Epidemiology - CKD 5D II

Nephrology Dialysis Transplantation 28 (Supplement 1): i472–i486, 2013 doi:10.1093/ndt/gft151 EPIDEMIOLOGY - CKD 5D II MP552 SHORT AND LONG-TERM OUTCOMES OF THE HEMODIALYSIS SELF MANAGEMENT INTERVENTION RANDOMISED TRIAL (HED-SMART) - A PRACTICAL LOW INTENSITY INTERVENTION TO IMPROVE ADHERENCE AND CLINICAL MARKERS Introduction and Aims: Adherence to treatment recommendations on diet, fluid and medication is important to maximize good clinical outcomes in Hemodialysis yet it remains suboptimal and not well-understood. This trial set out to examine the effect of the HED- SMART intervention, a four-session, group-delivered self-management intervention on treatment adherence indicators. Methods: Eligible HD patients were randomized to either usual care (N= 133) or HED-SMART intervention (n=102). Measures of self-report adherence, self-management skills and biochemical markers were collected at baseline, immediately and at 3 and 9 months post-intervention. The intervention was facilitated by renal healthcare professionals and involved problemsolving and goal-setting for fluid control, diet and medication. Results: A total of 235 participants were enrolled [mean age ± 53.46 (±10.41) years]. The study was completed by 74.8%. Significant differences between groups were found in change in interdialytic weight gains, potassium and phosphate levels during the intervention phase and the 3-month follow-up indicating improved dietary/fluid control and medication intake for the intervention participants (all p <.01). The Improvements in weight gains were maintained by 9 months yet the change in phosphate and potassium levels at 9 months was small and not significant ( p = 0.08). Significant differences between groups were found in secondary outcomes across all time points: self-reported adherence, self-management skills and self- efficacy. There were no adverse effects. Conclusions: These analyses indicate the efficacy of the HED-SMART program with significant post-intervention improvements in both clinical markers and self-report adherence. These observed improvements, if supported and maintained at the longer follow-up (18 months), could significantly reduce ESRD-related complications in the longer term. Given the feasibility of this kind of program, it has strong potential for providing effective support to many hemodialysis patients in the future. MP553 LEFT VENTRICULAR MASS IS A POWERFUL RISK FACTOR FOR ALL-CAUSE AND CARDIOVASCULAR DEATH IN END STAGE KIDNEY DISEASE (ESKD) PATIENTS ON DIALYSIS BUT DOES NOT CONTRIBUTE TO PROGNOSIS: AN ANALYSIS IN TWO EUROPEAN COHORTS Giovanni Tripepi1, Bruno Pannier2, Francesca Mallamaci1, Gerard London2 and Carmine Zoccali1 1 Clin. Epid. and Physiopath. of Renal Dis. and Hypertens. CNR-IBIM Reggio Calabria Italy, 2INSERM Nancy France Introduction and Aims: Left Ventricular Hypertrophy (LVH) is indisputably one of the strongest risk factors for death and CV events in end stage kidney (ESKD) patients. Causality apart, the concept that LVH is useful for CV risk stratification in ESKD has never been formally tested by state-of-art statistical analyses including risk discrimination (area under the ROC curve, AUC) and risk calibration and re-classification. Methods: We re-analysed the prognostic power of LVMI for all-cause and CV death in two independent ESKD cohorts in Italy and in France, the Cardiovascular Risk Extended Evaluation cohort (CREED;age: 60±15 years; mean FU duration: 55 months, n=254) and the Hospital Manhes cohort (HM, Paris;age: 53±16 years, mean FU duration:33 months, n=270]. Results: Mortality rate was 16/100 persons-year (CV death:50%) in the CREED cohort and 19/100 person-years (CV death:68%) in the HM cohort. In both cohorts, LV Mass Index (LVMI) predicted all-cause [CREED, hazard ratio (HR)(2 g/m2.7): 1.05; HM, HR: 1.03] and CV death [HR: 1.06 and 1.05, respectively] (all P<0.001). In these cohorts, the AUCs of LVMI for all-cause death were 0.71±0.03 (CREED) and 0.67±0.03 (HM) and those for CV death 0.64±0.04 and 0.69±0.03 which were lower than those by age alone both for all-cause (CREED: 0.81±0.03; HM: 0.88±0.02) and CV mortality MP554 PATIENT AND FACILITY-LEVEL VARIATION IN THE TIMING OF DIALYSIS INITIATION ACROSS CANADA: CANADIAN KIDNEY KNOWLEDGE TRANSLATION AND GENERATION NETWORK (CANN-NET) Manish Sood1, Braden Manns2, Joanne Kappel3, David Naimark4, Allison Dart1, Paul Komenda1, Claudio Rigatto1, Brett Hiebert1 and Navdeep Tangri1 1 University of Manitoba Winnipeg Canada, 2University of Calgary Calgary Canada, 3 University of Saskatchewan Saskatoon Canada, 4University of Toronto Toronto Canada Introduction and Aims: The appropriate timing of dialysis initiation in outpatients with progressive chronic kidney disease remains controversial with concerns that initiation at a higher GFR is associated with an increase in mortality. The purpose of this study is to determine the variation in timing of dialysis initiation across dialysis facilities and geographic regions in Canada after accounting for patient level factors (case-mix). Methods: Data on 33, 263 dialysis patients, 63 dialysis facilities and 12 geographic regions from the Canadian Organ Replacement Registry (CORR) with an eGFR measure at dialysis initiation between Jan. 2001 and Dec. 2009 were included in the final analysis. eGFR was estimated by the MDRD equation. Multi-level models were used to evaluate the variation in timing of dialysis by eGFR at the patient-, facility- and geographic-level. Models were adjusted for patient and facility characteristics to determine the relative variability at each level. Results: The mean eGFR and proportion initiated with an eGFR > 10.5 mls/min/m2 varied considerably across geographic regions and over the study period. For instance, in patients with >3months of predialysis care, the proportion initiating dialysis with an eGFR>10.5mls/min was 37.3% varying from 20.2% to 60.2% across geographic regions. In unadjusted models, variation of 2.6, 8.2 and 89.2% were attributable to geography, facility and patient-level characteristics. After adjustment for case-mix and facility-level quality indicators, 95.3, 4.5 and 0.2% of the variability was attributable to patient, MP554 © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: [email protected] Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Konstantina Griva1, Nandakumar Mooppil2, Deby Sarojiuy Pala Krishnan2, Hayley McBain3 and Stanton P. Newman3 1 Psychology National University Singapore Singapore Singapore, 2National Kidney Foundation National Kidney Foundation Singapore Singapore, 3Behavioural Medicine City University London United Kingdom (CREED: 0.66±0.04; HM: 0.78±0.03]. All predictive models were well calibrated, i.e. there was no significant difference between observed and predicted outcomes. In the CREED cohort a predictive model including Framingham risk factors, anti-hypertensive treatment, CV comorbidities, heart rate and two major ESKD-related risk factors (Hb and albumin) produced an AUC of 0.89±0.02 for all-cause death and 0.76±0.03 for CV death. The corresponding figures in the HM cohort were 0.92±0.02 and 0.87±0.02, respectively. LVMI did not materially affect the discrimination power for all-cause (CREED 0.89 vs. 0.89; HM: 0. 93 vs. 0.92) and CV death (CREED:0.76 vs. 0.76; HM: 0.88 vs. 0.87). In an aggregate analysis of the two cohorts (n=524) the net reclassification index (NRI) by LVMI was low and not significant both for all-cause (NRI: 4.5%, P=0.11) and CV mortality (NRI: 3.4%, P=0.33). A re-classification analysis carried out by calculating the integrated discrimination improvement (IDI) provided similar results (all-cause mortality, IDI: P=0.89; CV death, IDI: P=0.88). Conclusions: LVMI is a strong CV risk factor in the ESKD population. However, the prognostic power of this biomarker is by far lower than that by age alone or combined with standard,easily available, risk factors. While LVH remains a fundamental treatment target in ESKD, measurement of LVMI solely for risk stratification is unwarranted in these patients because it does not provide any additional information as compared to standard risk factors. Abstracts Nephrology Dialysis Transplantation facility and geography. The adjusted odds ratio for initiating dialysis with an eGFR > 10.5 was similar across all geographic regions except one suggesting that the noted variation across facilities and geographic regions was due to patient differences. This was consistent when eGFR was examined as a continuous variable, categorized as > 12.0 mls/min/m2 or in an analysis limited to patients with > 3 months of pre-dialysis care. Conclusions: We observed significant variation in timing of dialysis initiation across geographic regions, which were predominantly explained by patient-level variation. These data suggest similar practice patterns across Canada, with the predominant factor impacting dialysis initiation being patient characteristics. MP555 ASSOCIATIONS OF CHANGES IN QUALITY OF LIFE WITH MORTALITY AND HOSPITALIZATION: RESULTS FROM THE DOPPS Introduction and Aims: Cross-sectional measures of Health Related Quality of Life (HR-QOL) are associated with mortality and hospitalization among hemodialysis (HD) patients. Our aims were to describe within-patient changes in HR-QOL and estimate their effects on the rates of mortality and hospitalization. Methods: 13,786 patients had >1 measurement of HR-QOL from the Dialysis Outcomes and Practice Patterns Study (DOPPS) annual patient questionnaire (PQ). Changes in physical (PCS) and mental (MCS) component summary scores of the KDQOL-36TM were defined as the score from the second PQ (PQ2) minus score from the first PQ (PQ1). Median time from PQ1 to PQ2 was 12 months (IQR: 11, 14). Effects of change in HR-QOL ( per 5 point decline) on both mortality and first hospitalization were estimated using Cox regression with time at risk (median: 11 months, IQR: 6, 18) beginning at PQ2, adjusting for potential confounders. In addition, effects of HR-QOL at PQ2 (3 categories) were estimated in separate Cox models by category of HR-QOL at PQ1. Results: Mean ± SD age was 61±4 years; 59% were male, 32% diabetic, and mean albumin was 3.8±0.5 g/dL. Median PCS and MCS from PQ1 were 37.5 (IQR: 29.4, 46.2) and 46.4 (IQR: 37.2, 54.9); mean changes in PCS and MCS from PQ1 to PQ2 were -0.2 (IQR: -5.5, +4.7) and -0.1 (IQR: -6.8, +5.9). A decline in PCS and MCS from PQ1 to PQ2 was associated with all-cause mortality (PCS, HR=1.10 per 5 points, 95% CI: 1.07-1.14; MCS, HR=1.06 per 5 points, 1.04-1.08) and hospitalization (PCS, HR=1.02 per 5 points, 1.01-1.04; MCS, HR=1.02 per 5 points, 1.01-1.04). Change in HR-QOL was associated with all-cause mortality across levels of HR-QOL scores at PQ1 (Table). Conclusions: Changes in HR-QOL in HD patients are common, and are associated with mortality and hospitalization. Monitoring changes in self-reported HR-QOL measures in HD patients may help to identify a subset of patients at high risk for adverse outcomes and allow for targeted interventions to improve HR-QOL and reduce these risks. ASSOCIATION OF MULTIPLE FACILITY QUALITY INDICATORS WITH MORTALITY: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS) F. Tentori1, L. Zepel1, A. Karaboyas1, D. Mendelssohn2, T. Ikizler3, R. Pisoni1, S. Fukuhara5, B. Gillespie4, B. Bieber1 and B. Robinson1 1 Arbor Research Ann Arbor MI United States, 2Humber River Regional Hospital Weston ON Canada, 3Vanderbilt U Nashville TN United States, 4U of Michigan Ann Arbor MI United States, 5Kyoto U Graduate School of Medicine and Public Health Kyoto Japan Introduction and Aims: Dialysis providers often use the facility proportion of patients meeting clinical targets (“facility quality indicators”) as indicators of quality of care. Patients from dialysis units with better quality indicators may experience lower mortality. The combination of quality indicators associated with the best patient outcomes is not known. We assessed the distribution of quality indicators and their association with mortality, individually and in combination, in the international DOPPS cohort. Methods: 12,305 DOPPS 3 and 4 participants in 11 countries were included. Japan was excluded due to differing clinical targets. The case-mix adjusted quality indicators ( proportion of facility patients who achieved the clinical targets for modifiable practices, i.e. interdialytic weight gain [IDWG] <5.7%, hemoglobin ≥10 g/dl, Kt/V ≥1.2, fistula use, calcium 8.4-9.5 mg/dl, phosphorus 3.5-5 mg/dl, and renin angiotensin system [RAS] inhibitor use) were calculated using linear mixed models adjusting for patient demographics and comorbidities. Cox models were used to analyze the association between mortality and: (1) each adjusted quality indicator individually; and (2) the combination of adjusted facility quality indicators selected using a best subset selection method. Results: The distribution of crude facility quality indicators varied widely across facilities (Figure 1) and across countries (data not shown). Achievement of most quality indicators individually was associated with lower mortality (Figure 1). Using best subset selection, we identified the combination of the three adjusted quality indicators (fistula use, phosphorus, and hemoglobin) to have the strongest association with survival. Conclusions: The large variability in quality indicators observed likely in part reflects differences in clinical practices, rather, than patient characteristics alone. The combination of fistula use and achievement of hemoglobin and phosphorus targets has the potential to substantially improve survival in HD patients, though replication of findings in other datasets is needed. Since all of these practices are readily modifiable, clinicians may focus on these to improve quality of care and possibly impact patients' outcomes. MP556 MP557 MP555 Volume 28 | Supplement 1 | May 2013 PATIENT INVOLVEMENT WITH THE TASKS OF IN-CENTER HEMODIALYSIS AND HEALTH-RELATED QUALITY OF LIFE IN THE DOPPS Martin Wilkie1, Angelo Karaboyas2, Hugh Rayner3, Richard Fluck4, Hal Morgenstern2,5, Yun Li2,5, Peter Kerr6, David Mendelssohn7, Björn Wikström8, Francesca Tentori2, Ronald Pisoni2 and Bruce Robinson2,5 1 Sheffield Kidney Institute Sheffield United Kingdom, 2Arbor Research Collaborative for Health Ann Arbor United States, 3Birmingham Heartlands Hospital Birmingham United Kingdom, 4Derby City General Hospital Derby United Kingdom, 5Univ of Michigan Ann Arbor United States, 6Monash Medical Centre Clayton Australia, 7Humber River Regional Hospital Toronto Canada, 8Uppsala Univ Uppsala Sweden doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Jeffrey Perl1, Angelo Karaboyas2, Francesca Tentori2, Hal Morgenstern2,3, Ananda Sen3, Hugh Rayner4, Raymond Vanholder5, Christian Combe6, Takeshi Hasegawa7, Donna Mapes2, Bruce Robinson2,3 and Ronald Pisoni2 1 St. Michael's Hospital, Univ of Toronto Toronto Canada, 2Arbor Research Collaborative for Health Ann Arbor United States, 3Univ of Michigan Ann Arbor United States, 4Birmingham Heartlands Hospital Birmingham United Kingdom, 5 University Hospital Ghent Belgium, 6Centre Hospitalier Univ de Bordeaux Bordeaux France, 7Showa Univ Fujigaoka Hospital Yokohama Japan MP556 Abstracts MP557 MP558 FUNCTIONAL DEPENDENCE FOR ACTIVITIES OF DAILY LIVING IN PREVALENT DIALYSIS PATIENTS IN THE DOPPS Sarbjit Vanita Jassal1, Leah Comment2, Angelo Karaboyas2, Brian Bieber2, Hal Morgenstern2,3, Ananda Sen3, Patricia De Sequera4, Mark Marshall5, Shunichi Fukuhara6, Bruce Robinson2,3 and Ronald Pisoni2 1 University Health Network Toronto Canada, 2Arbor Research Collaborative for Health Ann Arbor United States, 3University of Michigan Ann Arbor United States, 4 Hospital Infanta Leonor Madrid Spain, 5Middlemore Hospital Auckland New Zealand, 6Kyoto University Kyoto Japan Introduction and Aims: Based on USRDS data showing increased mortality in patients unable to walk, we hypothesized that functionally dependent patients are more likely to die during follow-up than are functionally independent patients, even when adjusting for case mix. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides an opportunity to assess self-reported functional dependence and its association with mortality in 4 regions: Australia/New Zealand, Europe, Japan, North America. Methods: Functional dependence was measured in 7,879 patients in DOPPS 4 (2009-11), using a functional status (FS) score based on combining measurements of 5 basic and 8 instrumental activities of daily living (FS scoring range 1.25 to 13, with lower scores reflecting higher dependence). Cox regression, stratified by country, was used to estimate the effects of FS categories on all-cause mortality, adjusting for demographics, comorbidities, vascular access, and biomarkers. Results: As evidenced in the Figure, the prevalence of full independence (FS score = 13) declined with increasing age in all regions. Overall, 64% of patients reported some dependence. The most commonly affected activities were doing housework/handyman work, doing laundry, and grocery shopping. Compared with patients with full independence, the adjusted hazard ratio (95% CI) of mortality was 1.23 (1.02-1.47) and 1.66 (1.39-1.99) for patients with minimal (11 ≤ FS < 13) to moderate (8 ≤ FS < 11) degrees of dependence, and 2.29 (1.85-2.84) for patients with high levels of dependence (FS < 8). Conclusions: Functional dependence is prevalent at all ages in this international dialysis population, and it is positively associated with mortality. Although its effect on mortality is difficult to tease out from the effects of other health-status measures, including comorbidity, our findings suggest that assessment of functional disability may be a useful marker to follow for all dialysis patients. i | Abstracts MP558 MP559 EFFECT OF PROLONGED WEEKLY HEMODIALYSIS ON SURVIVAL OF MAINTENANCE HEMODIALYSIS PATIENTS: META-ANALYSIS OF CONTROLLED STUDIES Hui Min Jin2 and Yu Pan1 1 Division of Nephrology Shanghai Pudong Hospital Shanghai China, 2Division of Nephrology Fudan University, Pudong Hospital Shanghai China Introduction and Aims: Use of prolonged nocturnal or daytime hemodialysis (PHD, more than 12 h per week) is associated with improvement of some clinical parameters relative to conventional hemodialysis (CHD, 4 h sessions, thrice weekly), but the effect on survival is unclear. The purpose of this meta-analysis is to determine whether PHD improves survival of patients undergoing maintenance HD. Methods: Systematic review of observational studies by meta-analysis.Electronic searches in MEDLINE (PubMed, 1966 to 2012), EMBASE (1974 to 2012), www. clinicaltrials.gov, and the Cochrane Controlled Clinical Trials Register Database. All prospective or retrospective studies were considered eligible if they were prospective cohort studies or observational studies that compared CHD with PHD (more than 12 h of HD per week due to more HD sessions or increased duration of HD sessions) and the final outcome was all-cause death or mortality. Results: 13 studies with a total of 85 722 participants (10 285 PHD patients, 75 437 CHD patients) met the inclusion criteria. Summary estimates indicated that PHD was associated with decreased risk of mortality (OR = 0.72, 95%CI: 0.64–0.81, p < 0.00001). Analysis of residual confounders of pooled results from six retrospective studies indicated that PHD patients were less likely to have low hemoglobin (11.7 vs. 11.2 g/dL, p < 0.01), younger (51.2 vs. 58.8 years, p < 0.01), less likely to have diabetes (27.1% vs. 40.8%, p < 0.01), and less likely to use a catheter (18.4% vs. 27.1%, p < 0.01), so these may have affected the outcome measure in these studies. Conclusions: PHD is associated with improved survival relative to CHD, although residual confounders have affected this relationship in retrospective studies. Large, multi-center randomized, controlled trials are needed to confirm our results. MP560 DETERMINANTS OF PRE-DIALYSIS SERUM SODIUM TRENDS AND VARIABILITY AND THEIR ASSOCIATIONS WITH SURVIVAL IN INCIDENT HEMODIALYSIS PATIENTS: RESULTS FROM THE MONITORING DIALYSIS OUTCOMES (MONDO) INITIATIVE Jochen G. Raimann1, Michael Etter2, Jeroen Kooman3, Nathan Levin1, Daniele Marcelli4, Christina Marelli5, Frank van der Sande3, Stephan Thijssen1, Len Usvyat6, Peter Kotanko1 and MONDO Consortium7 1 RRI NYC United States, 2FMC AP Hong Kong China, 3Maastricht University Medical Center Maastricht The Netherlands, 4FMC EMELA Bad Homburg Germany, 5FMC LA Bad Homburg Germany, 6FMC NA Waltham United States, 7 MONDO Consortium NYC United States Introduction and Aims: Stable pre-hemodialysis (HD) serum sodium (SNa+) associates to reduced mortality in US HD patients ( pts; Raimann, ERA-EDTA 2012). We extend this analysis to other countries. Methods: The global MONDO initiative encompasses pts who started HD between 2000 and 2010 (Usvyat, Blood Purif 2013). Individual pre-HD SNa+average (avg), trend and variability as slope and standard deviation (SD), respectively, were calculated over Year 1. Pts were stratified in 3 avg SNa+ (<137; 137 to 141; >141 mEq/L) groups and tertiles of SNa+SD (<1.9, 1.9 to 2.9; >2.9 mEq/L), and SNa+slope (<-0.1, -0.1 to 0.1; >0.1 mEq/L/month). Multiple linear regression (MLR) adjusted for age, gender, white race, diabetes, urea distribution volume, interdialytic weight gain as % of body weight (IDWG%), neutrophil-lymphocyte ratio, albumin, nPCR, presence of residual renal function (RRF), serum potassium (SK+), SNa+and dialysate to SNa+ gradient (GNa+) was employed to identify predictors of SNa+ SD and trends. Time to death in Year 2 was assessed by two Cox regression analyses, one each with SNa+ slope and SNa+ Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Introduction and Aims: We measured the involvement of in-center patients in their dialysis treatment and assessed cross-sectional associations with measures of health-related quality of life in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods: Data on self-care activities (listed in Table 1) were available in DOPPS phase 4 (2009-11). Descriptive analyses included 5657 patients in 8 countries with >2% of patients reporting ≥1 activity. 3242 of these patients reported the physical (PCS) and mental (MCS) component summary of the KDQoL-36TM. Linear mixed models adjusted for many potential confounders, including country, estimated the effects of self-care activities on PCS and MCS. Results: The % of patients who performed ≥1 self-care activity was 9% overall and highest in Australia/New Zealand and Sweden (16% each, Table 1). The activity most commonly performed was setting up the machine/dialyzer (7%). Facility % of patients who performed ≥1 self-care activity was 0% in 39% of facilities, with median 4% (IQR: 0%, 12%) and 95th percentile 36%. Patients performing ≥1 self-care activity were younger (51 vs 66 yrs), had longer vintage (6.2 vs 3.6 yrs), lower catheter use (23% vs 36%), higher albumin (3.9 vs 3.6 g/dL), higher creatinine (9.3 vs 7.5 mg/dL), longer session length, (256 vs 238 min), and fewer comorbidities than patients performing none of the 4 activities. For patients performing ≥1 self-care activity: crude mean PCS (39.2 vs 34.9) and MCS (47.9 vs 45.3) were higher, and after covariate adjustment, mean PCS was 1.6 points higher (95% CI: 0.3, 2.8) and mean MCS was 2.2 points higher (95% CI: 0.7, 3.7). Conclusions: Greater patient involvement in the routine tasks of hemodialysis is associated with better physical and mental quality of life; however, methodological limitations limit causal inference. Marked variation in up-take of self-care is likely to represent facility preferences for empowering patients. The impact and safety of this approach requires prospective evaluation. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation variability, adjusted for SNa+, age, gender, diabetes and IDWG%. Results: We studied 10771 HD pts [60±15 years, 5923 males, 4668 diabetics, IDWG% 3.8±1.4 %]. Variability was positively related to diabetes, IDWG%, SK+and GNa+, and inversely to albumin, nPCR, SNa+and RRF. Trends related positively to age and nPCR. Survival analysis identified higher variability and unstable trends as significant predictors of death in some strata. Pts with SNa+<137 mEq/L showed the highest HRs without any discernible effect of SNa+ variability and trends (Table 1). Conclusions: Our analysis in an international cohort of HD pts confirms previous findings that unstable SNa+ are associated with poor survival, particularly in pts with SNa+>137 mEq/L. This suggests that pts with unstable SNa+ may require close observation. MP562 DEPRESSION IN PATIENTS REQUIRING HEMODIALYSIS: PREVALENCE, CORRELATES AND ASSOCIATION WITH MORTALITY IN A LARGE MULTI-NATIONAL COHORT STUDY Suetonia Palmer1, Valeria Saglimbene2, Marinella Ruospo3, Jonathan Craig4, Eduardo Celia3, Ruben Gelfman3, Paul Stroumza3, Anna Bednarek3, Jan Dulawa3, Joao Frazao3, Domingo Del Castillo3, Tevfik Ecder3, Jorgen Hegbrant3 and Giovanni F.M. Strippoli2,3,4,5 1 Department of Medicine University of Otago Christchurch New Zealand, 2 Department of Clinical Pharmacology and Epidemiology Consorzio Mario Negri Sud Santa Maria Imbaro Italy, 3Diaverum Medical Scientific Office Lund Sweden, 4 School of Public Health, University of Sydney Sydney Australia, 5Department of Emergency and Organ Transplantation University of Bari Bari Italy MP560 MP561 SNa+ trends (tertiles in ascending order)Hazard Ratio (95% CI) 3.9 (2.3 to 6.5)* 3.5 (2.1 to 5.9)* 3 (1.8 to 5.1)* 2.3 (1.3 to 3.8)* 1.8 (1.1 to 3.1)* 2.1 (1.3 to 3.6)* 2.2 (1.2 to 4)* Reference group 2.3 (1.2 to 4.2)* EFFECT OF FOLIC ACID SUPPLEMENTATION ON CARDIOVASCULAR EVENTS IN NON-DIABETIC CHRONIC KIDNEY DISEASES: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Kuo-Cheng Lu1, Hsin-Yi Yang2 and Sui-Lung Su2 1 Department of Medicine Cardinal Tien Hospital, Fu-Jen Catholic University New Taipei City Taiwan Republic of China, 2School of Public Health National Defense Medical Center Taipei City Taiwan Republic of China Introduction and Aims: Homocysteine (Hcy) is viewed as a nontraditional marker of the prognosis of cardiovascular disease in the general population and in patients with chronic kidney disease (CKD). The effects of Hcy-lowering therapy in patients with CKD remain controversial. The aim of this study was to assess the effect of homocysteine (Hcy) lowering with folic acid on cardiovascular outcomes in people with CKD. Methods: We carried out a meta-analysis of published trials according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A literature search was conducted with the following databases: PubMed, the Cochrane Controlled Clinical Trials Register Database and Nephrology Filters to June 2012. Randomized trials, which include CKD patients who took more than 12 months of folic acid based Hcy-lowering therapy, were selected and the effects of interventions on cardiovascular outcomes were assessed. No language restriction was applied. Two authors independently extracted the data and reached a consensus on all of the items. The endpoints included cardiovascular events (CVD), all-cause mortality, stroke and myocardial infarction (MI). The effects of folic acid based Hcy-lowering therapy on the outcomes were assessed by a meta-analysis using random effects models. Among thirty-nine studies reviewed, 13-studies (n = 11,106) that met our inclusion criteria were included in the meta-analysis. Results: Folic acid based Hcy-lowering therapy did not prevent CVD (RR = 0.96, 95% CI = 0.90 - 1.02, I2 = 8.6%) or any of the outcomes. In subgroup analyses, in the study groups which include less than 30 percent of the patients with diabetes mellitus (DM), the use of folic acid was associated with a 21% reduction in risk of cardiovascular events when compared with controls (RR = 0.79, 95% CI = 0.65 - 0.98, I2=0%). A large decrease in Hcy levels (> 30%) from pre-treatment level was associated with a significant (24%) reduction in risk of CVD when compared with controls (RR = 0.76, 95% CI = 0.58-0.99; I2 = 0%). In predefined subgroup analyses of background folic acid fortification condition (fortification, no fortification or mix fortification), study in no fortification groups revealed a potential therapeutic beneficial effect on CVD (RR =0. 87, 95%CI = 0.74-1.03, p=0. 35) when compared with fortification groups. Conclusions: Folic acid based Hcy-lowering therapy did not prevent cardiovascular events or any of the outcomes. DM may contribute the resistant to Hcy-lowering therapy in CKD patients. The response to Hcy-lowering therapy may also be influenced by mandatory folic acid fortification measures. In addition, reducing Hcy levels by more than 30% has beneficial effects on CVD risk regardless of folic acid fortification. Volume 28 | Supplement 1 | May 2013 Introduction and Aims: Depression is highly prevalent in people with chronic kidney disease (CKD) and is linked to increased all-cause mortality, although the association with cardiovascular mortality remains uncertain and large prospective studies that sufficiently adjust for potential confounding variables are lacking. Our aim was to evaluate the association between depression and cardiovascular mortality when controlled for relevant clinical and demographic variables. Methods: We conducted a multinational prospective cohort study of 3686 adult outpatients receiving hemodialysis in 76 randomly selected dialysis centers in 9 countries within a collaborative dialysis network. Consecutivepatients receiving hemodialysis between April and November 2010 were eligible. At baseline enrolment into the study, depression was assessed by the Beck Depression Inventory (BDI) II questionnaire. Participants with a BDI score of 14 or greater were considered to have depressive symptoms. The primary outcomes were total and cardiovascular mortality at 12 months.Cox regression models were used to analyze the association between depression and mortality adjusted for clinical and demographic variables. Results: 2280 (62%) of enrolled patients provided complete data for the BDI questionnaire (mean age 64.7 (14.8) years; 60.8% of men). Of these, 1047 (46%) reported a BDI score consistent with depressive symptoms, which were associated with female gender, education, use of anxiolytic drugs, lower dialysis duration and lower albumin levels. During a mean follow-up of 11 ±2.5 months, 30 of 1047 participants with depressive symptoms and 36 of 1233 participants without depressive symptoms died from cardiovascular causes. Compared to participants with depressive symptoms experienced increased risks of all-cause (adjusted hazard ratio 1.51 [95% CI, 1.04-2.20]) but not cardiovascular-related mortality (HR, 0.64 [95% CI, 0.38-1.07]). Conclusions: Depressive symptoms affect nearly one-half of persons with end-stage kidney disease but are not associated with cardiovascular mortality in analyses controlled for clinical and demographic variables. MP563 GENDER-ASSOCIATED DIFFERENCES IN DIALYSIS PATIENTS M. Hecking6, B. Bieber1, J. Ethier3, A. Kautzky-Willer4, M. Jadoul5, A. Saito6, G. Sunder-Plassmann4, M. Säemann4, B. Gillespie2, W. Hörl4, L. Mariani6, S. Ramirez1, R. Pisoni1, B. Robinson6 and F. Port1 1 Arbor Research Ann Arbor United States, 2UM Ann Arbor United States, 3UdeM Montreal Canada, 4MUV Vienna Austria, 5UCL Louvain Belgium, 6Tokai U Isehara Japan Introduction and Aims: Gender-associated differences in hemodialysis patients could affect outcomes, but might partly be modifiable. Here we evaluated the characteristics and mortality risk of female vs male participants in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods: 36,216 hemodialysis patients from DOPPS phases 1-4 were included. Cox regression models were used to evaluate mortality (various levels of adjustments in the Figure). Because female to male differences may vary by region, analyses were performed separately for North America (NA), Europe-Australia/New Zealand, and Japan. Results: The initial prevalent cross-sections (over phases) were 43% female vs 57% male with respective mean±SD ages 63.1±14.6 vs 61.9±14.6 years, vintages 5.4±5.7 vs 5.2±5.6 years, body mass indices (BMIs) 25.3±6.8 vs 24.6±5.2 kg/m2, and 21.2% vs 13.4% being obese (all p<0.001). Among comorbidities, hypertension was recorded less frequently in females, and diabetes more frequently. Among laboratory values, females had lower serum creatinine (8.4±2.6 vs 10.0±3.2 mg/dL) and higher parathyroid hormone (302±396 vs 285±373 pg/mL; both p<0.001). Serum phosphorus levels were similar. Among modifiable variables, catheter use was higher in females (18.5% vs 12.4%, p<0.001). Mortality results (Figure) showed that gender-associated mortality differences varied by region, being greatest among Japanese and very small in NA. The female survival advantage increased further after adjusting for most modifiable variables, especially catheter use, and decreased after adjusting for cardiovascular disease. doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 SNa+ variability (tertiles in Average SNa+ ascending order) Hazard Ratio (95% CI) [mEq/L] <137 2.8 (1.7 to 4.7)* 2.7 (1.7 to 4.5)* 3.6 (2.2 to 5.8)* 137 to 141 1.7 (1 to 2.7)* 1.7 (1.1 to 2.8)* 2.3 (1.4 to 3.7)* >141 Reference group 1.8 (1 to 3.2) 2.3 (1.3 to 4.1)* Abstracts Conclusions: Fewer women were undergoing dialysis, and differed from men in many aspects of biology, especially serum creatinine, but also patient care. Our findings of regional variation in the survival advantage for women are only partly explained by similar observations in population studies. The impact of various levels of adjustments on gender-associated mortality is informative and serves to generate hypotheses regarding dialysis practices for women, e.g., with respect to catheter use and control of secondary hyperparathyroidism. Nephrology Dialysis Transplantation BP, smoking, cholesterol, background cardiovascular events and PCT interacted with baseline GFR in predicting renal outcomes. Indeed the risk of for the combined end-point was minimal in patients with low PCT and high GFR and maximal in those with low GFR and high PCT. Conclusions: Plasma procalcitonin is a more sensitive biomarker of innate immunity than CRP in CKD patients and in part reflects excessive adiposity. High PCT in CKD patients predicts progression toward kidney failure. These results are compatible with the hypothesis that alterations in innate immunity play a role in the progression of CKD in humans. MP565 A PREDICTION RULE FOR LOSS OF PHYSICAL FUNCTION IN HEMODIALYSIS PATIENTS: A COHORT STUDY Introduction and Aims: Among Japan's aging hemodialysis population, loss of physical function (PF), which leads to loss of independence, has become a major issue. We aimed to develop a validated prediction rule to identify patients who were likely to lose PF while receiving chronic hemodialysis therapy. Methods: Using data from the Dialysis Outcomes and Practice Pattern Study (DOPPS) in Japan, we conducted a cohort study involving adult hemodialysis patients with dialysis duration ≥6 months. The derivation cohort consisted of 3,411 patients from early phase (1997-2008) and the temporal validation cohort consisted of 978 patients from late phase (2009-2012). Main outcome was reduction in PF score (measured by MP563 MP564 INNATE IMMUNITY AND CKD PROGRESSION Francesca Mallamaci1, Giovanni Tripepi1, Daniela Leonardis1, Carmine Zoccali1 and MAURO Work Group2 1 Clin. Epid. and Physiopath. of Renal Dis. and Hypertens. CNR-IBIM Reggio Calabria Italy, 2MAURO Work Group Reggio Calabria Italy Introduction and Aims: Alterations in innate immunity play a role in renal damage in experimental models but the role of these alterations in the progression of CKD in humans is still poorly defined. Procalcitonin (PCT), is a biomarker of innate immunity produced by C-cells of the thyroid and by the adipose tissue. Methods: We measured serum plasma PCT levels in a cohort of 670 patients with stage 3-5 CKD and tested the relationship between this biomarker and metrics of adiposity, proteinuria, GFR and progression to kidney failure over a 3 year follow-up. None of the patients had intercurrent infectious or acute inflammatory processes. PCT was measured by an ultrasensitive immunoluminometric assay. The GFR was estimated by a Cystatin-C based equation. The relationship between PCT and renal events was tested by multivariate Cox's regression and interaction analysis. Results: Procalcitonin exceeded the upper limit of the normal range (>0.064 ng/mL) in 492 patients (67 %) while the corresponding figure for high sensitivity CRP (>1mg/L) was 170 (25 %). PCT was higher (P<0.001) in males and strongly associated with the GFR (r=0.53) as well as diabetes (P=0.004) and a history of cardiovascular (CV) events (P=0.007). Furthermore PCT was inversely related with Hb (r=-0.16, P<0.001) and with serum albumin (r=-0.10, P=0.009) and directly associated with CRP (r=0.23, P<0.001) and with white blood cells count (r =0.12, P=0.002). Of note, PCT was higher (P<0.001) in patients with large waist hip ratio (IVth quartile) than in those normal or high normal WHR (1st to 3rd quartiles). During the follow up, PCT predicted the combined renal end-point (30% GFR loss, dialysis or transplantation) (HR for 1 ng/ml increase: 2.37, 95%CI:1.25-4.48, P=0.009) in a model adjusting for age, sex, diabetes, i | Abstracts MP565 MP565 Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Shingo Fukuma1,2, Tadao Akizawa3, Takashi Akiba4, Akira Saito5, Kiyoshi Kurokawa6 and Shunichi Fukuhara1,2 1 Kyoto University, Kyoto, Japan, 2Institute for Health Outcomes and Process Evaluation Research (iHope International), 3Showa University School of Medicine, Tokyo, Japan, 4Tokyo Women's Medical University, Tokyo, Japan, 5Yokohama Daiichi Hospital, Kanagawa, Japan, 6National Graduate Institute for Policy Studies, Tokyo, Japan Abstracts Nephrology Dialysis Transplantation MP565 variables Age >75 years female albumin < 3.0 g/dl Cerebrovascular disease Peripheral vascular disease dementia Moderate activities little difficult very difficult Climbing stairs little difficult very difficult beta 0.82 0.35 1.43 0.67 0.46 1.03 1.06 2.34 0.93 1.50 MP566 PULSE WAVE VELOCITY IN END STAGE KIDNEY DISEASE PATIENTS IS A STRONG PREDICTOR OF DEATH AND CARDIOVASCULAR EVENTS BUT LARGELY FAILS TO IMPROVE RISK STRATIFICATION IN THIS POPULATION Bruno Pannier2, Giovanni Tripepi1, Francesca Mallamaci1, Carmine Zoccali1 and Gerard London2 1 Clin. Epid. and Physiopath. of Renal Dis. and Hypertens. CNR-IBIM Reggio Calabria Italy, 2INSERM Nancy France Introduction and Aims: Pulse wave velocity (PWV) is a highly reproducible indicator of arterial disease which is recommended for cardiovascular (CV) risk stratification by the European Society of Hypertension and the European Society of Cardiology. This biomarker is frequently altered in end stage kidney disease (ESKD) patients and the usefulness of PWV for risk stratification is taken for granted in this population. However, to date no study specifically investigated the prognostic value of PWV by state-of-art statistical methods including risk discrimination (Harrel's C index), calibration and re-classification (net reclassification index NRI) neither in the general population or in the ESKD population. Methods: We have therefore re-assessed the prognostic power of Aortic PWV in a cohort of ESKD patients on dialysis enrolled at Manhes Hospital of Paris (age: 53±16 yrs, mean follow-up duration: 33 months, n=270) and previously analysed with standard Cox regression analysis (Kidney Int. 2003;63:1852-60). Results: PWV (mean 11.2±3.0 m/s) was above the upper limit of the normal range (cut-off: 12 m/s) in 30% ESKD patients. During follow-up, 135 patients died (CV death: 67%). In multivariate Cox regression models adjusting for Framingham risk factors and ESKD-related risk factors (Hb, albumin, phosphate), PWV was once again confirmed a strong predictor of all-cause [Hazard ratio (HR)(3rd vs 1st tertile): 3.3, 95% CI: 1.8-5.8] and CV death (HR: 5.7, 95% CI: 2.6-18.8) both P<0.001. The Harrel's C index showed that this biomarker has a moderate discrimination power for all-cause and CV mortality (75% and 79%). However these figures did not differ from the discrimination power for the same outcomes provided by age alone (77% and 76%). A risk prediction score based on standard, easily available risk factors provided a Harrel's C index of 78% for all-cause mortality and 77% for CV death. Furthermore, PWV added a minimal discriminatory power to the simple risk prediction score for all-cause mortality (79% versus 78%) and a modest one for CV death (81% versus 77%). The Net Reclassification Index by PWV was not significant both for all-cause (NRI: 4.5%, P=0.14) and CV mortality (NRI: 7.3%, P=0.10). Conclusions: PWV is a strong CV risk factor in the ESKD population. However, the prognostic power of this biomarker is of the same order of that predicted by age alone or combined with standard, easily available, risk factors. The measurement of PWV solely for risk stratification is unwarranted in these patients because it does not give any additional information as compared to a simple score based on standard risk factors. MP567 THE RELATIONSHIP BETWEEN GLOMERULAR FILTRATION RATE AND MORTALITY AT DIALYSIS INITIATION IS INFLUENCED BY BLOOD UREA NITROGEN CONCENTRATIONS Austin G. Stack1,2, Liam F. Casserly1, Ahad A. Abdalla1,2, Bhamidipati V.R. Murthy3, Avril Hegarty2, Cornelius J. Cronin1 and Ailish Hannigan2 1 Nephrology and Internal Medicine University Hospital Limerick Limerick Ireland, 2 Internal Medicine Graduate Entry Medical School, University of Limerick Limerick Ireland, 3Transplantation Baylor College of Medicine Houston TX United States Volume 28 | Supplement 1 | May 2013 Points Assigned 2 1 3 1 1 2 25 23 Introduction and Aims: Recent studies have demonstrated an inverse relationship between timing of dialysis initiation and mortality in end-stage kidney disease with higher mortality risks for those who are initiated at higher estimated glomerular filtration (eGFR) values. It is unclear to what extent other laboratory variables influence this relationship. The aim of this study was to determine whether blood urea nitrogen (BUN) concentrations, measured at dialysis initiation, modified the association of eGFR with mortality among incident patients. Methods: We compared mortality risks among 'early start' (eGFR: 10-15, and > 15 ml/ min/1.73 m²) and 'late start' patients (eGFR: < 5ml/min and 5-10) in 570, 903 incident patients who started dialysis between 1995-2005 in the US. To examine the influence of BUN concentrations on GFR- mortality relationships, we stratified by quintile groups (Q1 < 21.8, Q2 21.8-27.5, Q3 27.5-33.2, Q4 33.2-40.7 and Q5> 40.7 mmol/l). The association of eGFR with 2-year mortality was explored using Cox regression with adjustment for demographic characteristics (age, sex, race), clinical conditions (n=13) and laboratory variables (n=3). The interaction term (eGFR*BUN)was significant in the full model. In stratified analyses, the association of eGFR with mortality was assessed in quintile groups with eGFR 5-10 ml/min as the referent. Hazard ratios (HR) and 95% confidence intervals were determined and all analyses were conducted using SAS v 9.3 (Cary NY). Results: The relationship of eGFR with mortality varied significantly according to BUN concentrations recorded prior to first dialysis. For levels of < 27.5 mmol/l, the GFR-mortality relationship was u-shaped with mortality risks lowest for patients with eGFR 5-10 ml/min. In contrast, for levels >27.5 mmol/l, the GFR-mortality relationship was direct with the greatest risks for patients with the highest eGFR values. The HR and 95% CI are shown in Table below: Conclusions: The relationship between eGFR and mortality is significantly influenced by blood concentrations of urea nitrogen. This new finding is likely to have important clinical and prognostic implications when determining optimal thresholds for dialysis initiation. MP567 BUN (mmol/l) < 21.8 21.8 to <27.5 27.5 to < 33.2 33.2 to < 40.7 > 40.7 MP568 eGFR at Dialysis Initiation (ml/min/1.73m2) <5 5 to <10 10 to <15 Referent 1.14 (1.07-1.22) 1.00 1.02 (1.01-1.03) 1.05 (1.00-1.10) 1.00 1.05 (1.04-1.06) 0.99 (0.96-1.03) 1.00 1.08 (1.07-1.09) 0.90 (0.88-0.93) 1.00 1.10 (1.09-1.12) 0.81 (0.80-0.83) 1.00 1.10 (1.09-1.11) > 15 1.05 (1.04-1.06) 1.10 (1.09-1.12) 1.15 (1.13-1.17) 1.17 (1.15-1.19) 1.12 (1.09-1.14) DEMOGRAPHICS AND OUTCOMES STUDY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD) AND END STAGE RENAL FAILURE (ERF): A UK RENAL REGISTRY ANALYSIS ON BEHALF OF THE ADPKD STUDY GROUP Catriona Shaw1, David Pitcher1 and Richard Sandford2 1 UK Renal Registry Bristol United Kingdom, 2Academic Laboratory of Medical Genetics Addenbrooke's Hospital Cambridge United Kingdom Introduction and Aims: Despite ADPKD being the most common genetic cause of ERF, uncertainty remains over aspects of optimisation of routine clinical care. Aim: To describe ADPKD specific demographics, clinical characteristics and renal replacement treatment patterns in a population with ERF. Methods: An incident adult population commencing RRT between 1/1/2000 and 2/10/ 2010 was included in this analysis. Simple cross tabulations of baseline demographics, co-morbidity and care related measures were performed. Results are stratified by Primary Renal Disease (PRD). Results: Between 1/1/2000 and 2/10/2010 47,769 individuals commenced RRT. 3111 (7%) individuals had ADPKD recorded as PRD, 34,595 (72%) individuals had another PRD other than ADPKD or diabetes, and 10,063 (21%) individuals had diabetes recorded as PRD. The median age of starting RRT was lowest in the ADPKD group (55 years (IQR 47-63) compared to 62 years (IQR 50-71) for those with diabetes and 65 (IQR 49-75) years for those with all other causes of PRD . The median age of commencing RRT by PRD group has not changed over the last 10 years. There were less co-morbid conditions in those with ADPKD who were also seen earliest by renal doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Short Form 12 Health Survey [SF12]) to the worst level after one year follow-up. A prediction rule was developed by multivariate logistic regression model. To clarify the clinical importance of PF score, we also examined the association between baseline PF score and all-cause mortality with Cox model after adjusting for potential confounders. Results: The proportions of patients with loss of PF were 6.7% and 6.3% in the derivation and validation cohort, respectively. We developed the prediction rule including 8 variables listed in Table1. AUC were 0.81 and 0.82 in the derivation and validation cohort, respectively. Figure1 shows that calibration varied in both cohorts. We also found that the worst PS level was associated with the highest mortality rate (Figure2). Conclusions: Loss of PF can be predicted by baseline variables. Our prediction rule can help physicians to identify patients who may need some interventions to keep their PF. OR (95%CI) 2.26 (1.51-3.40) 1.41 (1.03-1.94) 4.20 (1.76-10.01) 1.95 (1.29-2.96) 1.69 (1.05-2.40) 2.79 (1.17-6.64) 2.90 (1.86-4.52) 10.41 (5.77-18.78) 2.53 (1.50-4.26) 4.50 (2.47-8.20) Abstracts services. Patients with ADPKD were more likely to commence RRT with a renal transplant as first modality (11% in the ADPKD, compared with 5% in the non-ADPKD/non-diabetes group and 4% in the diabetes as PRD group). In those that start with dialysis the median time to transplant was the same irrespective of PRD. Conclusions: Despite early engagement with renal services the median age of starting RRT remains lowest in individuals with ADPKD compared with other PRD's. This could suggest that current management strategies are not effectively influencing the natural history of the disease. An ADPKD-specific national cohort and dataset is being developed as a resource for research to identify contributing factors to variation in and improvement of patient outcomes. International collaboration with other registries will be invaluable and we aim to focus on developing these networks further. MP569 ADIPONECTIN IS A STRONG MODIFIER OF THE DEATH RISK BY RESISTIN AND LEPTIN IN END STAGE KIDNEY DISEASE PATIENTS Introduction and Aims: The plasma concentrations of the three major adipose tissue cytokines (adipokines) Adiponectin (ADPN), Leptin and Resistin are substantially raised in patients with End-Stage Kidney Disease (ESKD) but the relationship between these cytokines and major clinical outcomes in this population is highly controversial. The interactions among these adipokines for the prediction of all-cause and cardiovascular (CV) mortality has never been analysed. Methods: We studied an incident-prevalent cohort of 231 hemodialysis patients (age: 60±15 years; 127 M and 104 F)monitored for 57 ± 44 months (range: 0.2 to 155 months) and, during this period, fatal cardiovascular events and death for other causes were accurately recorded. Plasma concentrations of ADPN and Resistin were measured by enzymatic immunoassays and plasma Leptin by radioimmunoassay. Results: ADPN was inversely related to Leptin (r=-0.38; p≤ 0.001) and very weakly but not significant associated to Resistin (r=-0.12; p=0.09). Leptin and Resistin were unrelated ( p=0.24).During follow-up 165 patients died (96 for CV causes). On univariate analysis, patients in the first ADPN tertile had higher all-cause ( p for trend=0.02) and CV ( p for trend=0.02) mortality than those in the other tertiles. Leptin and resistin failed to significantly predict all-cause and CV mortality ( p=NS). Remarkably, ADPN modified the resistin-mortality link both on unadjusted analysis (≤0.001) and after adjustment for traditional, peculiar of ESKD and emerging risk factors (to 0.004). The risk excess for all-cause and CV mortality ( p for effect modification 0.001 and 0.01, respectively) portended by a fixed increase in plasma resistin (20 ng/mL) was indeed maximal in patients in the first ADPN tertile (all-cause death, HR: 1.32, 95% CI: 1.11-1.58; CV death, HR: 1.42, 95% CI: 1.12-1.79), intermediate in those in the second tertile (all-cause death, HR: 1.09, 95% CI: 0.95-1.26; CV death, HR: 1.03, 95% CI: 0.85-1.25) and minimal (all-cause death, HR: 0.91, 95% CI: 0.72-1.14; CV death, HR: 0.75, 95% CI: 0.56-1.01) in patients in the third ADPN tertile. Likewise, ADPN modified the association between Leptin and all-cause mortality and the risk excess resulting from a fixed increase in leptin (100 ng/mL) was progressivelylower from the first to the third ADPN tertile (ADPN, I tertile- HR: 1.40, 95% CI: 0.94-2.07; II tertile- HR: 0.55, 95% CI: 0.26-1.17; III tertile- HR: 0.22, 95% CI: 0.05-0.88) ( p for effect modification P=0.009). Conclusions: In ESKD, ADPN is a strong modifier of the link between Resistin and Leptin with mortality. These data further highlight the role of the adipose tissue on clinical outcomes in this population and indicate that the analysis of interaction among these adipokines is fundamental to fully capture the relevance of their associations with adverse clinical outcomes. MP570 RENAL DISEASE EPIDEMIOLOGY OF ADULT AA AMYLOID IN ALGERIA Khellaf Ghalia1 1 Nephrology - Dialysis & Kidney Transplantation Centre Hospitalo-Universitaire Beni Messous Hopital Isad Hassani Alger Algeria Introduction and Aims: Amyloid Nephropathy (AN) is a disease which is present in Algeria, and it most often complicates chronic infectious diseases. The AN is a serious disease and the renal damage influences the prognosis. In this study we analyze the clinical, biological, histological, etiological and evolutionary characteristics in adult patients with AN. Methods: Our study is retrospective and multicenter. It is focused on 7947 renal biopsies performed on native adult kidneys during a period going from January 1997 to December 2011 (15 years). We have collected all the records of patients who had histologically proven amyloidosis, thanks to renal biopsy. Only typing of amyloidosis was made by the technique of Wright and immunofluorescence with serum antiAA. We studied the following parameters: age, sex, geographic origin, clinical and laboratory signs at the time of the PBR, the specific therapeutic approach based on histological findings and evolutionary track of these patients for a period of 02 years. Results: Our study was focused on 309 adult cases, representing 4.40% of the glomerular nephropathies (GN). The annual incidence is 22.6 cases per year. The average age at the time of the PBR was 45. Extremes (17-83 years). 125 Women (40%) i | Abstracts and 184 Men (60%). Symptoms at the time of renal biopsy were: edema in 290 cases (95%), renal failure: 104 cases (33.7%), Interstitial Nd: 11cases (3% ), isolated proteinuria: 07cases (2%). Triggering factors: infections :29 cases (8.43%), surgical: 15 cases (4.36%), extra-renal signs: 53 cases. Etiological research: chronic infections: 105 cases (34.5%), chronic inflammatory diseases: 92cas (24.91), hereditary diseases: 36 cases (11.65%), neoplasia: 03 cases (0.97%), Undetermined: 71cas (22.97%). The average age of our patients was 45 years, more men than women. The most common nephrologic sign is INS, and patients were normo or hypotensive. A renal failure with creatinine superior to 18 mg / l is a poor prognostic factor. The infectious origin is the most frequent. Pulmonary and extrapulmonary tuberculosis represents by far the highest percentage. The frequency of the infectious origin tends to decrease and be replaced by inflammatory origin. The undetermined causes remain frequent compared to European countries. (Inherited AN are underestimated). A review of literature in the world as well as in the Maghreb will be reported in a comparative way over the years. Conclusions: Proteinuria and plasmatic creatinine measurement must be systematic in the monitoring of chronic infectious diseases and chronic inflammatory diseases. In Algeria we have to improve etiological research on genetic amyloidosis, and to create a laboratory bench for the genetics of mediterraneanfamily feverand other hereditary amyloidosis diseases. MP571 SURVIVAL AND DIALYSIS PRESCRIPTION IN VERY OLD PATIENTS ON DIALYSIS: DATA FROM SLOVENIAN RENAL REPLACEMENT THERAPY REGISTRY Jakob Gubensek1, Miha Arnol1, Rafael Ponikvar1 and Jadranka Buturovic-Ponikvar1 1 Dept. of Nephrology University Medical Center Ljubljana Ljubljana Slovenia Introduction and Aims: The age of patients reaching end-stage renal disease and requiring renal replacement therapy (RRT) is increasing. The aim of our study was to analyze RRT and survival of patients aged ≥ 80 years. Methods: We analyzed data from the Slovenian Renal Replacement Therapy Registry and included all incident (day 1) patients ≥ 80 years of age and who started RRT between Jan 1st, 2004 and Dec 31st, 2010. Patients were followed until Dec 31st, 2010. Survival was censored in case of recovery of renal function (4 cases); none of the patients was transplanted. Results: In the observed period, 214 patients aged ≥ 80 years started RRT, which represented 13% of all incident (day 1) patients. Median age was 83 (inter-quartile range (IQR) 81-85, range 80-101) years, 48% were male, and 26% had diabetes. Most common primary renal diseases were: unknown (34%), nephrosclerosis (22%) and diabetic nephropathy (18%). At the end of their first year on RRT (or prior to death for patients not surviving the first year) the dialysis prescription was as follows: all patients were treated with hemodialysis, 10% were treated with convective methods, 29% were treated in single-needle mode; median weekly duration of dialysis was 12 (IQR 8–12) hours; 70% had 3 procedures, 29% had two and 1% had only one procedure weekly; vascular access was AV fistula in 48%, catheter in 45% and unknown in 7%. In the observed period 127 (59%) patients died, median survival was 21 months, 1-, 2-, 3- and 5-year survival rates were 68%, 45%, 36% and 18%, respectively. The cause of death was: cardio-vascular (45%), unknown (23%), infection (17%), other (9%), and malignancy (6%). Median expected survival for this group of patients using demographic data from national statistics would be 7.3 years. Conclusions: Very old patients represent a significant portion of incident dialysis patients. Many are dialyzed only twice weekly or in single-needle mode and AV fistula is used as vascular access in half of patients. The survival of octogenarians on RRT, while being much shorter compared to healthy, age-matched population, is still good. MP572 PATIENT SATISFACTION OF DIFFERENT ASPECTS OF LONG-TERM HAEMODIALYSIS CARE: A MULTINATIONAL CROSS-SECTIONAL SURVEY OF PATIENTS Suetonia Palmer1, Giorgia de Berardis3, Jonathan C. Craig2, Fabio Pellegrini3, Marinella Ruospo5, Allison Tong2, Marcello Tonelli4, Jorgen Hegbrant5 and Giovanni F.M. Strippoli5 1 University of Otago Christchurch New Zealand, 2School of Public Health, University of Sydney Sydney Australia, 3Consorzio Mario Negri Sud S. Maria Imbaro Italy, 4University of Alberta Edmonton Canada, 5Diaverum Medical-Scientific Office Lund Sweden Introduction and Aims: Patients with end-stage kidney disease (ESKD) experience high rates of mortality, approaching 15-20% each year and have profoundly impaired quality of life. Better knowledge of how patients experience different facets of long-term dialysis could inform the design of targeted strategies to improve dialysis patients' experience of illness and their quality of life. This study aims to assess patients' satisfaction with individual aspects of dialysis care. Methods: This is a multinational cross-sectional survey using the 23-item Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) questionnaire in 2145 long-term outpatient clinic-based haemodialysis patients in clinics in Europe (Hungary, Italy, Poland, and Portugal) and South America (Argentina). Patients' ratings of satisfaction with overall care and specific aspects of dialysis care were evaluated. Results: Questionnaire response rates differed by country; patients in Portugal were most likely to respond to the survey (97.4%), with decreasing response rates in Argentina Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Belinda Spoto1, Patrizia Pizzini1, Sebastiano Cutrupi1, Graziella D'Arrigo1, Giovanni Tripepi1, Carmine Zoccali1 and Francesca Mallamaci1 1 Clin. Epid. and Physiopath. of Renal Dis.and Hypertens. CNR-IBIM Reggio Calabria Italy Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation (81.9%), Hungary (81.4%), Poland (74.4%), and Italy (73.6%). Fewer than half (46.5%) of haemodialysis patients rated their overall dialysis care as excellent. Within countries, global perceptions of care were uninfluenced by most patient characteristics except age and depressive symptoms; older patients were less critical of their care and those with depressive symptoms were less satisfied. Aspects of care patients most frequently ranked as excellent were attention of staff to cleanliness of the dialysis vascular access site (54%), caring of nurses (53%), responsiveness of staff to their pain or discomfort (51%), caring, helpfulness and sensitivity of dialysis staff (50%), and ease of reaching dialysis staff by telephone (48%). The aspects of care least frequently ranked as excellent were information provided when patients chose a dialysis modality (23%), ease of seeing a social worker (28%), information provided about dialysis (34%), accuracy of information from nephrologist (for example, about prognosis or likelihood of a kidney transplant) (37%), and accuracy of nephrologist's instructions (39%). Conclusions: Patients are least satisfied with the amount and reliability of information they receive during care for end-stage kidney disease. Meeting patients' expectations for information including prognosis, the likelihood of kidney transplantation and patients' options when choosing dialysis treatment, are likely to improve patient satisfaction of dialysis care. BRAIN NATRIURETIC PEPTIDE AS A BIOMARKER OF PULMONARY CONGESTION IN STAGE 5 CKD ON DIALYSIS Patrizia Pizzini1, Claudia Torino1, Sebastiano Cutrupi1, Belinda Spoto1, Graziella D'Arrigo1, Rocco Tripepi1, Giovanni Tripepi1, Carmine Zoccali1 and Francesca Mallamaci1 1 Clin. Epid. and Physiophat. of Renal Dis. and Hypertens. CNR-IBIM Reggio Calabria Italy Introduction and Aims: High Brain natriuretic peptide (BNP) is a marker of left ventricular hypertrophy (LVH) and LV dysfunction and volume overload and entails a high mortality risk in dialysis patients. Pulmonary congestion as assessed by the number of ultrasound B lines (US-B lines) is another emerging biomarker of death and cardiac events in the same population. We investigated the association between BNP and US-B lines and the interplay between these two risk factors in the high risk of death and cardiovascular (CV) events in dialysis patients. Methods: In a cohort of 136 dialysis patients (age: 63±14 yrs; M: 60%), we investigated the mutual associations among plasma BNP, LV mass (LVMI) and US-B lines and analysed the relationship between these biomarkers with a composite end point of death and/or fatal and non-fatal CV events.US-B lines were recorded over the whole lung area by using standard US probes by a novel technique well validated in dialysis patients (Mallamaci F, et al. JACC Img 2010;3:586). Results: BNP [median 112 pg/ml; IQR: 46–307] and US-B lines (median 15, IQR: 9-31) were directly and significantly interrelated (r=0.42, P<0.001) and this association was stronger than that between US-B lines and LVMI (r=0.27, P=0.002). In a multiple linear regression model, including age, gender, smoking, diastolic BP and CV comorbidities as well as BNP and LVMI, only BNP (β=0.30, P=0.002) maintained an independent relationship with US-B lines. In this model, LVMI failed to correlate with US-B lines (β=0.08, P=0.41) to become a significant correlate of this parameter (β=0.20, P=0.03) only after the exclusion of BNP from the model. The results of such statistical modelling suggest that high BNP captures the explanatory power of LVMI for pulmonary congestion. During the follow-up period (median: 29 months; IQR: 14-36) 65 patients had the composite end point. In two separate multivariate Cox's regression models both BNP (HR: 1.02, 95% CI 1.01-1.04, P=0.001) and US-B lines (HR: 1.05, 95% CI: 1.02-1.08, P=0.003) were independently associated with the combined outcome while in a model including both risk factors only BNP maintained an independent relationship with the same outcome. Conclusions: The strong, independent association between BNP and US-B lines in dialysis patients indicates that this biomarker provides information on a pathway conducive to pulmonary oedema generated and/or potentiated by LV disorders and volume overload. This steady-state relationship accords with prospective analysis showing that the predictive power for death and CV events of lung congestion largely overlaps with that of high BNP. Overall, these findings underscore the importance of targeting LV disorders and volume overload to curb the excessively high risk of death and CV complications in stage 5-D CKD patients. MP574 NUMBER OF DIALYSIS SESSIONS WITH HIGH ULTRAFILTRATION RATE ARE ASSOCIATED WITH POOR OUTCOMES IN AN INTERNATIONAL POPULATION OF HEMODIALYSIS PATIENTS Gero von Gersdorff1, Len Usvyat2, Mathias Schaller1, Michelle Wong2, Stephan Thijssen2, Daniele Marcelli3, Claudia Barth4, Peter Kotanko2 and MONDO Consortium5 1 University Hospital Cologne Cologne Germany, 2Renal Research Institute New York NY United States, 3Fresenius Medical Care Europe Bad Homburg Germany, 4Curatorium for Dialysis and Kidney Transplantation Neu-Isenburg Germany, 5MONDO Consortium New York NY United States Introduction and Aims: Ultrafiltration rate (UFR) > 10 ml/kg/h during hemodialysis (HD) has been associated with poor outcomes (Saran; KI 2006). Mechanisms proposed include arrhythmias secondary to cardiac stunning, hypotensive episodes and electrolyte disturbances. The number of dialysis sessions with high UFR may be Volume 28 | Supplement 1 | May 2013 MP575 SNORING IS A STRONG AMPLIFIER OF THE RISK BY HEART FAILURE FOR ALL CAUSE AND CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS ON DIALYSIS (STAGE 5D-CKD) Claudia Torino1, Graziella D'Arrigo1, Maurizio Postorino1, Giovanni Tripepi1, Francesca Mallamaci1, Carmine Zoccali1 and on behalf of PROGREDIRE Work Group2 1 Clin. Epid. and Physiopath. of Renal Dis. and Hypertens. CNR-IBIM Reggio Calabria Italy, 2PROGREDIRE Work Group Calabria and Sicilia Regions Italy Introduction and Aims: Self-reported snoring, an indicator of sleep disordered breathing (SDB), may associate with all-cause and cardiovascular (CV) mortality in the general population and in high risk conditions like heart failure (HF). SDB and HF are exceedingly frequent in the stage 5D-CKD population but the hypothesis that snoring may impact upon the relationship between HF and all-cause and CV mortality in these patients has never been tested. The issue is important because SDB has been in part attributed to reversible pharyngeal edema secondary to volume expansion in HF patients (Chest 2007;132:440-6) and may therefore be a modifiable risk factor. Methods: We investigated this problem in a cohort of 827 stage 5D-CKD patients, all of Caucasian descent. HF was assessed at baseline on the basis of clinical symptoms, radiological and echocardiographic examinations. At enrolment, participants provided self-reported information about snoring and were classified as non-snorers, moderate snorers and heavy snorers. Patients were followed up for a median time of 28 months (inter-quartile range: 21-35). Results: One hundred and thirty-two patients (16%) were affected by HF at baseline. Overall, 194 patients (24%) were classified as heavy snorers, 308 (37%) as moderate snorers and 325 patients (39%) as non-snorers. During the follow-up period, 233 patients died, 127 of whom of CV causes. Both on univariate (P≤0.001) and multivariate (P≤0.02) Cox regression analyses, HF significantly predicted the study outcomes whereas snoring did not (P=NS). However, snoring was a strong modifier of the risk of HF for all-cause and CV death. In fully adjusted Cox models (including age, gender, smoking, diabetes, systolic BP, anti-hypertensive treatment, CV comorbidities, dialysis vintage, CRP, phosphate, cholesterol, Hb and albumin), the hazard ratios (HR) associated to HF for the study outcomes were highest in heavy snorers [all-cause death: HR: 2.5 (95% CI: 1.5-4.2, P<0.001); CV death: HR: 3.1 (1.8-5.3), P<0.001], intermediate in moderate snorers [all-cause death: HR: 1.5 (1.1-2.1, P=0.01); CV death: HR: 1.6 (1.1-2.3, P=0.009) and lowest and not significant in non-snorers [all-cause death: HR: 0.9 (0.6-1.5); CV death: HR: 0.8 (CI: 0.5-1.5)]. Conclusions: Snoring is an effect modifier of the relationship between HF and all-cause and CV mortality independently of traditional and non-traditional risk factors in stage 5D-CKD patients. Clinical trials are needed to verify whether intensified surveillance and treatment (UF intensification) of HF snorers on dialysis may translate into better clinical outcomes in this very high risk population. MP576 WHAT DETERMINES WHETHER END-STAGE KIDNEY DISEASE PATIENTS COMMENCE ON THEIR CHOSEN TREATMENT MODALITY? Dimitrios Chanouzas1, Khai Ping Ng1 and Jyoti Baharani1 1 Renal Unit Heart of England NHS Foundation Trust Birmingham United Kingdom Introduction and Aims: Despite the use of pre-dialysis programmes, there is often a discrepancy between initial pre-dialysis choice and actual treatment modality doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 MP573 associated with a cumulative risk for survival. Methods: The MONitoring Dialysis Outcomes (MONDO) consortium consists of HD databases from Renal Research Institute (RRI) clinics in the US, Fresenius Medical Care (FMC) clinics in Europe (EU), Asia Pacific (AP), Latin America (LA), KfH clinics in Germany, Imperial College in UK, Hadassah Medical Center in Israel, and University of Maastricht, The Netherlands (Usvyat, Blood Purification 2013). Databases from RRI and KfH were queried to find all incident hemodialysis patients who had their first in-center treatment between 1/2000 and 12/2010 and who survived at least 12 months on HD. The fraction of sessions with UFR > 10ml/kg/h (“high-UFR session; hiUFS”) was computed on a per patient basis in the first 6 months (“baseline”) and between months 7 and 12 on HD (“follow up”). Patients were then stratified into nine groups depending on the proportion of hiUFS during baseline and in the follow up period, respectively. Patient survival was assessed in months 13 to 24 from HD initiation. Cox proportional hazards models adjusted for age, gender, diabetic status, albumin, post-dialysis body weight, and hemoglobin were constructed to assess associations of hiUFS during baseline and follow up, respectively, and survival. Results: We studied 15,757 patients. Mean age was 64,9 years, 59,5% were male, 53,2% diabetic. Average UFR was 7,9 and 8,2 ml/kg/h during baseline and follow up, respectively. 40% had hiUFS < 5% and 40% had hiUFS > 20%. A higher proportion of hiUFS was associated with worse outcome, but further increases during follow up only moderately increased risk (Figure 1). By contrast, a decrease of hiUFS in the follow up period conferred a risk reduction.[figure1] Conclusions: Our international study indicates that performing > 20% of HD sessions, or about 3/month, with UFR > 10 ml/kg/h is associated with poor survival in incident HD patients. This increased risk seems to be modifiable by subsequent reduction of hiUFS. These findings underscore the importance of balancing the interrelated parameters of treatment time, weight gain and UFR for every dialysis session. Further studies need to define more clearly the best strategies for reducing the risk associated with high UFR. Abstracts MP577 THE IMPACT OF FIM SCORE IN THE SHORT TERM MORTALITY OF HEMODIALYSIS PATIENTS Misako Endo1, Yuya Nakamura1, Masaki Hara1, Takuya Murakami1, Hideki Tsukahara1, Yoshinobu Watanabe1, Yoshiyuki Matsuoka1, Kiichiro Fujita1, Michiyasu Inoue1, Tatsuo Simizu1, Hiromichi Gotoh1 and Yoshikazu Goto1 1 Saiyu Soka Hospital Soka City/Saitamaken Japan Introduction and Aims: Decreased activity of daily living (ADL) has been associated with mortality in general population, in hemodialysis patients, decreased ADL seems to be more common than general population. Therefore, correlation between ADL and mortality in hemodialysis patients should be noted. However, these relations in hemodialysis patients are still unclear. We studied the level of ADL using functional independence measure (FIM) score, which is one of the major surrogate markers of ADL, and the association between FIM score and all-cause mortality in these patients. Methods: This prospective cohort study included 107 patients on maintenance hemodialysis (68 men and 39 women; mean age, 72.4 ± 9.9 years) in 2 years. The underlying diseases for hemodialysis were 54 diabetic nephropathy, 18 chronic glomerulonephritis, 10 nephrosclerosis, and 25 others. ADL was assessed using FIM score (total points, 126), which comprises 13 motor items (total points, 91) and 5 cognitive items (total points, 35). Each item is scored from 1 to 7 based on level of independence, where 1 represents total dependence and 7 indicates complete independence. A survival curve was drawn using Kaplan-Meier analysis and stratified into 4 groups using the interquartile range value of FIM score. The Cox proportional hazards analysis, adjusted for age, gender, albumin, and C-reactive protein, was used to calculate mortality hazard ratio (HR) and its 95% confidence interval (CI). Results: The mean total FIM score was 60.0 ± 24.7, and the scores for FIM motor and cognitive items were decreased in the study patients (34.4 ± 16.8 and 25.5 ± 10.5, respectively). Cumulative mortality rate was significantly higher in FIM 41 - 60 and ≤ 40 groups compared to the rate in the reference with FIM scores 85 ≤. 804;. In addition, the HR for mortality significantly increased with FIM 41 - 60 and ≤ 40 groups. Conclusions: The FIM score was decreased by half in hemodialysis patients, especially in motor items. FIM score was a novel predictive marker for 2-year mortality in these patients. Our findings suggest that comprehensive strategies which could increase ADL in hemodialysis patients are required. MP577 Variable Reference FIM 85 ≦ FIM 61 - 84 FIM 41 - 60 FIM ≦ 40 MP578 HR 2.02 3.75 7.04 95% CI 0.52 - 9.05 1.04 - 17.50 2.19 - 31.68 P nalue 0.3125 0.0393 0.0006 CLINICAL AND BIOLOGICAL VARIABLES ASSOCIATED WITH MORTALITY IN HEMODIALYSIS PATIENTS Pierre Delanaye1, Etienne Cavalier2, Olivier Moranne3, Jean-Marie Krzesinski1, Xavier Warling4, Nicole Smelten5 and Hans Pottel6 1 Nephrology-Dialysis University of Liege, CHU Sart Tilman Liège Belgium, 2Clinical Chemistry University of Liege, CHU Sart Tilman Liège Belgium, 3Nephrology and Public Health CHU de Nice Nice France, 4Nephrology-Dialysis CHR La Citadelle Liège Belgium, 5Nephrology-Dialysis CHBA Seraing Belgium, 6Interdisciplinary Research Center University of Leuven, Kulak Kortrijk Belgium Introduction and Aims: Global and cardiovascular mortality remains high in hemodialysis patients. Different hypotheses have been proposed to explain this over-mortality. We tested here potential clinical and biological variables which are associated with a higher mortality risk. Methods: Prevalent hemodialysis patients from three centers in Belgium (Liège) were recruited. Following clinical data were available: age, gender, BMI, dialysis vintage, status of hypertension and diabetes, smoking status, and history of cardiovascular (CV) disease. Among biological variables, we tested classical variables in serum like calcium, phosphorus, parathormone, 25-OH vitamin D, albumin and C-reactive protein (CRP). Several new biomarkers were also tested: bone-specific alkaline phosphatase, C-terminal telopeptide of collagen type I (CTX), intact amino-terminal propeptide of type I procollagen, tartrate-resistant acid phosphatase 5b, osteoprotegerin, troponin T, homocystein, interleukin-6, TNFα, FGF-23, fetuin and desphospho-uncarboxylated matrix Gla-protein. Time of follow-up is expressed in months. Cox proportional hazards regression and logistic regression were performed to evaluate the possible effect of covariates. Results: The sample included 165 patients with the following clinical characteristics: median age was 74 y [63;80], mean BMI was 26±7 kg/m², median dialysis vintage 22 months [11;43], 44% were diabetic, 87% were hypertensive, 21% were smokers and 65% had history of CV disease. Mean follow up time was 22.1±11.3 months. A total of 74/165 (44.8%) died with a mean follow up time of 13.1±9.1 months (median value was 11.3 [5.4;20.8]). Hazard ratios were calculated using Cox proportional hazards modeling with the following statistically significant covariates in the final model (HR and 95% HR confidence limits): history of CV disease (HR: 0.544 [0.31-0.953] for no history), age (HR: 1.054 [1.09-1.079]), phosphorus (HR: 1.223 [1.029-1.454]), troponin T (HR: 253.283 [14.831-4325]) and CTX (HR: 1 [0.999-1]). When considering logistic regression to estimate mortality probability, age phosphorus, troponin T and CTX were still in the final model of prediction, but not history of CV disease. In this last analysis, concentration of 25 OH-vitamin D was also significant. Conclusions: In this longitudinal study, we confirmed that age and phosphorus levels are clearly associated with a higher risk of mortality. Among the “non-classical” variables, concentration of troponin T is the most interesting one to assess the risk of mortality in our hemodialysis populations. MP579 IMPROVEMENT OF COGNITIVE FUNCTIONS AFTER A SINGLE DIALYSIS SESSION Sabrina Schneider1,2, Anne K. Malecki1, Hermann G. Haller2, Olaf Boenisch2 and Jan T. Kielstein2 1 Department of Psychology MLU Halle-Wittenberg Halle (Saale) Germany, 2 Department of Nephrology and Hypertension Medical School Hannover Hannover Germany MP577 i | Abstracts Introduction and Aims: Cognitive function is impaired in CKD5D patients. The potential effect of a single dialysis function on cognitive function remains still elusive. Aim of the study was to assess cognitive function using a wide test battery and avoiding exclusing effects of circadian variations. Methods: Twentyfive (11 female) CKD5D patients (54 ±12 years, dialysis vintage 4.3 ±5.7 years) were enrolled. Cognitive testing was performed 1 h prior to dialysis as well as 24 h thereafter including assessment of memory, attention and concentration, executive functioning and psychomotor speed by using the following tests: Rivermead Behavior Memory Test (RBMT), Rey Complexe Figure Test (RCFT), Trail Making Test A+B (TMT), Wechsler Memory Scale (WMS- R), Behavior Assessment of Dysexecutive Syndrome (BADS), Regensburger word fluency test (RWT) and test battery for attention (TAP). Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 commenced. We aimed to examine the factors that determine whether end-stage kidney disease (ESKD) patients commence treatment on their chosen modality. Methods: This is a follow-up study of a previously published questionnaire study in 118 pre-dialysis patients. The questionnaire consisted of 20 items that patients were asked to rate based on their importance in influencing their modality decision. We followed up the study participants for 43 months to determine whether they indeed commenced treatment on their initial chosen modality. Results: 49% of patients reached ESKD. 94.3% (n=35) and 53.8% (n=13) of patients that chose haemodialysis (HD) and peritoneal dialysis (PD) respectively, commenced on their initial chosen modality. The remaining patients that chose PD started on HD. This was not due to PD technique failure. 90.0% (n=10) of patients that selected conservative management (CM) retained their choice. There was no association between age, gender or ethnicity and retention of choice. For HD choice, scoring the 'distance to travel to hospital' item highly was associated with commencement on HD ( p=0.024). Among patients who had chosen PD, those who valued 'modality fitting with lifestyle' highly ( p=0.008) or were more functionally able ( p=0.015) were more likely to commence on PD. Interestingly the 'modality fitting with lifestyle' factor was also found to be a crucial determinant of PD choice versus HD in our original study. There was a trend for patients with low educational attainment and patients who scored the item 'importance of family in helping with decision' highly, to commence on HD instead of their initial choice of PD, although the results did not reach statistical significance ( p=0.092, p=0.060). Conclusions: Patients who initially chose PD but did not perceive the lifestyle benefits of PD as important, or were less functionally able, were more likely to commence on HD. These findings are important in informing the design of more effective pre-dialysis programmes to increase the uptake of self-care modalities. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation Results: A single dialysis session lead to a significant improvement in logical and visual memory (RBMT [ pre: 7.5 and 6 digits/ post: 8.5 and 8 digits] and RCFT [ pre:32.5 digits/ post:48 digits]) psychomotor speed and concentration (TMT A), while task switching (TMT B) did not improve. 40% of patients were on psychotropic medication, but this factor did not affect outcomes. Conclusions: Our data demonstrate improvements in memory functions, executive functions and psychomotor abilities after a single dialysis session, pointing to a reversible component of cognitive impairment in CKD5D. MP580 END DIALYSIS OVER-WEIGHT IS ASSOCIATED WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN UREMIC PATIENTS ON REGULAR HEMODIALYSIS TREATMENT. A 3-YEAR PROSPECTIVE OBSERVATIONAL STUDY Introduction and Aims: We hypothesize that the difference between the really attained and the prescribed end dialysis body weight (dBW), defined end-dialysis over-weight, (edOW; Kg) could impact survival of hemodialysis (HD) patients. Aim of this prospective observational study was to evaluate if edOW could influence survival in a cohort of prevalent HD patients, controlled for multiple dialysis and clinical risk factors and followed for 3 years. Methods: 182 patients, 117 men, age 65±13 years, on regular HD treatment for at least 6 months (median 48; range 6-366 months) were followed from January 1st 2008 to December 31st 2010. Eighty four patients (46%) did not achieve dBW, their median edOW was 0.4 Kg (range 0.1-1.4 Kg). During follow-up 98 patients died, mainly for cardiovascular causes(69%). Multivariate Cox regression analysis was utilized to evaluate the effect on mortality of edOW, ultrafiltration rate (UFR),interdialysitic weight gain (idWG), age, sex, dialytic vintage, cardiovascular disease (CVD), antihypertensive therapy, diabetes, duration of HD, body weight (dBW), body mass index (BMI), mean arterial pressure (MAP), Kt/V, protein catabolic rate (PCRn). Results: At the Cox's proportional hazard risk analysisage (HR 1.04; CI 1.03-1.05; p <0.0001), idWG (HR 2.62; CI 2.06-3.34; p<0.01), UFR (HR 1.13; CI 1.09-1.16; p<0.01), PCRn (HR 0.02; CI 0.01-0.04; p<0.001) and edOW (HR 2.71; CI 1.95-3.75; p<0.02) were independently correlated to survival The relative receiver operating characteristic (ROC) curve identified a cut-off value of edOW in predicting death of 0.3 Kg. The same analysis was performed by examining edOW and cardiovascular mortality. A significant greater cardiovascular mortality was observed for patients with edOW ≥ 0.3 Kg ( p< 0.009). Conclusions: High edOW are independently associated with an increased long-term risk of all-cause and cardiovascular mortality in HD patients. Better survival was observed in patients with edOW < 0.3 Kg. For patients with higher edOW, longer or more frequent dialysis sessions should be considered in order to prevent the deleterious consequences of excessive body fluid expansion. MP581 Suetonia Palmer1, Marinella Ruospo2, Patrizia Natale2, Letizia Gargano2, Valeria Saglimbene3, Fabio Pellegrini3, David W. Johnson4, Jonathan C. Craig5, Jorgen Hegbrant2 and Giovanni F.M. Strippoli2 1 University of Otago Christchurch New Zealand, 2Diaverum Medical Scientific Office Lund Sweden, 3Mario Negri Sud Consortium S.Maria Imbaro Italy, 4 University of Queensland Brisbane St Lucia Australia, 5University of Sydney Sydney Australia MP579 MP579 TESTS Story RBMT (words) recall delay Wechsler digit span foreward backward Trail Making Test (seconds) Trail A Trail B RWT (words) lexical lexical-change semantic PREVALENCE OF ORAL LESIONS IN HEMODIALYSIS PATIENTS: THE ORAL-D PROSPECTIVE MULTINATIONAL COHORT STUDY PRE-dialysis (median ± SD) POST-dialysis (median ± SD) p 7.5 (2.6) 6 (2.5) 8.5 (3.8) 8 (3.6) .002* .001* 8 (1.4) 6 (2.0) 8 (1.9) 6 (1.6) .055 .266 46 (13.7) 108 (38.2) 40 (12.1) 93 (44.9) .002* .726 12 (4.2) 16 (4.4) 28 (9.0) 17 (5.8) 17 (5.9) 31 (8.4) .000* .764 .272 Volume 28 | Supplement 1 | May 2013 Introduction and Aims: Oral diseases are common in the general population and are associated with socioeconomic status. It is plausible that the prevalence of oral diseases is increased in people on hemodialysis due to impaired role functioning and health status, but this has not been formally established. We conducted a systematic prospective survey of oral lesions in adults on hemodialysis. Methods: ORAL-Dis a multinational prospective cohort study. We consecutively enrolled adults receiving hemodialysis in 75 outpatient clinics selected randomly from a collaborative dialysis network in Europe and South America. A dental surgeon conducted a standardized examination of dental, periodontal, mucosal and salivary lesions based upon standard dental practice methodology. We analyzed prevalence of oral diseases using descriptive statistics. Results: 4720 (mean age 62.85 years (SD 15.76) adults on hemodialysis in the participating clinics received a complete oral examination. Of these, 922 (20%) were edentulous, 1693 (39%) had tooth attrition and dental erosion, and 109 (2%) had enamel hypoplasia. The mean decay/missing/filled teeth (DMFT) score was 21.9 (9.18), salivary pH was 7.48 (1.32). There was a high prevalence of patients with high buffer capacity (n=1834 [61%]), and only 96 patients (8%) with low buffer capacity. Salivary flow rate before dialysis was 0.84 ml/min (0.78), versus 0.77 ml/min (0.72) post dialysis. 1491 (32%) patients had mucosal lesions, 2074 (45%) patients reported mouth dryness, doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Ezio Movilli1, Corrado Camerini1, Paola Gaggia1, Roberto Zubani1, Paolo Feller1, Patrizia Poiatti1, Alessandra Pola1, Orsola Carli1, Brunella Valzorio1, Stefano Possenti1, Laura Bregoli1, Paolo Foini1 and Giovanni Cancarini1 1 O.U. of Nephrology A.O. Spedali Civili di Brescia and University of Brescia Brescia Italy Abstracts 229 (5%) had oral burning and 351 (8%) reported mouth pain. Periodontitis was present in 1516 (42%) of 3672 dentate patients. Conclusions: Oral lesions are prevalent in people receiving hemodialysis and may indicate impaired healthcare practices, although further research on the predictors of oral disease in this population is needed. MP582 DEFINING THE SERUM SODIUM SET POINT TO IMPROVE FLUID STATUS IN HEMODIALYSIS PATIENTS Steven Brunelli1, Mahesh Krishnan1,2, David Van Wyck2, Robert Provenzano2, Irina Goykhman2, Chhaya Patel2 and Allen Nissenson2 1 DaVita Clinical Research Minneapolis MN United States, 2DaVita Healthcare Partners, Inc Denver CO United States MP582 MP583 THE IMPORTANCE OF AGE IN DIALYSIS Andreana De Mauri1, Maria Maddalena Conte1, Doriana Chiarinotti1, Paola David1, Federica Capurro1 and Martino De Leo1 1 Nephrology and Dialysis Unit University Hospital “Maggiore della Carità” Novara Italy Introduction and Aims: The incidence and the prevalence of elderly people (age>60 years, ys) receiving hemodialysis (HD) is increasing in the westernworld. Elderly people represent an heterogeneous group of patients, burdened by several comorbidities. They could be divided in “young Old” (yO: 60-69 ys), “common Old” (cO:70-79 ys) and “very Old” (vO:>80 ys). The aim of our retrospective study is to evaluate the vascular access, the main therapies, the comorbidities and the mortality rate of elderly attending our Dialysis Centre during the last 13 years. Methods: Subjects older than 60 years, starting HD from 01.01.2000 to 31.12.2012 were enrolled, divided in jO, cO and vO and compared each other. Patients ( pts) with follow up less than 3 months were excluded. i | Abstracts Results: Of 385 incident pts, 110 are younger than 60 ys and 10 with follow up less than 3 months. Of 265 elderly people 91 (35.7%) are jO, 121 (47.5%) cO and 43 (16.9%) vO. Cause of renal disease: diabetes is the first cause in jO, angiosclerosis in vO; urological disease is relevant in cO; glomerulopathies account for about 8-10% in all groups. Early referral: in all groups about 80% of pts refer to our Department during the preHD stage of the disease. 70% undergo arteriovenous fistula (AVF) creation on native vessels before starting HD. 11.6% in vO and 7.4% in cO do not receive AVF because of unpracticable vessels (vs 1% in jO, p=0.03). Comorbidities: the prevalence of hypertensive status (50%), diabetes (40%), cardiac disease (about 35% in jO and cO, 50% in vO) and lower limb ulcerations (25%) are not different. In vO arrhythmia is common (40% vs 17.5% in jO and 25% in cO, p=0.01) and neoplasia as well (not statistically significant). Therapy: Angiotensin Converting Enzyme Inhibitors or Angiotensin Receptor Blockers are assumed by 26.4% of jO and 10% of cO and vO ( p=0.002); Vitamin K antagonists are assumed by 15.4% of jO, 19% cO and 9% vO. AVF is the first access in all groups for about 60-70% and the last access in 92,%, 71% and 69% in jO, cO and vO, respectively ( p=0.003); in all groups the number of AVF creation per pts is 1.3±0.6 and 60% receive only one AVF. Catheters: in all groups the number of catheter per pts is 1.1±1.4; 40-45% and 25% need none or only one central venous catheter, respectively. The survival curves reveal lower but similar life expectancy for cO and vO in comparison to jO (median survival 34, 35 and 64 months respectively, p=0.001). Conclusions: Our study demonstrates that, when old pts are referred early to the nephrologists, the vascular access presents a good outcome, since the native AVF is the main access ant the catheter's use is restricted to 10% in jO and 30% in vO. The prevalence of the comorbidities are high but similar with aging; the survival in vO is similar to cO and lower than in jO. The aging is the main determinant of death, that in cO and vO is becoming similar to non HD old people. MP584 A PARADIGM SHIFT IN NUTRITIONAL DISORDERS IN CHRONIC KIDNEY DISEASE PATIENTS ON DIALYSIS: THE RISING TIDE OF OBESITY IN THE DIALYSIS POPULATION IN A SOUTHERN EUROPEAN REGION Maurizio Postorino1, Carmela Marino1, Antonio Vilasi1, Giovanni Tripepi1, Carmine Zoccali1 and Calabrian Dialysis and Transplantation Work Group2 1 CNR and Nephrology Unit CNR-IBIM Reggio Calabria Italy, 2Calabrian Dialysis and Transplantation Work Group Reggio Calabria Italy Introduction and Aims: Obesity is an epidemic phenomenon worldwide. In the past decades, the prevalence of obesity in the general population doubled in the USA and in most European countries. This trend is parallel to the growth of the population with end stage kidney disease (ESKD) on dialysis, a population typically considered at high risk for protein wasting and malnutrition. No time-trend analyses of nutrition status by the Body Mass Index (BMI) are available in European countries. Methods: We investigated the evolution of the average BMI and the time trends of the prevalence of nutrition disorders (from underweight to obesity) across 18 years (1994-2011) among patients included in a dialysis Registry (the Calabrian Registry of Dialysis and Transplantation) affiliated with the ERA-EDTA Registry. This Registry has average demographic characteristics, death risk and comorbidities very close to the corresponding average values of the ERA-EDTA Registry. Results: The average BMI rose from 23.5 kg/m2in 1994 to 25.5 kg/m2 in 2011 (P<0.001) (Fig.1). This temporal evolution of average BMI was accompanied by a decline in the prevalence of severely underweight (BMI <18.5 kg/m2 ) and mild to moderate underweight (BMI 18.6-22.5 kg/m2) patients (Fig 2). Remarkably, both the prevalence of overweight (BMI 25.1-30 kg/m2: 26%→35%) , and frankly obese patients (BMI>30kg/m2: 6%→14%) increased considerably (P<0.001) (Fig.2) over the same time-frame. These secular trends were evident across various population strata including gender and age. The rising tide of overweight and obesity in this population was accompanied by a parallel increase in the prevalence of diabetic nephropathy as a diagnosis of ESKD (1994: 7%; 2011:15%). Similar analyses focusing exclusively in incident patients fully confirmed these trends and showed a substantial decline in the risk of underweight status (from 12% to just <3%) and a doubling in the risk of overweight and obesity. Conclusions: Analysis of BMI in a Registry representative of the ERA-EDTA population shows a fast rise of the prevalence of overweight and obese patients in the dialysis population and a specular decline of patients in the underweight categories. These secular trends have obvious implications for the growth of the total ESKD population in the years to come. MP584 Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Introduction and Aims: Recent data suggest that tailoring dialysate sodium concentration to an individual patient's serum sodium “set point” decreases the magnitude of interdialytic weight gain and improves blood pressure and volume control. Little information is available, however, to determine the number of same-patient serum sodium measurements needed to estimate a reliable homeostatic set point. Methods: We conducted a retrospective analysis of all pre-dialysis serum sodium measurements taken from 10,413 randomly selected in-center hemodialysis patients, keeping dialysate sodium constant over a 6-month (m) period, January–June 2012. For each subject, we considered serum sodium as individual measurements and as 2m, 3m, 4m and 5m rolling window means. We used intra-class correlation coefficient (< 0.5 = weak, 0.5–0.7 = moderate, > 0.7 = strong) to evaluate reproducibility of each measure. Results: 10,413 patients contributed a total of 55,540 individual sodium measurements. Median ( p25, p75) number of sodium measurements was 6 (6, 6) over the 6-month period. Mean sodium concentration for the cohort was 137.9 mEq/L. Intra-class correlation coefficient was incrementally higher for windows of longer duration. Incremental gains in intra-class correlation were comparatively less for windows > 3m in duration (Figure). Conclusions: Predialysis serum sodium is reliably reproducible when evaluated over rolling windows as short as 2 to 3 months. Though longer intervals may yield incremental improvements in reproducibility, the clinical utility of the test would likely be offset by consequent delay in decision making. To tailor dialysate sodium to serum sodium in hemodialysis patients, clinicians and researchers should consider 2-or 3-month sampling windows to determine serum sodium set point. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation MP585 OBSERVATIONAL STUDY OF THE PREVALENCE OF STAPHYLOCOCCUS TOXIN GENE POSITIVITY IN DIFFERENT POPULATIONS INCLUDING A RENAL DIALYSIS UNIT IN GLASGOW, UK Aileen Helps1, Giles Edwards2, Robert Mactier1 and John Coia2 1 Glasgow Renal and Transplant Unit Western Infirmary Glasgow United Kingdom, 2 MRSA Reference Laboratory Stobhill Hospital Glasgow United Kingdom MP585 No. S. aureus (% total screened) 41 (28.5) 36 (27.7) HD patients Healthy patients Community 58 swabs Blood cultures 64 MP586 No. MRSA (% S. aureus positive) 4 (9.8) 1 (2.8) TSST positive (% S. aureus positive) 4 (9.8) 0 ETA or ETB positive (% S. aureus positive) 3 (7.3) 3 (8.3) 8 (13.8) 5 (8.6) 3 (5.2) 14 (21.9) 8 (12.5) 4 (6.3) TOTAL AND HIGH MOLECULAR WEIGHT ADIPONECTIN AND MORTALITY IN PATIENTS WITH CHRONIC HEMODIALYSIS PATIENTS Yasuhiro Abe1, Kenji Ito1, Satoru Ogahara1, Yoshie Sasatomi1, Takao Saito1 and Hitoshi Nakashima1 1 Division of Nephrology and Rheumatology Fukuoka University School of Medicine Fukuoka Japan Introduction and Aims: A number of vasculo-protective roles have been reported for adiponectin (ADPN) and some studies in hemodialysis (HD) patients demonstrated that low ADPN levels were associated withan increased risk of cardiovascular mortality and/or all cause mortality.In contrast, recent study showed that higher, rather than lower, plasma ADPN levels predict adverse outcomes. Moreover, the relationship of plasma ADPN with outcomes was non-linear in HEMO study, suggesting that both low and high ADPN levels were shown to be a predictor of mortality. Three major adiponectin isoforms are present in plasma; low molecular weight (LMW) trimers, middle molecular weight (MMW) hexamers, and high molecular weight (HMW) multimers. Clinical and basic studies suggest that HMW adiponectin has the greatest cardiovascular protective effects. However, it has not been elucidated whether plasma HMW adiponectin is a more useful prognostic predictor than total adiponectin in HD patients. Methods: 114 HD patients in a stable condition (age: 65.4 ± 8.8 years , male/female: 50/64 ) were enrolled in this study. Based on total and HMW ADPN levels, patients Volume 28 | Supplement 1 | May 2013 MP587 RENAL PROGNOSIS AT ONE YEAR OF PATIENTS STILL ON DIALYSIS AFTER AN INTENSIVE CARE UNIT STAY Cartier Jean-Charles1,2, Villemaire Morgane2, Potton Leila1, Schwebel Carole1, Carron Pierre-Louis2, Zaoui Philippe2 and Timsit Jean-François1 1 Intensive Care University Hospital Grenoble France, 2Néphrology University Hospital Grenoble France Introduction and Aims: Acute renal failure (ARF) in intensive care is common -from 35 to 65%- and associated with excess mortality. In case of extra renal purification (ERP), hospital mortality can reach up to 60% of patients, surviving after an ICU stay. In case of persistent renal failure after the ICU stay, no data is available. This thesis offers describes this population and evaluates the vital and renal prognosis a year after with the study of associated risks' factors. Methods: Patients who have showed an ARF with an ERP not weaned before the output of intensive care were inclued in this retrospective study realized in a French University Hospital between December 2005 and March 2011.Initially, survival without dialysis has been followed over a year thanks to the Cox model. A competitive risk model in sub distribution of Fine & Gray was also used to follow jointly the setting of chronic dialysis and the mortality. Results: Among the 4132 ICU stays, 551 benefited from an ERP, 337 patients have survived whom 115 were still on dialysis after the output of intensive care. They were 77 men and 32 women, average age 63,5 year old (IQR: 55,73) with a severity score IGS II up to an average of 54,5 (IQR: 40,5;65,5). They received an injection of iodine, aminoglycosides or vancomycin in respectively 45,7%, 31% and 12,9% of the cases. The main etiologies of the ARF were the sepsis (23,3%), non-infectious shock (22,4%), functionnal (19,8%) or toxic (16,4%). Acute tubular necrosis (ATN) was admitted as the etiology of ARF for 102 patients (87,9%). Chronic dialysis-free survival at 1 year was 64,3% (95%CI= 54,9 to 72,3%). The cumulative risk of dialysis and death at 1 year was respectively 23,5% (95%IC=17-32%) and 12,1% (95%IC=7,4 to 19,7%). Independent factors associated with a lower survival without dialysis are: advanced age, a mechanism other than ATN, the administration of vancomycin during the ICU stay and lower renal function prior to 60ml/min/1.73m². In addition, the presence of statins in the treatement of substance is a protective factor with a HR=0,35 (95%IC= 0,17-0,71). The cumulative risk of chronic dialysis was significantly aggraved by a cause other than the ATN (SHR=3,59 with 95%CI=1,2-10,7) and the use of aminoglycosides during the ICU stay (SHR=4,25 with 95%CI= 1,36-13). It was reduced by a previous clearance greater than 60ml/min earlier (SHR =0,033, 95%CI=0,004-0,27) and statins SHR=0.06 (95%CI=0,01 to 0,49). Statins did not alter signifantly the cumulative risk of death (SHR=0,086 95%CI=0,68 to 2,43,p=0,09). Conclusions: Two thirds of patients requiring ERP at the end of ICU stay are alive and not on dialysis at 1 year. The previous level of renal function, the age, the use of vancomycin and aminoglycosides during the stay and the presence of statins in the treatement of substance are determinant independent factors. MP588 MODELING TREATMENT TRAJECTORIES TO OPTIMIZE THE ORGANIZATION OF RENAL REPLACEMENT THERAPY AND PUBLIC HEALTH DECISION MAKING Cecile Couchoud1, Emmanuelle Dantony2,3, Mad-Helenie Guerrin2,3, Emmanuel Villar2,4 and Rene Ecochard2,3 1 REIN Registry Agence de la Biomédecine Saint Denis La Plaine France, 2Service Biostatistique Hospices Civils de Lyon Lyon France, 3CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé Université Lyon 1 Villeurbanne France, 4Service de Néphrologie Dialyse Centre Hospitalier Saint-Joseph Saint-Luc Lyon France Introduction and Aims: ESRD patients require thorough and balanced information about global long-term RRT strategies that combine various complementary modalities. Similarly, health-care planning requires anticipation of the necessary or available supply of these different modalities. ESRD registries provide numerous essential indicators about RRT, such as point prevalence rates. Nonetheless, these indicators are especially difficult to interpret when the underlying dynamic process is not well understood. To obtain a dynamic view of patient trajectories through RRT, we doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Introduction and Aims: Staphylococcus aureus toxin genes have been held responsible for outbreaks of community acquired invasive disease. Prevalence of toxin gene colonisation varies in different geographical areas and populations. Up to 50% of haemodialysis patients and 30% of the general population are colonised with S. aureus. The prevalence of Panton Valentine Leucocidin (PVL), Toxic Shock Toxin (TST) and exfoliative toxins A and B (ETA and ETB) in these populations is unknown. We aim to assess the prevalence of PVL, TSST, ETA and ETB toxin genes in 4 different patient groups. Methods: Haemodialysis patients and healthy patients from an orthopaedic preoperative clinic were tested for S. aureus nasal colonisation. Isolates from skin infections from GP practices were analysed for an estimate of community-based disease. S. aureus positive blood cultures from the same geographical area were also evaluated. Polymerase chain reaction (PCR) followed by gel electrophoresis tested for the presence of PVL, TSST, ETA and ETB toxin genes. Results: 148 HD and 125 healthy patients were tested for S. aureus nasal colonisation. 58 skin swabs positive for S. aureus were identified from the general microbiology laboratory and 64 blood cultures were S. aureus positive. There was no significant difference between the age of patients colonised with S. aureus (mean 60.73 years) and those not colonised with S. aureus (59.68 years). There was no significant difference between the age of those colonised with S. aureus and those with clinically significant infection characterised by a positive skin or soft tissue swab or bacteraemia (mean 61.1 years). There was no significant difference in the prevalence of S. aureus colonisation in HD patients and healthy patients from the orthopaedics preoperative clinic. Overall, virulence toxin gene prevalence was low. There were no isolates containing the PVL toxin gene. Conclusions: Prevalence of S. aureus colonisation from this study was in keeping with previous research. Overall toxin gene prevalence in all populations was low. It was reassuring that there was no significant difference between the 4 groups although numbers are small. We suggest that although virulence toxin genes may cause more severe disease, they are not more likely to cause disease in a colonised patent. More observational research is required to determine virulence toxin gene prevalence in the general population. were classified into two groups: low and high group (n = 76) and middle group (N = 38). Age, sex, dialysis vintage, diabetes, blood pressure (BP), body mass index (BMI), hemoglobin (Hb), serum albumin, high sensitive C-reactive protein (CRP), total cholesterol (TC), triglyceride(TG), high density lipoprotein (HDL), total and HMW adiponectin were included in association analysis with all cause mortality. Results: After a median observation period of 6.2 years, total mortality was 27.2% (31/ 114). Kaplan-Meier analysis revealed that patients with total, but not HMW, high and low ADPN levels had a significantly lower survival rate compared with those with low ADPN levels (P = 0.025). In multiple cox regression analysis, plasma levels of total adiponectin levels (hazard ratio: 2.954, 95% Confidence Interval: 1.011-8.635, p=0.048) and sex (hazard ratio: 2.425, 95% Confidence Interval: 1.140-5.158, p=0.021) were independent prognostic risk factors of mortality. Conclusions: These findings indicate that total adiponectin is more useful for assessing mortality risk than HMW adiponectin and a high and low plasma total adiponectin levels is an independent prognostic predictor especially in hemodialysis patients. Abstracts MP589 THE COMPARATIVE EVALUATION CONCERNING THE START OF DIALYSIS BETWEEN ELDERLY AND YOUNGER PATIENTS IN JAPAN Shinichi Nishi1, Shunsuke Goto1, Kentaro Nakai1, Keiji Kono1, Yuriko Yonekura1, Jun Ito1 and Hideki Fujii1 1 Division of Nephrology and Kidney Center Kobe University Graduate School of Medicine 7-5-2 Kusunoki-cho Chuoku Kobe City Hygo Prefecture Japan Introduction and Aims: Elderly CKD patients start dialysis treatment in Japan. Median age at starting dialysis is more than 70 years-old and ageing tendency has not stopped yet. The elderly CKD patients have various senile complications and are anticipated to start dialysis treatment in earlier phase from uremic complications. We evaluated the clinical data at the beginning of dialysis concerning renal function and uremic conditions. Methods: We evaluated 1829 stage-5 CKD patients who newly started dialysis from 2004 to 2008. Thirty one % of them were diabetic patients. They were divided into 3 groups; younger age group (YAG) <65 years-old n=989, middle age group (MAG) from 65 to 75 n=487 years-old, and older age group (HAG) >75 years-old n=353. Clinical data including S-Cr, eGFR, Ccr, electrolytes and acid-base balance disorders were compared among three groups. ANOVA, Student-t, chi-square tests were used as statistical methods. Results: S-Cr was significantly lower in HAG group ( p<0.001), while eGFR and Ccr were not significantly different among three groups. BMI, albumin, diastolic blood pressure, CTR were significantly lower in HAG group ( p<0.001), but serum potassium, hematcrit and HCO3- did not showed significant differences between three groups. Over volume sings including edema and dyspnea on effort emerged at significantly higher rate in HAG group ( p<0.005).[figure1] Conclusions: From the evaluation of renal function, commencing time of dialysis was even in three groups. S-Cr was not useful as a marker to determine the beginning of dialysis. The beginning of dialysis in HAG group was performed in milder electrolytes and acid-base balance disorders compared to younger groups. This might be induced from the higher rate of over volume sings such as edema and dyspnea. MP590 THE EFFECT OF DIALYSIS DURATION ON MARGINAL DONOR TRANSPLANTATION DECISION IN DIALYSIS PATIENTS Serhat Korkmaz1, Alparslan Ersoy2, Salih Gulten2, Ilker Ercan3 and Nizameddin Koca4 1 Internal Medicine Mardin Devlet Hastanesi Mardin Turkey, 2Nephrology Uludag University Bursa Turkey, 3Biostatistics Uludag University Bursa Turkey, 4Internal Medicine SYEAH Bursa Turkey Introduction and Aims: Organ shortage is one of the most important problems in kidney transplantation (KT). For this reason, the expanded donor criteria have been developed in recent years. In this study, we aimed to compare the factors affecting the decision to accept marginal deceased kidney donation in dialysis patients with short or long dialysis durations. Methods: 597 dialysis patients, according to the duration of dialysis were divided into two groups (Group 1: <40 months, n=145, Group 2: >40 months, n=452). Patients were asked about the acceptance of marginal associated donor and/or kidney properties with certain diseases or some of the features that differ from normal cadaveric kidneys. Hospital Anxiety and Depression Scale was performed. Patient's donor kidney i | Abstracts selectivity score (DKSS)'was obtained by asking 32 questions that evaluate their consents for marginal kidney donation. Results: Groups characteristics (gender, age, body weight, body mass index, systolic and diastolic blood pressure) were similar ( p>0.05). While 69.3% of dialysis patients wanted to have KT, 30% of them registered on the waiting list. While 60 patients (10%) did not want to have KT, 299 of them (50.1%) wants to receive from live donors and 238 of them (39.9%) wants to receive from cadaveric donor. Ratios of patients that had live donor was 11.7%. DKSS in Group 1 is 37.8±21.6 and 31.9±3.23 in Group 2 ( p<0.05). Patients in Group 2 were more selective for marginal donor KT. The acceptance of a donor kidney from close relatives, excessive fat or thin, alcoholic, the opposite sex, mentally ill or made illegal works was significantly higher in Group 1. DKSS and selectivity was significantly decreased as the duration of education was increased. No significant relationship was observed between DKSS and total dialysis period and socioeconomic score. In addition, negative relationship was noted between anxiety and depression scores and DKSS ( p<0.05). Conclusions: Increased waiting time negatively effects the decision of receiving kidney from marginal donor. MP590 Table 1. Comparison of the groups thoughts about donors diseases and habits Donor kidney properties With hepatitis B With hepatitis C With Hypertension With diabetes mellitus With heart disease With pulmonary disease With non-methastatic brain cancer Older than 70 yaers Younger than 15 years Younger than 5 years Died secondary to intoxication With morbid obesity Extremely weak Alcoholic donor P Value NS NS NS NS NS NS NS NS NS NS NS <0.05 <0.05 <0.05 MP590 Table 2. Thougts about receiving cadaveric kidney from the donors with social properties Donor kidney properties from partner mother, father sibling from dead relatives from dead close friend from mentally ill donor from opposite sex from donor who did illegal work from other religion from atheist MP591 P Value <0.05 <0.05 <0.05 0.05 <0.05 <0.05 NS NS SURVIVAL OF PATIENTS ON HEMODIALYSIS THERAPY IN TURKEY: AN ANALYSIS OF 20,087 PATIENTS Kamil Serdengecti1, Gultekin Suleymanlar2, Mehmet Altiparmak1, Nurhan Seyahi1, Kitty Jager3, Sinan Trabulus1 and Ekrem Erek1 1 Nephrology Istanbul Univesity, Cerrahpasa Medical Faculty Istanbul Turkey, 2 Nephrology Akdeniz Univesity, Medical Faculty Antalya Turkey, 3Medical Informatics ERA EDTA Registry, Academic Medical Center Amsterdam The Netherlands Introduction and Aims: Comparison of mortality across countries is an important tool to help us explore patient- and process-related factors that contribute to mortality differences reported in dialysis patients. However, data on dialysis survival on developing countries are largely missing. We aimed to analyze the survival and factors affecting survival in hemodialysis (HD) patients in Turkey. Methods: Data from the patient-based database of the Turkish Society of Nephrology were used. Between 1995 and 2005, a total of 36654 patients were recorded in the database. At the end of data cleaning and elimination, 20087 HD patients were eligible for the study. The survival of HD was calculated according “as-treated” method using Kaplan-Meier survival analysis. Cox regression analysis was used for determining the influences of the prognostic factors over survival. Results: Demographic and clinical data of the patients were shown in Table 1 The survival at 1 year was 90.5%, at 5 years was 68.2%, and at 10 years was 54.2%. According to multivariate analysis, older age, male sex, diabetes mellitus, coronary heart disease, congestive heart failure, cerebrovascular disease, and malignancy were associated with decreased survival (Table 2). On the contrary hypertension was associated with a better survival. Conclusions: Our analysis of data from over the 10-year period disclosed that the survival of HD patients in Turkey was comparable to other European countries. Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 are developing a statistical tool to: 1/ illustrate the course of a cohort of incident ESRD patients over time through RR modalities, and 2/ simulate and quantify the impact of various expected changes or new strategies. Methods: The model first estimated transition rates between 10 treatment modalities and between each of these modalities and death, in 6 separate groups stratified in three age groups (at ESRD onset), each with or without diabetes. In a second step a continuous-time deterministic structural model predicted the mean volume of each compartment at each time point for the 180 months after RRT began. Results: The study used outcomes of 67 258 adult patients. As expected, the role of transplantation decreased with age and with diabetes, a change mirrored by the increased role of in-center hemodialysis. In all groups, peritoneal dialysis accounted for only a small portion of the total time spent in RRT. To illustrate the possibility of simulating policy changes, a first scenario tested an increased use of non-assisted automated PD in patients aged 18-44 years without diabetes; a second scenario tested improving access to kidney transplants from cadaveric donors for patients 45-69 years with diabetes. Conclusions: A model based on patients' treatment trajectories can usefully improve descriptions and understanding of the dynamic phenomenon of RRT. It should help nephrologists as well as the Ministry of Health and the health insurance funds to optimize the organization of renal care and public health decision-making. It may also be a tool to facilitate evidence-based public health decisions by evaluating the performance of the organization of renal care, before and after modification, under different useful configurations and over long periods of time. As many factors are related to treatment choice and in view of the lack of randomized clinical trials, simulations may be a way to promote translational research in public health and clinical medicine. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation MP591 Hemodialysis (n=20087) 48.2 ± 17.6 4251 (21.2%) 8486 (42.4%) 10074 (50.2%) 4141 (20.6%) 1928 (9.6%) 1375 (6.8%) 715 (3.6%) 478 (2.4%) 435 (2.2 %) Mean Age (years) Older age (≥65 years) Sex (female) Hypertension Diabetes Mellitus Coronary heart disease Congestive heart failure Periferal vascular disease Cerebrovasculary disease Malignancy MP591 MP592 Hazard Ratio (%95 confidence interval) 1.038 (1.035-1.040) 0.887 (0.838-0.939) 0.911 (0.861-0.963) 1.504 (1.411 – 1.603) 1.155 (1.063 – 1.255) 1.485 (1.356 – 1.627) 0.981 (0.860 – 1.119) 1.381 (1.193 – 1.598) 2.100 (1.824 – 2.417) P 0.000 0.000 0.000 0.000 0.000 0.000 0.0778 0.000 0.000 Introduction and Aims: Disease registries have tremendous potential as tools for quality improvement and research. Chronic kidney diseases database in Estonia is an internet-based system where data on patient ( pts) status, treatment quality indicators and outcome are systematically gathered. Aim of the study was to examine renal replacement therapy (RRT) incidence and prevalence trends with regard to age and gender. Methods: All pts on RRT between January 1, 2000 and December 31, 2012 were considered in the analysis. The information was obtained from the Chronic Kidney Disease Database. Results: End-stage kidney disease affects more than 700 persons in Estonia, i.e., 552 per million population ( pmp) among whom 41% are on dialysis and 59% are living with a functioning graft at the end of 2012. RRT incidence and prevalence pts increase was the highest during 2000-2008 even up to 19 percent of prevalence pts increase in 2001 but last 5 years increase was much lower and last two years we examined only small increase. Incidence rate has quite similar during the last four years (mean 65 pmp) compared with higher rate during previous years. The most common cause of kidney failure have been several years diabetes among incidence pts and among prevalence pts glomerulonephritis whereas diabetes holds the second place. We have noticed the higher acceptance of RRT among pts over 75 years and male predominance during all the study period. Conclusions: Increase of RRT prevalent patients remain low already two years in the row and incidence tends to stabilize, except in persons aged 75 years or older and in those with diabetes in whom it continues to rise. BASAL PHYSICAL ACTIVITY IN HEMODIALYSIS PATIENTS. CORRELATION WITH BIOCHEMICAL PARAMETERS AND WITH BODY COMPOSITION Gabriela Cobo Jaramillo1, Paloma Gallar1, Cristina Di Gioia1, Isabel Rodriguez1, Olimpia Ortega1, Juan C. Herrero1, Aniana Oliet1 and Ana Vigil1 1 Nephrology Hospital Severo Ochoa Leganes Madrid Spain Introduction and Aims: The benefits of regular physical activity (PA) are well known in general population. Patients with CKD are less active compared to general population. Pedometers have been validated for the quantification of PA, although these devices have not been widely used in the dialysis population. The objectives of this study were both measuring the level of PA in hemodyalisis (HD) patients by the use of pedometers and determining the relation between PA with body composition and with biochemical parameters. Methods: In a cross-sectional study we analyzed: PA with a geonaute onstep-400 pedometer, body composition using bioelectric impedance measure and general biochemical parameters. For the measure of PA, patients were asked to use the pedometer during 6 days (2 HD days, 2 non-HD midweek days, 2 non-HD weekend days). The information of the activity carried out, was obtained from the memory of the device. It was necessary to have a minimum of 4 days measured for considering the valoration as valid. In addition to the number of steps taken, the device also provides the time of active walking (AW). Results: 58 patients (mean age 64±12 years) with an median of 37 months (range 2-240) in HD. Thirty four participants (59%) were male, 18 (31%) were diabetic and 11 (19%) had history of isquemic cardiopathy. Vascular and diabetic nephropathies were the most frequent causes of ESRD. In relation to PA, the average of steps taken per day was 3069±2632 steps. PA was lower in women (2103±1439 vs 3713±3042 steps; p=0,011). Likewise, the average number of steps taken in a HD-day was lower compared to non-HD day (2276±2052 vs 3684±3292 steps). Also the number of steps taken in a non-HD weekend day was lower compared to a non-HD midweek day (3355 ±3352 vs 3798±3473 steps). Accordingly, nobody reached the objective of 10000 step in a HD day and just the 9% (5) did in a non-HD day. In regard to the time of AW the mean was 30±27 minutes per day (22±20 vs 39±35 minutes between HD and non-HD day). No correlation between PA and Charlson Comorbidity Index was found. By linking the degree of PA with laboratory parameters, we found a positive association with urea ( p=0.007), creatinine ( p<0,001), total proteins ( p=0.004), PTH levels ( p=0.041) and an inverse association with CRP ( p=0.007) and EPO resistence index ( p=0.015). Concerning the relationship between PA and body composition, higher levels of PA were associated with increased lean mass ( p<0.001) and a lower percentage of fat mass ( p<0.001). In the same way, we found a strong positive correlation between the degree of PA with body cell mass ( p<0,001) and phase angle ( p=0.001). Conclusions: Pedometers are useful for estimating PA in HD patients. Hemodialysis patients have a decreased level of PA. There is a strong correlation between PA with serum creatinine, body cell mass and lean body mass. MP593 INCREASE OF RENAL REPLACEMENT THAREPY PATIENTS IN ESTONIA REMAIN LOW Ülle Pechter1, Merike Luman4, Madis Ilmoja3, Eino Sinimäe2, Asta Auerbach4, Kadri Lilienthal4, Maris Kallaste4, Kristin Sepp3, Ljubov Piel3, Evelin Seppet3, Volume 28 | Supplement 1 | May 2013 MP593 MP594 RED CELL DISTRIBUTION WIDTH AND MORTALITY IN PATIENTS ON MAINTENANCE HEMODIALYSIS (HD) AND PERITONEAL DIALYSIS (PD) Csaba Ambrus1, Lóránt Kerkovits1, János Szegedi1, Attila Benke1, Eszter Tóth1, Lajos Nagy1, Béla Borbás1, Antal Rozinka1, József Németh1, Gábor Varga1, Imre Kulcsár1, László Gergely1, Szilvia Szakony2 and István Kiss1 1 B.Braun Avitum Hungary CPLC Dialysis Network Budapest Hungary, 2Central Laboratory of St Imre Teaching Hospital Budapest Hungary Introduction and Aims: Recent studies have shown that increased red cell distribution width (RDW), a quantitative measure of anisocytosis is associated with higher mortality in critically ill patients, patients with heart failure, coronary artery disease and also in the general population. The underlying pathophysiological process in unclear. Methods: We examined the association of RDW and all-cause mortality in a retrospective cohort of 1396 chronic dialysis patients (63±14 years of age, 49% female, all Caucasian, 36% diabetic, 9% on PD) from 10 dialysis centers in Hungary between 2006 and 2012. Demographical and laboratory data were extracted from electronic medical records of the past 5 years, mortality data were ascertained from the dialysis patient registry. Uni- and multivariable Cox proportional hazard models were created to assess the association between RDW and mortality. Results: At the start of the observation period, patients were on dialysis for 16 months (3-362), 11% were anemic (hgb<100) and the mean RDW was 15.16±1.46. 47% of patients had RDW above the normal range (11-15%). RDW was associated with hemoglobin (r=-0.243, p<0.001), albumin (r=-0.312, p<0.001), CRP (rho=0.291, p<0.001), transferrin saturation (rho=-0.170, p<0.001), cholesterol (rho=-0.133, p<0.001) and triglyceride levels (rho=-0.125, p<0.001). RDW was higher in patients on HD than on PD (15.19±1,44 vs 14.84±1,54, p=0.011). During a mean follow-up of 26 ±21 months, 625 (45%) patients died. In a multivariable model RDW was an independent predictor of mortality after adjustment for age, gender, diabetes, dialysis modality, dialysis vintage, albumin, hemoglobin and CRP. doi:10.1093/ndt/gft151 | i Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Age (year) Sex (Female) Hypertension Diabetes Mellitus Coronary artery disease Congestive heart failure Periferal vascular disease Cerebrovascular disease Malignancy Margit Muliin3, Kadri Telling3, Elviira Seppet2, Kulli Kõlvald2, Kristi Veermäe2 and Mai Ots-Rosenberg1 1 Internal Tartu University Tartu Estonia, 2Internal Tartu University Hospital Tartu Estonia, 3Internal West-Tallinn Central Hospital Tallinn Estonia, 4Internal North Estonia Medical Centre Foundation Tallinn Estonia Abstracts Nephrology Dialysis Transplantation Conclusions: A 1% increment in RDW was associated with a 17% greater risk of mortality (hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 1.1-1.24). Mortality HRs in the 2nd, 3rd and 4th quartile of RDW were 1.17 (0.87-1.56), 1.47 (1.10-1.95) and 1.83 (1.38-2.44), respectively, compared to the 1st quartile in the fully adjusted model. Our data suggests that RDW is a strong and independent predictor of mortality in dialysis patients. MP595 INCIDENCE, PROGNOSIS AND RISK FACTORS FOR TRAUMATIC INJURY IN CHRONIC HEMODIALYSIS PATIENTS Ja-Ryong Koo1, Myung-Jin Choi2, Mi-Hyun Yoon2, Ji-Yean Park2, Eun-Young No2, Jang-Won Seo1, Young-Ki Lee2 and Jung-Woo Noh2 1 Internal Medicine Hallym University Dongtan Sacred Heart Hospital Hwaseong Gyeonggi-Do Republic of Korea, 2Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Kidney Research Institute Chuncheon Gangwon-Do Republic of Korea i | Abstracts MP595 hypotension (HR 1.60, 95% CI 1.35-1.90 for every one event per 12 HD sessions; p<0.001), low serum albumin (HR 0.34, 95% CI 0.13-0.90 for every 1g/dL increase; p<0.05) and increased high-sensitivity CRP level (HR 1.12, 95% CI 1.08-1.32 for every 10 mg/dL increase; p<0.001). Conclusions: Traumatic injury is common in chronic HD patients and associated with high complication rate and mortality. Intra-dialytic hypotension with wide pulse pressure, malnutrition, inflammation and Monday seem to be major risk factors for the traumatic injury. The high risk population delineated by our study appears as a priority target for intervention support (including avoidance of intra-dialytic hypotension, nutritional support, control of inflammation and greater attention to weekend care) to reduce the incidence and complications of traumatic injury in chronic HD patients. Volume 28 | Supplement 1 | May 2013 Downloaded from https://academic.oup.com/ndt/article/28/suppl_1/i472/1838890 by guest on 13 January 2023 Introduction and Aims: As the number of hemodialysis (HD) patients with multiple comorbidities continues to increase, more patients are at risk of traumatic injury during peridialytic period. However the incidence, prognosis and risk factors for traumatic injury in chronic HD patients have not been studied well. Methods: 222 chronic HD patients (age 61.8±12.4 years, male 52.3%, diabetes 64.9%) were studied for a mean duration of 208±92 weeks starting from January 2007. Traumatic injury events requiring hospitalization were identified with review of medical records. Potential risk factors for traumatic injury were collected monthly until study end (July 2012), traumatic injury event, death, transplantation or transfer to another HD center. Results: During the whole follow up periods, 49 traumatic injuries (38 falls, 8 traffic accidents, 3 falling object injuries) occurred (traumatic injury incidence: 5.5/100 person-year). Fifteen (30.6%) traumatic injury events occurred on Monday. Thirty-one patients (63.3%) were complicated by fracture and 9 patients (18.4%) were complicated by intracranial hemorrhage. The overall mortality rate during the follow up period was 34.7% (17/49) in the patients with traumatic injury and 20.8% (36/173) in the patients without traumatic injury. Kaplan-Meier survival curve (figure 1) showed significant difference in the cumulative mortality rate between two groups (log-rank P<0.05). In multivariate Cox analysis, independent risk factors for traumatic injury were pulse pressure (HR 1.67, 95% CI 1.21-2.30 for 10mmHg increase; p<0.002), intra-dialytic