Higher Prevalence Of Renal Disease Research Articles

Prevalence and risk factors for kidney disease among hospitalized PLWH in China

BackgroundKidney disease is an important comorbidity in people living with HIV(PLWH), and is associated with poor outcomes. However, data on renal function of PLWH are limited in China so far. In this study we assessed the prevalence of kidney disease in patients either on antiretroviral therapy (ART) or not respectively in a single center in China and explored the possible risk factors associated.MethodsIn the cross-sectional study, we recruited hospitalized adult PLWH. Demographic characteristics, clinical information and laboratory variables were collected. Kidney disease was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, and/or isolated hematuria, proteinuria, microalbuminuria. We calculated the prevalence of kidney disease and used logistic regression to assess its associated risk factors.ResultsA total of 501 adult PLWH were enrolled, 446 (89.0%) males and 55 (11.0%) females. The median age was 39 (IQR 30–50) years old. The prevalence of kidney disease was 19.0%, 22 (4.4%) patients with eGFR < 60 mL/min/1.73 m2, 53 (10.6%) patients with hematuria, 11 (2.2%) patients with proteinuria, and 40 (8.0%) patients with microalbuminuria. 297 (59.3%) patients were receiving ART. The patients on ART had a higher prevalence of renal disease than those had not been administrated with ART (22.6% vs. 13.7%, P = 0.013). On the multivariate logistic regression analysis among patients not on ART, lower haemoglobin (OR 0.994, 95%CI: 0.902–0.988, P = 0.013) were significantly associated with kidney disease. While among those on ART, older age (OR 1.034, 95%CI: 1.003–1.066, P = 0.032), lower haemoglobin (OR 0.968, 95%CI: 0.948–0.988, P = 0.002) and lower albumin (OR 0.912, 95%CI: 0.834–0.997, P = 0.044) were significantly associated with kidney disease.ConclusionsThe prevalence of kidney disease among hospitalized PLWH in China is high, especially in patients on ART. A larger scale study on Chinese outpatient PLWH should be conducted, so as to precisely assess prevalence of kidney disease in general Chinese PLWH.

Outcomes of heart failure with preserved ejection fraction (HFpEF) in patients with and without cardiac amyloidosis: analysis from 2016–2019 national inpatient sample

Abstract Background Cardiac amyloidosis (CA), a restrictive cardiomyopathy that leads to heart failure, is often under-diagnosed in its early-stages, leading to patients being diagnosed with it in advanced stages. Most patients presenting with heart failure are presumed as non-amyloid heart failure due to a lack of awareness. A high degree of clinical suspicion is of paramount importance for early diagnosis and management of CA because the extent of cardiac involvement determines overall prognosis. Purpose Our study highlights the outcomes of HFpEF in patients with and without CA. Methods This is a retrospective cohort study involving principal hospitalizations for HFpEF between January 1, 2016 and December 31, 2019 from the National Inpatient Sample (NIS), the largest all-payer public database of hospital care data in the United States. Our study sample included discharged adult patients (≥18 years) hospitalised for HFpEF using ICD-10 codes validated in previous studies. Confounders were adjusted using multivariable regression analysis. Results During the study period, there were 87,219 index hospitalizations for HFpEF. Among them, 38.3% (n=33405) were males, 61.7% (n=53814) were females, and 0.24% (n=209) had CA. Racial distribution is as follows: 76% Whites, 13.4% Blacks, 6.4% Hispanics, and 4.2% other races. Mean patient age was 74.6±13.2 years, and 68.1% were on Medicare. A total of 59,135 (67.8%) hospitalizations had a Charlson Comorbidity Index (CCI) of &amp;gt;3, with an in-hospital mortality of 2.5%. Compared to the non-CA cohort, the CA cohort had lower prevalence of diabetes mellitus (8.5% vs 27%, p&amp;lt;0.0001) and COPD (23.5% vs 46.8%, p&amp;lt;0.001) but a higher prevalence of renal disease (51.6% vs 41.9%, p=0.004), cancer (25.4% vs 4.2%, p&amp;lt;0.001) and greater incidence of cardiogenic shock (5.2% vs 0.5%, p&amp;lt;0.001). Compared to the non-CA cohort, patients with CA were less likely to be female (38% vs 61.7%, p&amp;lt;0.001), were of similar age (mean age 74.7 vs 74.6 yrs, p=0.907), had longer length of hospital stay (LOS, 6.7 vs 5.1 days, p&amp;lt;0.001), higher in-hospital mortality (5.2% vs 2.5%, p=0.023), and a higher likelihood of having a CCI &amp;gt;3 (74.2% vs 67.8%, p=0.017). Multivariate regression analysis showed that subjects in the CA cohort had significantly increased adjusted odds of in-hospital mortality (aOR=2.2; 95% CI: 1.2–4.4; p=0.017) and cardiogenic shock (aOR=9.5; 95% CI: 5–17.9; p&amp;lt;0.001) than those in the non-CA cohort after adjusting for age, sex, race, and CCI. Conclusions Our study illustrates that patients with a history of CA admitted for HFpEF had greater incidence of cardiogenic shock, higher prevalence of renal diseases and cancer with a longer LOS, and higher in-hospital mortality. Funding Acknowledgement Type of funding sources: None.

TCT-412 Use of Intravascular Lithotripsy in a Population With a High Prevalence of Renal Disease and Diabetes: Insights From Real-World Data

TCT-412 Use of Intravascular Lithotripsy in a Population With a High Prevalence of Renal Disease and Diabetes: Insights From Real-World Data

Abstract 335: Association of Amyloidosis With In-hospital &amp; 30-day Outcomes Among Patients Hospitalized With Heart Failure

Objectives: Cardiac amyloidosis is an underdiagnosed cause of heart failure (HF). We investigated the prevalence and impact of amyloidosis in HF. Methods: All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015 were identified in the National Readmission Database (NRD). Of these, hospitalizations with amyloidosis were matched in a 3:1 fashion to hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes of interest were inpatient mortality and 30-day readmission. Multivariable logistic regression models were used to estimate the association of HF with amyloidosis with adverse clinical outcomes. Results: Overall, 2,846 (0.2%) hospitalizations had HF with amyloidosis. Hospitalizations for HF with amyloidosis had a higher prevalence of renal disease (56% vs. 45%), atrial fibrillation (48% vs 42%) and malignancy (20% vs 4%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis had higher odds of in-hospital mortality (6% vs. 3%; OR 1.60, 95% CI 1.28, 2.00), 30-day readmission (OR 1.18, 95% CI 1.06, 1.32), and longer length of stay (CIE 1.73, 95% CI 1.44, 2.03). Among the HF with amyloidosis group, there were similar incidences of CV and non-CV-related readmissions (48% and 52%, respectively), but HF was the most common primary readmission diagnosis, constituting 35% of all readmissions. The incidence of inpatient mortality and 30-day readmission did not change significantly over time during the study period for either HF hospitalizations with or without amyloidosis. Conclusion: In decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.

First Database Comparison Between the United States and Japan: Coronary Artery Bypass Grafting

International collaboration has an interest in health care quality evaluation. We compared characteristics and surgical outcomes between Asian patients in the United States and Japanese patients who undergo adult cardiac surgery. Using the Japan Adult Cardiovascular Surgery Database (JCVSD) and The Society of Thoracic Surgeons (STS) National Database, we compared Asian patients undergoing isolated coronary artery bypass graft surgery between 2013 and 2016 in Japan and the United States. The STS had 16,903 Asian patients among 573,823 patients of all races undergoing isolated coronary artery bypass graft surgery (2.95%); the JCVSD had 55,570 patients, almost all of whom are Japanese. Descriptive statistics were analyzed independently, then the data were aggregated for comparison. The JCVSD patients were older (69 vs 65 years) with a smaller body surface area (1.65 m2 vs 1.81 m2) and body mass index (24 kg/m2 vs 26 kg/m2). The proportion of males (79% vs 78%), prevalence of chronic lung disease (82% vs 86%), and diabetes mellitus (54% vs 60%) were similar. The JCVSD had higher prevalence of renal disease requiring dialysis (11% vs 6%). The numbers of anastomoses were similar (3.1 vs 3.3); off-pump procedures and the usage of right internal mammary artery were more prevalent (60% vs 15% and 38% vs 7%, respectively) in the JCVSD. The unadjusted operative mortality was 2.7% in the JCVSD and 2.1% in the STS database. Comparisons of coronary artery bypass graft surgery characteristics and outcomes were conducted between the STS National Database and the JCVSD to illustrate the value of international collaboration on adult cardiac surgery databases.

Screening urinalysis demonstrates that haematuria is a frequent finding in persons with haemophilia treated at a paediatric haemophilia treatment centre.

Haematuria is a recognized complication of haemophilia A and B (HA, HB). Adult persons with haemophilia (PWH) have a higher prevalence of renal disease than the general population. There is limited literature investigating the prevalence of haematuria in paediatric PWH. Our paediatric haemophilia treatment centre (HTC) had previously used quality improvement methods to increase the frequency of screening urinalyses at annual comprehensive visits. We retrospectively reviewed the data collected to determine the prevalence of haematuria and explore for associations in those with haematuria. Retrospective chart review to identify the frequency of haematuria on screening urinalysis in all male PWH ≥2years old. Haematuria was defined as ≥3 red blood cells (RBCs) per high power field. Univariate logistic regression was performed to evaluate for associations with haematuria. A total of 93 patients met eligibility criteria. Sixty-seven with HA (11 mild, 17 moderate, 39 severe) and 26 with HB (three mild, 16 moderate, seven severe). Forty-two of ninety-three (45%) patients were identified as having haematuria (median RBCs 7, mean RBCs 332). Of those with haematuria, 76% were identified by screening UA, as opposed to clinical symptoms, and 52% had recurrent haematuria. Older age and HA were associated with an increased likelihood of haematuria. Our study demonstrated that the prevalence of haematuria was high in PWH treated at our paediatric HTC. Future investigation is needed to determine the population-wide prevalence of haematuria in paediatric PWH and its impact on renal function.

Risk factors, clinical features, management and in-hospital outcome of ST-elevation myocardial infarction in La Réunion

A better knowledge of coronary artery disease is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention and to reduce the burden of cardiovascular diseases. La Réunion is a French overseas island located in the Indian Ocean with a population of 845,000 inhabitants. It is characterized by varied ethnic origins, the high rate of unemployment, coexisting with a high standard health system. Our aim was to describe the risk factors, characteristics, management and outcome of ST-elevation myocardial infarction (STEMI) in La Réunion. We conducted a retrospective registry that included all MI hospitalized in La Réunion in the four hospitals (1 private and 4 public) within the year 2016. Patients were identified from the hospitalization databases (PMSI-MCO). All medical records of patients hospitalized in CHU de La Réunion were reviewed. Data on risk factors, management and in-hospital mortality of STEMI were extracted and compared to recent published data in continental France (CF) (FAST-MI 2015 registry). Three hundred and three STEMI were included. Mean age was 62 ± 14 years, 37% were current smokers, 21% were already taking aspirin and 19% taking statins before MI occurrence. These features were not significantly different to those observed in CF. Conversely, we found a very high proportion of women (36%), of patients with diabetes (34%), hypertension (61%) and patient with history of cardiovascular disease (33%). Overall, the revascularization rate was comparable to CF (80% vs. 82%), with a three-fold higher rate of thrombolysis in La Réunion (20% vs. 6% in CF). In hospital mortality was very high (17%), partly due to the high incidence of cardiogenic shock (17%) and the high prevalence of renal disease (25%). Our data confirm the unusual risk factor pattern and the severity of STEMI in La Réunion and stress the need of prospective studies including biological and ethnic data.

PRESENTATION OF COPA SYNDROME IN AN ADULT: A NEWLY DESCRIBED PRIMARY IMMUNODEFICIENCY

Introduction COPA syndrome is a newly discovered primary immunodeficiency syndrome which consists of interstitial lung disease, pulmonary hemorrhage, inflammatory arthritis and renal disease. The majority of patients present with symptoms before the age of 5. Emerging case reports defining presentations of this syndrome have been important in further characterizing this disease. Case Description 55-year-old female with a past medical history of chronic cavitary aspergillosis, pulmonary hemorrhage, undifferentiated connective disease, adrenal insufficiency, and recurrent squamous cell carcinoma presented to the NIH for evaluation of immunodeficiency. Physical exam was remarkable for a left forehead scar and nose lesion being worked up for squamous cell cancer. Her significant medications included posaconazole and previously voriconazole. Remarkable negative studies include buccal biopsies for Sjogren's, rheumatoid factor (RF), cyclic citrullinated peptide (CCP), anti-nuclear antibodies, anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies. CT scan showed increased cavitation in left lung nodule. She tested positive for COPA gene in July 2016 after years of suspected immunodeficiency. Her recurrent skin cancers were initially considered to be secondary to voricozole but the persistence of recurrent skin cancers can be related to COPA syndrome. She has normal renal function while there is a higher prevalence of renal disease in COPA synrome. Currently, she is following at NIH with further investigative studies. Discussion Our case highlights the findings of recurrent cavitary aspergillosis and recurrent skin cancers in COPA syndrome. As more cases are being detected, it is important to recognize presentation and consider undiagnosed COPA syndrome in adults with suspected immunodeficiency.

Cystic Fibrosis: A Risk Condition for Renal Disease

Cystic fibrosis (CF) is the most common autosomal recessive disease affecting the Caucasian population, with a birth incidence ranging between 1:2,500 and 1:1,800. It is caused by mutations in the CF transmembrane regulator gene which is localized on 7 chromosomes. Renal disease is reported as a relatively rare complication in adult patient with CF. We evaluated proteinuria and chronic renal failure (CRF) in a population of patients with CF. A retrospective study was carried out in a referral center for CF at University of Messina in Italy. We identified all patients with renal disease, characterized by proteinuria and/or CRF, during the period 2007 to 2012 and reviewed their medical records to assess influence on renal disease of genotype, number of pulmonary exacerbation, pancreatic insufficiency, pulmonary function, CF-related diabetes, and antibiotics courses. From a population of 77 adult patients with CF, we identified 9 patients with proteinuria (11.7%), and 11 patients (14.28%) with CRF. Mean age was 35.6 (+5.1 standard deviation) years, 55% were female and 33% had diabetes mellitus. Renal biopsy was performed in 3 patients because of nephrotic syndrome in 1 patient and proteinuria with renal failure in the other 2 patients. Renal amyloidosis was disclosed in 2, whereas IgA nephropathy in 1 patient. The ΔF508 mutation in homozygosis was present in 44% of patients with proteinuria (vs. 27% of our CF population, relative risk 2.07), whereas genotype ΔF508/N1303K in 22%. ΔF508 allele mutation was present in 77.7% of proteinuric patients. Our study shows a higher prevalence of renal disease in patients with CF, than was previously described. The main reason may be related to increased life expectancy because of better management. Moreover, patients with ΔF508 homozygosis had higher risk of proteinuria.

Treatment of canine leishmaniasis with marbofloxacin in dogs with renal disease.

Treatment of canine leishmaniasis (CanL) represents a challenge. Due to the high prevalence of renal disease associated to CanL, it is important to find an effective drug that does not damage the kidneys. Marbofloxacin has been shown to be effective and well tolerated in non-azotemic dogs with leishmaniasis. To evaluate the safety and efficacy of marbofloxacin in dogs with leishmaniasis and decreased renal function, 28 dogs suffering from leishmaniasis and chronic kidney disease (CKD) were treated with oral marbofloxacin at 2 mg/Kg/day for 28 days. During treatment dogs were assessed by performing weekly physical exams, measuring blood pressure and evaluating blood and urine parameters. Lymph node aspirations were also obtained at days 0 and 28. The global clinical score decreased significantly, from 6.2±3.4 to 4.7±3.1 (p = 0.0001), after treatment. Marbofloxacin also decreased parasitic load in 72% of the dogs. No significant differences in plasma creatinine, urine specific gravity, urinary concentrations of cystatin C, ferritin and urinary protein loss were detected during treatment. A transient but significant decrease in blood pressure was detected up to day 14 (from 180.1±36.6 to 166.0±32.7 mmHg; p = 0.016). Moreover, dogs showed a significant increase in plasma albumin concentration (from 15.0±5.2 to 16.6±3.9 g/L; p = 0.014) and a significant decrease in globulin concentration (from 59.0±18.1 to 54.1±18.0 g/L; p = 0.005). The results demonstrate that, in addition to being effective for treatment of CanL, marbofloxacin is a very safe drug in dogs with CKD and leishmaniasis.

Renal Disease among HIV Positive Patients in Senegal

Introduction: Renal disease (RD) in human immunodeficiency virus (HIV) infection is a decisive turning point in the development and prognosis of this disease. In Africa, the prevalence varies between 2.5% and 48.6%. In Senegal, little data are available in the literature. The objective of our study was to describe the epidemiological, clinical, paraclinical, therapeutic and progressional aspects in patients living with HIV (PLWHIV). Patients and methods: This was a retrospective, descriptive and analytical study carried out over a 10-year period in the Department of Internal Medicine and Nephrology at the Aristide Le Dantec Hospital in Dakar, Senegal. We included all 15-year old and above PLHIV with available CD4 count and viral load. Results: Out of 248 PLHIV, 32 had kidney disease (KD), which means a hospital prevalence of 12.9%. The mean age was 51.22 ± 10 years (extremes of 36 and 77 years) with a sex ratio (male/female) of 1.28. Renal signs were dominated by glomerular nephropathy syndrome. It was present at 80%. Tubulo-interstitial nephropathy syndrome and chronic uremic syndrome accounted for 6.25% and 3.1% of cases, respectively. Renal function Impairment was present in 21 patients with 18 cases of acute kidney injury (85.7%) and 3 cases of chronic renal failure (14.3%), including 2 in stage 5 of chronic kidney disease. Renal biopsy (RB) was indicated and performed in 20 (62.5%) patients with glomerular signs in 12 patients (60%). Glomerular lesions were dominated by focal and segmental glomerulosclerosis (FSGS) in 6 cases, membraneous nephropathy (MN) in 4 cases and minimal change disease (MCD) in 2 cases. Tubulo-interstitial and vascular lesions were present in 45% and 12.5% of cases, respectively. In highly active antiretroviral therapy (HAART), 12 (37.5%) patients had total remission, 9 (28.12%) had partial remission. One (3.12%) death from severe metabolic acidosis on chronic renal failure was deplored. Conclusion: This study illustrates the high prevalence of RD in PLHIV in our exercise context.

Abstract TP169: Temporal Trends and Outcomes of Acute Ischemic Stroke in Patients With Human Immunodeficiency Virus Infection

Introduction: Human Immunodeficiency Virus (HIV) infection is associated with acute ischemic stroke (AIS) and HIV incidence is increasing yearly. Neurological complications (NC) are common in HIV and may increase stroke risk, but no large population based studies have studied NC in HIV and the HIV-AIS association. Hypothesis: We hypothesized that: HIV prevalence among AIS is increasing over time; HIV is associated with worse outcomes and greater cost in AIS; and NC increases risk of AIS. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS, HIV and NC were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, Jonckheere trend test, and the Wilcoxon rank-sum test. Results: Among 5,224,074 AIS hospitalizations, 8277(0.16%) had HIV. Those with HIV, compared to without, were more often younger (median 49 vs. 72 years; p&lt;0.001), male (69.0% vs. 45.5%; p &lt;0.001) and Black (59.5% vs. 15.8%; p&lt;0.001). AIS with HIV was associated with discharge to skilled nursing facilities and intermediate care facilities (48.7% vs. 43.3%; p&lt;0.001), lower use of Medicare/Medicaid (69.1% vs. 74.6%; p&lt;0.001), and increased length of stay (+3 days; p&lt;0.001) and cost (+$6714; p&lt;0.001). Among those with HIV and AIS, only 5.6% had concurrent NC (p&lt;0.001), including CMV encephalitis (1.45%), neurosyphilis (1.30%), cryptococcal meningitis (0.99%), cerebral toxoplasmosis (0.14%), and primary CNS lymphoma (0.13%). On trend analysis, prevalence of concurrent AIS and HIV increased from 0.11% in 2000 to 0.17% in 2011 (p&lt;0.001). Those with HIV in AIS, compared to those without HIV, had lower prevalence of hypertension (52.6% vs. 75.6%; p&lt;0.001) and diabetes mellitus (19.7% vs. 32.2%; p&lt;0.001), but higher prevalence of renal disease (31.6% vs. 24.6%; p&lt;0.001), and psychosis and depression (31.4% vs. 12.1%; p&lt;0.001). Conclusions: There was an increasing trend over time of HIV infection in AIS hospitalizations and increased discharge to long-term care facilities and high cost burden. Further research would clarify AIS risk factors in HIV patients to mitigate adverse outcomes, considering the lower prevalence of traditional AIS risk factors.

High lactate levels are predictors of major complications after cardiac surgery

Although hyperlactatemia after cardiac surgery is common, the implications of raised levels remain controversial. The aim of this study was to evaluate whether high lactate levels after cardiac surgery are predictors of major complications including mortality. This was a substudy of TRACS (Transfusion Requirements After Cardiac Surgery), which was designed as a prospective, randomized, controlled trial evaluating the effects of a transfusion strategy on morbidity and mortality. Of the 502 patients enrolled, 52 (10%) had at least 1 major complication. Patients with complications were older, had a higher EuroSCORE, lower left ventricular ejection fraction, lower preoperative hemoglobin, a higher prevalence of renal disease, and received more blood transfusions than the group without complications. Lactate levels were higher in the group with complications at the end of surgery (3.6 mmol/L [2.8-5.1] vs 3.3 mmol/L [2.2-4.8]; P = .018), immediately after intensive care unit (ICU) admission (0 hour) (4.4 mmol/L [3.1-8.4] vs 4 mmol/L [2.6-6.4]; P = .048); 6 hours (4 mmol/L [2.7-5.8] vs 2.6 mmol/L [2-3.6], P < .001), and 12 hours after admission (2.3 mmol/L [1.8-3.2] vs 1.7 mmol/L [1.3-2]; P < .001). In a multivariate model, higher age (odds ratio [OR], 1.048, 95% confidence interval [CI], 1.011-1.086; P = .010), left ventricular ejection fraction (LVEF) lower than 40% (OR, 3.03; 95% CI, 1.200-7.510; P = .019 compared with LVEF of 40%-59%; OR, 3.571; 95% CI, 1.503-8.196; P = .004 compared with LVEF higher than 60%), higher EuroSCORE (OR, 1.138; 95% CI; 1.007-1.285; P = .038), red blood cell transfusion (OR, 1.230; 95% CI, 1.086-1.393; P = .001), and lactate levels 6 hours after ICU admission (OR, 3.28, 95% CI; 1.61-6.69; P = .001) are predictors of major complications. Hyperlactatemia 6 hours after ICU admission is an independent risk factor for worse outcomes in adult patients after cardiac surgery.

Image fusion for hybrid repair of dislocated superior mesenteric branch of a branched endovascular aortic graft

Recent advances in imaging technology allow the projection of volumetric imaging data from the preacquired computed tomography angiography over live fluoroscopy during interventions. This "fusion" technology is currently underused, although its application carries distinct advantages. We introduce a case in which fusion technology was used for the placement of two thoracic and one branched abdominal aortic endograft and to treat late dislocation of its side branch using a hybrid technique.

Dose reductions and delays in patients (pts) with renal cell carcinoma (RCC) treated with sorafenib (SR) or sunitinib (SU): Retrospective analysis of two large U.S. health care claims databases.

6090 Background: A previously conducted retrospective analysis demonstrated that RCC pts treated with first-line SU have a higher incidence of dose reduction than pts treated with SR. The primary objective of this study was to validate these findings through the addition of a second claims database and introduction of a comparison of treatment delays. Methods: Authors pooled data from two U.S. health care claims databases to create the primary dataset used to support this retrospective cohort study. Claims originated from the care of 35 million pts per year on average from 2002 to 2009 and represented all U.S. census regions. The analysis cohort included pts with ≥ 2 RCC claims (ICD9 189.0 or 198.0) who had continuous coverage during illness, ≥ 180 days' coverage preceding diagnosis (first RCC claim) with no prior SR/SU treatment. Only pts with ≥ 2 dispensings of standard doses of SR or SU as first-line treatment were compared. Reductions in dose and treatment delays (interruption of treatment for > 30 d for SR, > 42 d for SU) were tracked across first-line therapy. Results: Most first-line pts were treated initially with standard full doses (SR 89.5%, SU 88.2%; p = 0.449). Baseline characteristics were similar between 320 SR-treated and 684 SU-treated pts, except that SR- treated pts were older (mean age 62.7 vs. 60.2; p < 0.001) and had a higher prevalence of renal disease (24.1% vs. 16.8%; p = 0.007). First-line SU- treated pts were 1.95 times more likely and had a significantly higher incidence of ≥1 dose reduction (17.5% vs. 34.1%; p < 0.001). There was no difference in treatment delays between SR (19.7%) and SU (16.0%) groups (p = 0.142). Conclusions: This study, the largest comparative retrospective US claims database analysis of its kind to date, validates prior work presented by the authors. The incidences of dose reductions in this real- world cohort are comparable to those observed in phase 3 clinical trials of these agents. There was no difference in treatment delays between groups. Differences observed between SR- and SU-treated pts suggest that SR may be chosen in practice more often for older and sicker pts. Further analyses assessing outcomes are warranted. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bayer Bayer Bayer Bayer

Proton Pump Inhibitors and Clopidogrel – Hazardous Drug Interaction or Hazardous Interpretation of Data?

Proton Pump Inhibitors and Clopidogrel – Hazardous Drug Interaction or Hazardous Interpretation of Data?

Renal disease in HIV-seropositive patients in Nigeria: an assessment of prevalence, clinical features and risk factors

In order to determine the pattern of renal disease and risk factors for renal disease in HIV-infected Nigerians, we studied 400 consecutive HIV/AIDS patients (210 males, 190 females) aged between 18 and 65 years (mean +/- SD; 34.6 +/- 9.4 years), and examined renal disease factors attributable to the infection. Diagnosis of renal disease was based on the consistent presence of at least 1+ albuminuria and/or elevated serum creatinine (>132 micromol/l) as well as the absence of other identifiable causes of chronic kidney disease (CKD). We determined socio-demography and clinical findings, as well as full laboratory work-ups including haemogram, CD4+ cell count, serum electrolytes, urea, creatinine, protein, cholesterol and urine analysis. Renal biopsies were taken in 10 patients who had moderate to massive proteinuria and had consented to the procedure. Finally, we compared HIV/AIDS cases with and without renal disease to determine the risk factors for nephropathy. We observed a high prevalence of renal disease (proteinuria and/or elevated serum creatinine), which was present in 152 (38%) of the patients. This subgroup included 74 males and 78 females with a M:F ratio of 1:1. The mean age (+/-SD) was 35.8 (+/-10.01) years. Systolic and/or diastolic hypertension was seen in 13.2% of these patients while the mean (+/- SD) body mass index (BMI) and packed cell volume (PCV) were 18.5 (+/-3.1) kg/m(2) and 25.26 (+/-6.81)%, respectively. The mean (+/-SD) CD4+ count was 246.49 (+/-192.8) cells/microl, while the mean (+/-SD) serum creatinine and 24-h urine protein excretion rates were 210.11 (+/-337.8) micromol/l and 2.57 (+/- 2.42) g/day, respectively. In subjects with and without nephropathy, there were significant differences in age, BMI, serum cholesterol, serum albumin and CD4+ counts, suggesting that these parameters may be risk factors for nephropathy. Histology revealed mainly focal glomerulosclerosis (FGS) with glomerular collapse. We conclude that the prevalence of proteinuria in HIV-seropositive patients is high in Nigeria. Such subjects show an equal male:female distribution, and glomerular histology revealed that a majority of biopsied patients had the collapsing FSGS variant. The risk factors for renal disease included severity of the HIV infection (inferred from the generally low CD4+ count), anaemia, malnutrition and increasing age.

MORTALITY OF CAPTIVE BLACK-FOOTED FERRETS (MUSTELA NIGRIPES) AT SMITHSONIAN'S NATIONAL ZOOLOGICAL PARK, 1989–2004

Black-footed ferret (Mustela nigripes) mortality was investigated retrospectively based on the pathology records of 107 captive animals held at Smithsonian's National Zoological Park from 1989 to 2004. The majority of deaths in neonates were due to cannibalism (n = 42; 64.6%) and maternal trauma (n = 11; 16.9%); both of these causes of mortality decreased during the study period. Prior to 2001, juvenile mortality was most often caused by gastrointestinal disease (n = 11; 52.4%), including coccidiosis, salmonellosis, and clostridium infection. In 2001, improvements in husbandry, hygiene, and medical treatment led to decreases in juvenile mortality associated with gastrointestinal disease. The most common causes of death in adult ferrets were renal or neoplastic disease. The etiology of the high prevalence of renal disease in the last 4 yr of the study is unknown; it was not associated with increasing age or inbreeding. Improved hygiene and vigilant monitoring for signs of gastrointestinal and renal disease will continue to improve the success of the captive propagation of this species.

Genetic linkage of systemic lupus erythematosus to 13q32 in African American families with affected male members

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder involving genetic and environmental factors. Previously, our group showed that SLE females with affected male relatives have higher prevalence of renal disease than SLE females with no affected male relatives in a sample of 372 individuals from 159 families. By adding 392 individuals from 181 new families, we replicated this finding in the largest collection of families with affected males, confirming our hypothesis that multiplex SLE families with at least one affected male member ("male families") comprise a distinct subpopulation of SLE multiplex families. We studied 64 male families by a genome-wide scan for SLE and found the largest signal (lod=3.08) at 13q32 in 18 African American male families using an affected-relative-pair model-free linkage method. Closer examination of IBD sharing at this region suggested a dominant mode of inheritance. Multipoint model-based linkage analysis generated a lod score of 3.13 in the same chromosomal region with a low-disease allele frequency of 0.0004 and a disease penetrance of 0.5 for the 18 African American male families. We performed fine mapping in these and three additional African American male families and the SLE predisposing locus was localized to a region tightly linked to the marker D13S892. We have therefore confirmed the linkage of SLE to 13q32, which was reported previously, and suggested that an SLE susceptibility gene in this region is specific to predisposition of African Americans to a specific form of SLE, with males at high risk.

Activation of the interferon‐α pathway identifies a subgroup of systemic lupus erythematosus patients with distinct serologic features and active disease

Gene-expression studies have demonstrated increased expression of interferon (IFN)-inducible genes (IFIGs) in peripheral blood mononuclear cells (PBMCs) of many patients with systemic lupus erythematosus (SLE), with a predominant effect of type I IFN. This study examined the hypothesis that increased disease severity and activity, as well as distinct autoantibody specificities, characterize SLE patients with activation of the type I IFN pathway. Freshly isolated PBMCs from 77 SLE patients, 22 disease controls, and 28 healthy donors were subjected to real-time polymerase chain reaction for 3 IFIGs that are preferentially induced by IFNalpha, and the data were used to derive IFNalpha scores for all individuals. Expression of IFIGs was significantly higher in SLE patients compared with disease controls or healthy donors. SLE patients with high and low IFNalpha scores were compared for clinical manifestations of disease, disease severity, disease activity, serologic features, and potential confounders, by bivariate and multivariate analyses. SLE patients with a high IFNalpha score had a significantly higher prevalence of renal disease, a greater number of American College of Rheumatology criteria for SLE, and a higher Systemic Lupus International Collaborating Clinics damage index (SDI) score than did SLE patients with low IFNalpha scores. Patients with high scores showed increased disease activity, as measured by lower C3 levels, hemoglobin levels, absolute lymphocyte counts, and albumin levels, and a higher anti-double-stranded DNA (dsDNA) titer, erythrocyte sedimentation rate, and SLE Disease Activity Index 2000 score. The presence of antibodies specific for Ro, U1 RNP, Sm, and dsDNA, but not phospholipids, was significantly associated with a high IFNalpha score. Logistic regression analysis confirmed that renal disease, higher SDI scores, low complement levels, and presence of anti-RNA binding protein (RBP) autoantibodies were associated with a high IFNalpha score. Activation of the IFNalpha pathway defines a subgroup of SLE patients whose condition is characterized by increased disease severity, including renal disease, increased disease activity, reflected in complement activation, and autoreactivity to RBP.