EB PEDS-donor kidney was associated with a significantly increased risk of DCGS in recipients with DM (aHR 1.78, 95%CI 1.27-2.48), but not HTN (aHR 1.04; 95%CI 0.77-1.41) or IMD (aHR 1.13, 95% CI 0.76-1.67). Single kidney transplantation from small pediatric donors is associated with similar risks (approximately 2.4 fold) of DCGS regardless of disease etiology. En bloc pediatric grafts are associated with worse DCGS in recipients with DM but not HTN or IMD. Etiology of ESRD does not appear to be a putative risk factor for outcomes with the use of single pediatric-donor kidneys. The increased risk of graft failure in EB recipients with DM, but not HTN or IMD, suggests an opportunity for risk stratification based on ESRD; however, further analyses are needed.

Uric Acid Levels and All-Cause Mortality in Peritoneal Dialysis Patients

Background: Epidemiological studies have shown that hyperuricemia is associated with all-cause and cardiovascular mortality in chronic kidney disease (CKD) and hemodialysis patients. Our study investigated the influence of serum uric acid (UA) levels on survival in peritoneal dialysis (PD) patients. Methods: This was a retrospective study involving 156 subjects who had undergone PD. The patient demographics, etiology of ESRD, comorbid conditions and other laboratory parameters were collected. The subjects were divided into three groups according to their serum UA concentrations (group 1, the lowest quartile; group 2, the middle quartiles; group 3, the highest quartile). The risk of death was calculated using a multivariate Cox regression model. Results: There were 41 deaths during a follow-up period of 31.3±17.5 months. Compared with group 2, which had a mortality rate of 5.7 per 1000 person-months, the mortality rates were higher in group 1 (14.3 per 1000 person-months, p<0.05) and group 3 (13.3 per 1000 person-months, p<0.05). A multivariable Cox regression model revealed that age, serum albumin, diabetes mellitus (DM), hypertensive nephropathy, residual renal function and UA group were factors associated with mortality in the PD patients. Using group 2 as a reference, the hazard ratio (HR) of mortality was found to be 1.15 (95% confidence interval [CI] 0.20-2.57, p>0.05) for group 1 and 2.96 (95% CI 1.29-6.80, p=0.01) for group 3. Conclusions: In PD patients, a higher serum UA level is related to increased mortality and is an independent risk factor for all-cause mortality. Uric acid levels and all-cause mortality in peritoneal dialysis patients.

1197 SATISFACTION AFTER BOWEL AND BLADDER RECONSTRUCTIVE SURGERY FOR CONTINENCE IN THE PEDIATRIC POPULATION

postoperative VUR than those without [16 vs. 6 pts (relative risk 3.7), p 0.002], as were younger pts (mean age 9.4 vs 13.6 years, p 0.02). Postoperative VUR was not associated with intraoperative stent placement (p 0.99), UNC technique (p 0.99), donor type (p 0.99), ESRD etiology (p 0.16). Complication and de novo VUR rates remained stable over time (p 0.1 and p 0.8 for trend). CONCLUSIONS: Patients with pre-existing urologic pathology undergoing RTX are at increased risk of postoperative VUR but not other acute surgical complications. Renal donor type, etiology of ESRD, and patient age did not correlate with an increased number of complications. Early post-RTX assessment and management is critical in patients with pre-existing urologic pathology.

Hypertension and diabetic distribution of ESRD in Hamadan Province of Iran

Background: ESRD is multi- causes disease with irreversible reduction of kidney function. The patients need replacement therapy to survive in west of Iran. Materials and Methods In this is a descriptive study, a total of 455 patients with ESRD were studied to determine the etiology of ESRD. Data were collected by a questionnaire and then analyzed by SPSS software version 16. ResultsThe mean age of patients was 54/3 and the most of them were in the range of 50-60 year. 236 patients (%51.87) were male and 219 patients (%48.13) were female. The ESRD was unknown (Idiopathic) (%29.33). The diabetic nephropathy (%23.73), hypertension (%22.19), glomerulonephritis (%17.48) and others (%7.27) were the other causes by respectively. Concluaion: Our study suggests that the commonest cause of ESRD is unknown (Idiopathic), while diabetic nephropathy is the commonest cause in other studies. Therefore it is necessary to pay more attention to determine the etiology of ESRD to plan strategies for prevention and treatment of them.

Impact of Pre-Existing Hepatitis B Infection on the Outcomes of Kidney Transplant Recipients in the United States

Pre-existing hepatitis B virus (HBV) infection has been associated in inferior renal transplant outcomes. We examined outcomes of HBV+ renal recipients in a more recent era with availability of oral anti-viral agents. Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, we selected adult primary kidney recipients transplanted in the United States (2001 to 2007). The cohort was divided into HBV+ (surface antigen positive, n = 1346) and HBV- patients (surface antigen negative; n = 74,335). Five-year graft survival, patient survival, hepatic failure incidence, and associated adjusted risks were compared. HBV+ recipients were more frequently Asian, had a lower body mass index, and glomerulonephritis was more prevalent as the etiology of ESRD. HBV+ recipients had less pretransplant diabetes and cardiovascular disease, were less likely a living donor recipient, and were less likely to receive steroids at discharge. Five-year patient survival was 85.3% and 85.6% and graft survival was 74.9% and 75.1% for HBV+ and HBV-, respectively. HBV infection was not a risk factor for death or kidney failure, although 5-year cumulative incidence of hepatic failure was higher in HBV+ recipients (1.3% versus 0.2%; P < 0.001), and HBV+ was associated with 5.5- and 5.2-fold increased risk for hepatic failure in living and deceased donors, respectively, compared with HBV-. In a recent era (2001 to 2007), HBV-infected renal recipients were not at higher risk for kidney failure or death; however, they remain at higher risk of liver failure compared with HBV- recipients.

CARDIO-PROTECTIVE, ANTI-THROMBOTIC MEDICATION AND SURVIVAL IN VASCULAR ACCESS FOR HEMODIALYSIS: PP.15.75

Introduction: It is known that drugs such as HMG CoA inhibitors (statins) Inhibitors of angiotensin converting enzyme (ACEI) angiotensin II receptor blockers AT1 (ARB) inhibitors calcium channel, and acetylsalicylic acid (ASA), reduced in vitro neo-intimal proliferation. Purpose: Was to analyze multivariate regression the effect of medication cardio-protective survival has on primary and secondary (AVF). Patients and Methods: We designed a retrospective cohort study of 96 hemodialysis patients with clinical evidence of dysfunction of the AVF studied by Doppler ultrasound and Fistulography: dependent variable was considered as primary and secondary survival of the AVF. The independent variables were: sex, hyperlipidemia, diabetes, anti-hypertensive medication, ischemic heart disease, etiology of ESRD, antiplatelet drug, age. Cox regression was used to analyze the Primary and Secondary Survival, adjusted for covariates. The survival rate of vascular access in relation to drugs was modeled by Kaplan-Meier test. The statistical significance was considered if p < 0.05. Results: 96 patients, 61 were men, 35 women, mean age 59 years. 24% had diabetes, 40% were taking statins, 60 patients were taking ACEI + ARB, 13 patients beta-blockers, 4 Calcium -antagonists, 19 were not taking antihypertensive, antiplatelet drug 91 of 96, In primary survival the treatment with ACEI is a protective factor that decreases the relative risk of losing AVF in 42% (HR: 0.58, p: 0.038 HR 95% CI: (0.354 0.970) present Dyslipidemia is a risk factor that increases the probability of losing twice AVF HR: 2.192, p = 0.002, HR 95% CI: (1.328 3.618). The secondary survival is greater after making ATP (HR: 0.244, p = 0.0001), HR 95% CI (0.111 0, 533) and lower in patients with dyslipidemia HR: 3.547., p: 0.04, HR 95%: (1.499 8.393). Conclusions: The ATP and treatment with an ACEI are protective and decrease the relative risk of losing the AVF by 76% and 42% respectively, while presenting dyslipidemia increases the relative risk of losing access vascular more than threefold.

Neighborhood poverty and racial disparities in kidney transplant waitlisting.

Racial disparities persist in the United States renal transplantation process. Previous studies suggest that the distance between a patient's residence and the transplant facility may associate with disparities in transplant waitlisting. We examined this possibility in a cohort study using data for incident, adult ESRD patients (1998 to 2002) from the ESRD Network 6, which includes Georgia, North Carolina, and South Carolina. We linked data with the United Network for Organ Sharing (UNOS) transplant registry through 2005 and with the 2000 U.S. Census geographic data. Of the 35,346 subjects included in the analysis, 12% were waitlisted, 57% were black, 50% were men, 20% were impoverished, 45% had diabetes as the primary etiology of ESRD, and 73% had two or more comorbidities. The median distance from patient residence to the nearest transplant center was 48 mi. After controlling for multiple covariates, distance from patient residence to transplant center did not predict placement on the transplant waitlist. In contrast, race, neighborhood poverty, gender, age, diabetes, hypertension, body mass index, albumin, and the use of erythropoietin at dialysis initiation was associated with waitlisting. As neighborhood poverty increased, the likelihood of waitlisting decreased for blacks compared with whites in each poverty category; in the poorest neighborhoods, blacks were 57% less likely to be waitlisted than whites. This study suggests that improving the allocation of kidneys may require a focus on poor communities.

Graft Vesicureteral Reflux in Children

PURPOSE Few reports have been published on the incidence of VUR in children after kidney transplantation. We analyze our graft VUR incidence and its clinical relevance. MATERIAL AND METHODS We report 140 kidney transplantations that were done during 1996-2006 (mean follow-up 4 yrs). A modified Lich-Gregoir antireflux procedure was used in all. We analyzed etiology of ESRD, native and graft VUR, bladder dysfunction and residual diuresis, rejection and acute pyelonephritis (APN). A routine VCUG was made 1 year after transplant. RESULTS Mean age at renal transplantation was 7 yrs (1-16) and 44% were less than 6 yrs old. Reflux was present in 35% of grafts, (13% also the native kidney), and reflux was present in the native kidneys alone in 17%. ESRD was due to PUV in 23% and half of these had graft VUR. Bladders were dysfunctional in 16% of the patients and without diuresis in 24%. Graft reflux was present in 42% of the former and in 50% of the patients with non-diuretic bladders. Four patients with graft VUR had a previous bladder augmentation. APN was related with graft VUR in 37% of patients, increasing to 70% in those with graft and native VUR. No patients without VUR had APN. Graft function and rejection episodes were similar in those with or without VUR. Five grafts were lost, 2 to primary failure and 3 to chronic allograft nephropathy. CONCLUSIONS The incidence of graft VUR is elevated and was associated with an increased risk of APN. However, it does not seem to negatively affect graft survival.