Epidemiology and outcome research in CKD 5D

Nephrology Dialysis Transplantation 27 (Supplement 2): ii268–ii294, 2012 doi:10.1093/ndt/gfs227 EPIDEMIOLOGY AND OUTCOME RESEARCH IN CKD 5D FP586 BUNDLED PAYMENT FOR RENAL DIALYSIS IN A PORTUGUESE SETTING: ECONOMIC IMPLICATIONS Introduction and Aims: The Portuguese National Health Service funds haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system, since 2008. However, this package does not include hospitalizations, physician/emergency room visits, access-related procedures and patient transportation. The aim of our study was to evaluate the annual health care expenses of chronic kidney disease (CKD) patients initiating HD with a catheter (CVC) or an arteriovenous fistula (AVF) and PD, in Portugal. Methods: The study was performed from the Public Administration perspective. One year cost data of 152 CKD patients who consecutively initiated dialysis in our institution in the year 2008 (HD-AVF, n=65; HD-CVC, n=45; PD, n=42) were generated and analyzed, using an intention-to-treat approach. Annual health care expenses were evaluated using a mixed costing method: a) HD and PD treatment expenses were established as the bundled payment of €547.94 per patient-week; b) hospitalizations (inpatient), physician/emergency room visits (outpatient) and transportation data, related or unrelated to kidney failure as defined by the discharge diagnosis [International Classification of Diseases Ninth Revision codes], was captured from the Information Management Division of São João Hospital. Expenditure was determined in accordance with the Ministry of Health and Welfare Ordinance Legislation; c) dialysis access expenses were estimated using a micro-costing approach, using publicly available hospital suppliers’ price lists. Multivariate analysis was used to assess the impact of various comorbid factors on the outcome of interest (annual health care expenses). Results are reported in 2010 Euros (€). Results: Dialysis treatment expenses for HD-AVF, HD-CVC and PD modalities were €28,270, €27,332 and €28,062 per patient-year at risk, respectively (p=0.002). Compared with HD-AVF and PD patients, HD-CVC patients were more likely to have outpatient (€2869 vs. €1794 vs. €1315 per patient-year at risk for, HD-CVC, HD-AVF and PD; p<0.001) and inpatient expenses (€10,554.1 vs. €1324.7 vs. €2052.2 per patient-year at risk, for HD-CVC, HD-AVF and PD; p<0.001). Transportation expenditure were significantly lower in PD modality (€852 vs. €2232 vs. €2099 per patient-year at risk, for PD, HD-AVF and HD-CVC; p<0.001).The costs related to dialysis access for PD, HD-AVF and HD-CVC patients were €1172, €1555 and €4208 per patient-year, respectively (p<0.001). Mean annual health care expenses for HD-AVF, HD-CVC and PD patients were €33,621, €42,855 and €32,282 per patient-year at risk, respectively (p<0.001). In multivariate analysis, PD and HD-AVF modalities were associated with approximately €7500 per patient-year cost savings, compared to HD-CVC modality (β-coefficient= -7364, 95%CI [3749 to 10979]; p<0.001). Conclusions: Patients who choose PD or HD with a functioning AVF incur significant lower annual health care expenses compared to those who initiate HD with a catheter, in the new Portuguese bundled payment plan. FP587 TRENDS BEFORE AND AFTER THE INTRODUCTION OF A REIMBURSEMENT FLAT RATE AND A QUALITY MONITORING PROGRAM: EXPERIENCE FROM THE DOPPS IN GERMANY Werner Kleophas1, Werner Kleophas1, Angelo Karaboyas2, Yun LI2, Juergen Bommer3, Ronald Pisoni2, Bruce Robinson2 and Friedrich Port2 1 Gemeinschaftspraxis Karlstrasse, Dusseldorf, Germany, 2Arbor Research Collaborative for Health, Ann Arbor, USA, 3Dialysezentrum Heidelberg, Germany Introduction and Aims: The pressure of rising health care expenditures has forced Germany like many other countries to restructure certain key elements of the reimbursement system. Rates for dialysis procedures were reduced in 2002 and 2003 and changed from per session payment to a weekly flat rate. In order to avoid lowering of quality, a quality monitoring (QM) system was introduced. First, all centers had to deliver their documentation of all treatments (this started in the 3rd quarter 2007). From the 1st quarter of 2009 all centers with more than 15% outside defined limit for 4 parameters (Kt/V, dialysis frequency and duration, hemoglobin) have to respond to FP587 questions from the local QM committees. Since DOPPS has been observing practice patterns before and during the introduction of the flat rate and the QM program this is a perfect opportunity to look at the effects on relevant treatment parameters. Methods: DOPPS data on these four parameters are available for hemodialysis patients in Germany with vintage > 90 days, based on the initial prevalent cross-sections in phase 1 (1999) and phase 2 (2002), and multiple cross-sections in phase 3 (2005-08) and phase 4 (2009-10). Prescribed treatment time (TT) was used as a proxy for TT if actual TT was missing (7% of patients). Data on prescribed dialysis sessions per week was available in all patients. The spKt/V was re-calculated based on the components (Daugirdas) for patients on thrice weekly HD. Results: Achievement of the hemoglobin (Hgb) target > 10 g/L was greatest from 2005-2008 (only 8-9% of patients below target), but showed a substantial reversal in 2009-2010 to 16-18% of patients below target. The proportion of patients with < 3 prescribed sessions per week was consistently low (< 4%) in each cross-section (data not shown). Achievement of the TT and spKt/V targets has improved throughout the study period and was greatest in 2009-2010 after the implementation of the QM program: 4-6% of patients had TT < 4 hours and 10-12% of patients had spKt/V < 1.2 (Figure). Conclusions: Since 1999 (DOPPS I), large improvements of quality have been seen in Germany, especially for spKt/V and TT which is now longer than in most other countries. Trends to improve quality continued further after the implementation of a reimbursement flat rate for spKt/V and TT. The observed higher frequency of low Hgb targets since 2009 is probably caused by the discussion about revising upper Hgb targets, starting with the CREATE and CHOIR trials in 2006 and the TREAT study in 2009. Facility practice changes after these substantial new requirements in Germany can be useful for understanding the ability of these programs to maintain quality of care in a cost-containment environment. FP588 IS SLEEP AND LIFE QUALITY OF CAREGIVERS AFFECTED AS MUCH AS THAT OF HEMODIALYSIS PATIENTS? Gülperi Çelik1, Bilge Burcak Annagur2, Mümtaz Yilmaz3, Tarik Demir4 and Fatih Kara5 1 Department Of Internal Medicine, Division of Nephrology, Selçuklu Faculty of Medicine, Selcuk University, Konya, Turkey, 2Department of Psychiatry, Selçuklu Faculty of Medicine, Selcuk University, Konya, Turkey, 3Department Of Internal Medicine, Division of Nephrology, Kütahya State Hospital, Kütahya, Turkey, 4 Department Of Internal Medicine, Selçuklu Faculty of Medicine, Selcuk University, Konya, Turkey, 5Department Of Public Health, Selçuklu Faculty of Medicine, Selcuk University, Konya, Turkey Introduction and Aims: The purpose of this study was to determine and compare the quality of sleep, quality of life, and anxiety and depression symptoms reported by hemodialysis (HD) patients and family caregivers of HD patients. Methods: The study included 142 pairs of HD patients and their caregivers. To assess quality of sleep, quality of life, and depression and anxiety symptoms, the 36-item Short Form, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale were used. Variables are presented as mean ± standard deviation (SD) or frequency. A chi-square test was used to compare categorical data. A chi-square test was used to compare categorical data. The differences between the © The Author 2012. 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-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Luis Coentrao1, Carlos Ribeiro2, Carla Santos-Araujo1, Ricardo Neto1 and Manuel Pestana1 1 Nephrology Research and Development Unit, Faculty of Medicine, University of Porto, Sao Jao Hospital Centre, Porto, Portugal, 2Financial Management Unit, São João Hospital Centre, Porto, Portugal. Abstracts Nephrology Dialysis Transplantation two groups were compared with the Mann-Whitney U test. All tests were two-tailed, and the level of significance was p < 0.05. Results: The mean age of the caregivers was 46.1 ± 10.8 years. Most caregivers were women (62%). The mean age of the patients on HD in this study was 57.33 ± 15.89 years. Of the patients, 67 (47.2%) were women. For the patients 73.9% were poor sleepers. Low Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were found in 89.1% and 76.3% of HD patients, respectively. For the caregivers, 88% were poor sleepers. Low PCS and MCS scores were found in 62% and 70.4% of the caregivers, respectively. Mean PSQI scores, subjective sleep quality scores, sleep latency, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction scores of the caregivers were significantly higher than the scores of the HD patients ( p < 0.001) (Table 1). Quality of sleep scores for both groups is shown in Figure 1. Conclusions: Caregivers of dialysis patients experience adverse effects on their quality of sleep and quality of life. Educational, social, and psychological support interventions should be considered to improve their ability to cope. SLEEP QUALITY, DAYTIME ACTIVITY AND RESTLESS LEGS SYNDROME IN PATIENTS UNDERGOING HEMODIALYSIS AND HEMODIAFILTRATION: A SINGLE CENTRE EXPERIENCE. Konstantina Trigka1, Periklis Dousdampanis1, Nikolaos Vaitsis2 and Stamatina Aggelakou-Vaitsi1 1 Kyanous Stayros Patron, 2Kyanous Strayros Patron Introduction and Aims: Many hemodialysis (HD) patients complain of poor sleep. The aim of this study was to determine sleep quality (SQ) in HD and hemodiafiltration (HDF) patients and its impact on daytime activity and well-being. Additionally, we assessed the prevalence of restless leg syndrome (RLS) and its possible associations with insomnia. Methods: We have retrospectively studied 75 HD (43M, 32F) patients aged 68.5±14.6 years from a single HD centre on dialysis for 31.93±34.37 months. 27.38% of them were diabetics. We applied a combined questionnaire with the Epworth Sleepiness Scale (ESS) for the evaluation of daytime sleepiness and the entire eight- item Athens Insomnia Scale (AIS) in order to measure sleep quality. The ESS is a scale intended to measure daytime sleepiness with a scale value of 10–24 indicating that expert medical advice should be sought. The AIS is a self-assessment psychometric instrument with a score of 6 or higher used for diagnosing individuals as insomniacs. In addition, we used the four clinical criteria suggested by the International Restless Legs Syndrome Study Group for the diagnosis of RLS in our patients. Results: 25% of our patients had ESS score >10 and were characterized as sleepers. 83.33% had AIS total score =6 and were characterised as insomniacs. The mean ESS score was 4.42, with men having more difficulty in dealing with daily tasks comparing to women. The mean AIS score was 10.79, with women having more sleeping difficulty comparing with men. No significant differences were observed between insomniacs and non-insomniacs, concerning HD shifts, age (>65 vs <65 years), sex and HD versus HDF. 91.66 % of our HD patients had poor SQ, with only 4.16% reporting using sleep medications (benzodiazepines). Regarding RLS, 33.33% patients were presenting it. No significant differences were observed between insomniacs with RLS versus non RLS, sex, HD shifts, age (>65 vs <65 years) and HD vs HDF. Conclusions: Our results indicate that insomnia is extremely frequent among our HD patients, with a considerable impact on daytime activity and well-being, but it is also undertreated. A large proportion of our HD patients is suffering from low sleep quality and experiences some sort of sleep disturbances. RLS is not very frequent and there is no association between RLS and insomnia in our HD patients. FP590 HEALTH RELATED QUALITY OF LIFE, SLEEP QUALITY AND DEPRESSION IN ELDERLY HEMODIALYSIS PATIENTS Kultigin Turkmen1, Ibrahim Guney2, Faruk Turgut3, Lutfullah Altintepe2, Halil Zeki Tonbul4 and Emaad Abdel-Rahman5 1 Konya University, Meram School of Medicine, Konya, Turkey, 2Meram Training and Reseach Hospital, 3Iskenderun Training and Research Hospital, Iskenderun, Turkey, 4Konya University Meram School of Medicine, Konya, Turkey, 5University of Virginia, Health System, Division of Nephrology, Virginia, US PSQI, Pittsburgh Sleep Quality Index; MCS, SF-36 Mental Component Summary; PCS, SF-36 Physical Component Summary; HAD, Hospital Anxiety and Depression Scale Introduction and Aims: Depression is prevalent in elderly patients. Health-related quality of life and sleep quality were found to be associated with depression in hemodialysis (HD)patients. However,this association was not confirmed in elderly HD patients. We aimed to demonstrate the relationship between SQ, HRQoL and depression in elderly HD patient. Methods: Sixty-three elderly HD patients (32 females, 31 males with mean age 70.5 ±4.7 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), Short Form of Medical Outcomes Study (SF-36) and Beck Depression Inventory (BDI) were applied. Results: Socio-demographic and clinical characteristics of elderly ESRD patients were shown in Table 1. The prevalence of poor sleepers (PSI-4 scores=4) was 71.4%. Of the 45 poor sleepers, 15 had depression defined as BDI =17. Presence of diabetes mellitus was found to be significantly high in poor sleepers compared with good sleepers ( p=0.03). Poor sleepers had significantly higher total BDI scores and lower PCS and MCS domain of HRQoL (Table 1). PSI-4 scores correlated negatively with PCS and MCS (r=-0.500 p<0.001; r=-0.527, p<0.001, respectively)and positively with BDI score (r=0.606, p<0.01). In multivariate analysis, independent predictors of PSI-4 score were BDI score (β=0.219, p=0.007) and MCS (β=-0.19, p=0.018). Conclusions: Poor sleep is very common and is associated with depression and lower HRQoL in elderly hemodialysis patients FP591 ASSESSING QUALITY OF LIFE IN DIALYSIS PATIENTS: A ROLE FOR COMPNENTS OF FRAILTY Paola Sclauzero1, Giovanni Galli2, Giulia Barbati3, Michele Carraro2 and Giovanni Oliviero Panzetta2 1 Nephrology and Dialisis Unit Aouts, Trieste - Italy, 2Nephrology and Dialysis Unit Aouts, Trieste - Italy, 3Cardiology Unit Aouts, Trieste - Italy FP588 Figure 1: Mean scores for components of the PSQI for the 142 pair hemodialysis patients and family caregiver of hemodialysis patients. Volume 27 | Supplement 2 | May 2012 Introduction and Aims: Most of dialysis patients are elderly and present components of frailty: various comorbidities, disabilities, dependence, malnutrition doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 FP588 Table 1: The mean ± SD (range) scores for global and component PSQI, SF-36 MCS and PCS, and HAD depression and anxiety domains for hemodialysis patients and family caregivers of hemodialysis patients FP589 Abstracts FP590 Table 1. Socio-Demographic and Clinical Characteristics of Good Sleepers vs Poor Sleepers Nephrology Dialysis Transplantation FP592 PREDICTING MORTALITY IN DIABETIC INCIDENT DIALYSIS PATIENTS Merel Van Diepen1, Marielle Schroijen1, Olaf Dekkers1 and Friedo Dekker2 1 Leiden University Medical Center, Leiden, Netherlands, 2Leiden University Medical Central ii | Abstracts FP593 DOES THE DAILY SODIUM INTAKE INFLUENCE MORTALITY IN DIALYSIS PATIENTS? Aleksandar Sikole1, Galina Severova- Andreevska1, Lada Trajceska1, Saso Gelev2, Vili Amitov1 and Svetlana Pavleska- Kuzmanovska1 1 University Clinic of Nefrology, 2University Clinic OD Nefrology Introduction and Aims: Among dialysis patients, myriad observational and interventional studies of patients with CKD have shown that restricting sodium intake is an essential tool for volume and blood-pressure control. Daily salt intake suggested for dialysis patients is no more than 5 g. So, an appropriate daily salt intake can raise the risk for cardiovascular morbidity and mortality. The aim was to assess the influence of daily sodium intake (DSI) on cardiovascular mortality in dialysis patients. Methods: 156 patients of mean age 55.69±13.5 years and dialysis vintage 8.9±6.6 years were included in a prospective study. Patients were followed for 36 months, up until death, kidney transplantation or until the end of the observational period. Biochemical, body weight and blood pressure data were examined at baseline and thereafter at regular intervals to calculate the average values DSI was estimated by the following calculation: NaCl (g/day) = 8*serum Na(mmol/L)/140(mmol/L) (mean weekly interdialysis weight gain (IDWG) (Kg)*3/6,5)). DSI of survived and deceased patients were compared with independent T- test. Kaplan-Myer survival log rang test was used to compare the patients grouped by median level of DSI (11.7 g/day). Results: In the time period of 36 months of follow-up 37(24%) HD patients died and one was kidney transplanted. Cardiovasular-dissease mortality rate was 64% of all deceased patients. DSI didn’t differ between the two groups of survived and died patients (11.66 ± 2.71 vs. 11.64±3.4 g/day, p=0.976). The difference of the survival of pts with regard to all-cause and CVD mortality in relation to low (below median intake), or high (above median intake) of sodium, was not found to be significant (33.38 ± 1.12 mo. vs. 33.97 ± 0.75 mo., Log Rank p=0.817); (33.78 ± 0.96 mo. vs. 35.15 ± 0.61 mo., Log Rank p=0.820), respectively. Conclusions: These results of our hemodialysis patients might be partly explained by good individual sodium profiling in patients with high DSI and restriction in use of 20% NaCL during hemodialysis. But also, these results could be another proof of the theory for free of water storage of sodium under the skin, which abolished the effect of volume overload -associated cardiovascular morbidity and mortality. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 and cognitive impairment. Frailty, in addition to traditional factors, is suspected to affect the quality of life (QoL) of dialysis patients. However, little is available in the Literature on this topic. The aim of the study was to evaluate the role of various components of frailty (disability, dependence, nutritional status, comorbidities, social conditions) on QoL in dialysis patients. Methods: We enrolled in the study 203 eligible dialysis patients according to the following criteria: stable clinical conditions, adequacy of dialysis treatment, normal cognitive function estimated by Mini Mental State Examination (MMSE). We administered them the Short-Form 36 (SF-36) questionnaire to evaluate QoL, applied Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) scales to measure disability, Karnofsky Index (KI) to analyze dependence, Subjective Global Assessment (SGA) scale to evaluate nutritional state and analyzed their social conditions. Results: Patients (126 males) had a mean age of 72.03+11.9 years, and a dialytic age of 42.6+55.6 months. The SF-36 cluster depicting physical component of QoL presented a mean score of 39.3 +10.4, while the score of the mental component was 48.5+8.6 (range 0-100). Our data show that 32.5% of patients revealed one or more disabilities (ADL scale), 38,4% were totally or partially dependent (IADL scale), 42.9% of subjects needed help to take care of themselves (KI) and 34% presented malnutrition (SGA). The mean number of comorbidities was 3,04 (range: 0-8). Patients living without family support were 31.5% and 44.5% of them complained a lack of social relationships. Linear regression analysis shows that dependence (p<0.001), malnutrition (p=0.001) and disability (p=0.005) had a primary negative role on many domains of SF-36. The algorithm excluded comorbidities, even significant at an univariate analysis (data adjusted for gender, age and age in dialysis). Living with family instead of in a nursing home or with another caregiver (p=0.002), good economic conditions (p=0.01), and above all, widespread social relationships (p<0.001) were found to be significantly related with a better QoL (test ANOVA). Conclusions: The individual components of frailty have a significant role on the physical component of QoL that is more compromised than the mental one. In addiction the absence of social components of frailty (poor economic condition, lack of social support) is associated with a significantly better QoL. The role of frailty on QoL is more important than that of comorbidities in dialysis population. Our results suggest the need of a global approach to the patient, comprehensive of nursing care, rehabilitation, social interventions in addiction to medical care. Indispensable activities to guarantee a satisfactory QoL are: constant screening of patients to point out the first signs of dependence and malnutrition; promotion of nutritional and functional rehabilitation; prevention of social isolation. Introduction and Aims: Patients with diabetes mellitus have a high risk of developing micro and macrovascular complications, such as cardiovascular and renal complications. However, although a risk factor, diabetes alone is generally not sufficient to discriminate between those who get an outcome and those who do not. Recently, some risk scores, for example for cardiovascular outcomes, have been developed within diabetic populations, but prediction rules for renal outcomes in diabetic patients are still lacking. As renal disease progresses through several stages of severity, different risk scores may apply in different stages. In diabetic patients with End-Stage Renal Disease, risk scores for mortality could aid clinical decision-making and guide tailored patient care. The objective of this study is therefore to identify predictors for 1-year all-cause mortality in diabetic patients on dialysis treatment and use the results to develop a risk score for this population. Methods: Patients from a prospective follow-up study among incident dialysis patients (NECOSAD) with DM at baseline are included. A prediction algorithm for 1-year all-cause mortality is developed through multivariate logistic regression. Candidate predictors are selected based on existing literature and clinical expertise, and include age, blood pressure, comorbidities, duration of diabetes and several laboratory values. The final model is constructed through backward selection. The model's predictive performance is estimated by assessment of goodness-of-fit, calibration and discrimination. The model's performance is internally validated through bootstrapping and a shrinkage factor is computed to adjust for potential overfitting. Several sensitivity analyses are performed, among which an analysis where missing values are imputed through multiple imputation. Results: A total of 394 patients are available for statistical analysis, 82 (21%) of whom reached the outcome. The final prediction model contains six predictors; age, smoking, history of cardiovascular accident or myocardial infarction, duration of diabetes mellitus, karnofsky score, and hemoglobin level. The model has good apparent performance with for example a C-index of 0.805. Internal validation through bootstrapping shows a slightly lower, but still adequate performance. Sensitivity analyses show stability of results, with the same set of final predictors, similar coefficients and similar model performance. Conclusions: A prediction model containing six predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model is good, although there is some room for improvement. Before implementing the model in practice, external validation is necessary. Abstracts Nephrology Dialysis Transplantation FP594 HIGHER DIALYSATE SODIUM IS ASSOCIATED WITH BETTER HEMODIALYSIS PATIENT-REPORTED OUTCOMES: RESULTS FROM THE DOPPS Angelo Karaboyas1, Hugh Rayner2, Yun LI1, Raymond Vanholder3, Ronald Pisoni1, Bruce Robinson1, Friedrich Port1 and Manfred Hecking4 1 Arbor Research Collaborative for Health, Ann Arbor, USA, 2Birmingham Heartlands Hospital, UK, 3Ghent University Hospital, Belgium, 4Medical University of Vienna, Austria FP595 LONGITUDINAL EVALUATION OF SYMPTOM BURDEN IN HEMODIALYSIS PATIENTS Beverly Jung1, Marianna Leung1, Fong Huynh1, Tinnie Chung1, Stan Marchuk1, Mercedeh Kiaii1, Lee Er2, Ronald Werb1, Clifford Chan-Yan1 and Monica Beaulieu3 1 St. Paul's Hospital, Vancouver, Canada, 2Bc Renal Agency, 3St. Paul's Hospital, Vancouver, Bc FP594 Volume 27 | Supplement 2 | May 2012 FP596 SUBJECTIVE GLOBAL ASSESSMENT, NUTRITIONAL STATUS AND HEALTH RELATED QUALITY OF LIFE IN HEMODIALYSIS PATIENT Pavlos Malindretos1, P Makri1, G Zagkotsis1, G Koutroumbas1, G Loukas1, E Nikolaou1, M Pavlou2, E Gourgoulianni3, M Paparizou1, M Markou4, E Syrgani1 and Ch Syrganis1 1 Nephrology Department, Acillopoulion General Hospital, Volos, Greece, 2 Biochemistry Department, “achillopoulion General Hospital, Volos, Greece, 3 Statistician, Volos, Greece, 41st Department of Internal Medicine, Achillopoulion General Hospital Introduction and Aims: In patients suffering from chronic kidney disease (CKD), nutritional status and Health related Quality Of life are known to be affected. Nutritional status can be evaluated both by subjective global assessment (SGA) and by protein equivalent of nitrogen appearance (nPNA), predialysis serum albumin, total cholesterol and hemoglobin levels. Moreover, protein-energy malnutrition, has been strongly associated with both hospitalization and mortality rates. The following study will provide data regarding possible correlation between nutritional status and health related quality of life (KD-SF36) in ESRD patients. Methods: HRQOL was estimated with the KDQOL-SFTM questionnaire, version 1.3, which includes 43 kidney disease targeted items, and 36 items, organized in 20 major subscales that provide a generic core and an overall health rating item, with a higher score reflecting a more favorable health state. The questionnaire was administered to 106 prevalent hemodialysis patients. Seventy five patients responded (70.7%). In these patients SGA was also estimated and demographic and laboratory data were drawn from their medical files. Predialysis concentrations of blood urea nitrogen (BUN), serum creatinine, albumin, total cholesterol, iPTH, hemoglobin, BUN levles at the end of previous hemodialysis session were measured. Additionally, sp. Kt/V was also estimated. Results: Malnurished patients were considered those with nPNA< 1,2 and well nurished those with nPNA => 1,2. Well nurished patients showed better scores in Cognitive function (77,6 ±25,8 vs. 54,4±22,1; p=0,039), Work status (none of the malnurished was working) and hematocrit levels (37,4 ±3,3 vs. 32,75 ±5,8; p=0,004). Total cholesterol and albumin even though in favor of well nurished, like Kt/V showed no significant difference between groups. According to SGA, patients were divided in 3 groups: A-category SGA - well nourished (60 patients – 80%), B-category SGA – moderately malnourished (12 patients – 16%) and C-category SGA – severely malnourished (3 patients – 4%). Well nourished patients tended to be younger (mean age in years: 61.4 ±13.1 vs. 65.0 ±12.8 and 67.1 ±9.1) and received dialysis for a shorter period (median in months: 39.6 vs. 60.7 and 118.5), these differences were not proven to be statistically significant though. They scored better in the Pain component summary(69.1 ±30.6 vs. 55.4 ±25.3 and 33.3 ±27.7; p=0.046), as well as in Physical Functioning component summary (48.8 ±29.1 vs. 31.7 ±30.5 and 22.5 ±23.7; p=0.04). Age was found to be the major determinant of HRQOL, negatively correlated with overall Health rating (cc=-0,314 p=0.006), Kidney disease component summary (cc=-0,336 p=0.003), Physical component summary (cc=-0,258 p=0.027), Physical functioning (cc=-0,443 =0.0001), Work status (cc=0,422 doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: Many dialysis patients report poor quality of life and prolonged time to recover after each dialysis session. Dialysate sodium (DNa) prescriptions have been recommended to be adjusted to the serum sodium (SNa) concentration or below, to reduce the DNa-to-SNa gradient and hence intradialytic sodium loading. However, data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) do not show reduced mortality or hospitalization risk with lower DNa, along with only slight decreases in interdialytic weight gain. Here we aimed to extend our prior research and examine the association between DNa prescription and patient-reported outcomes in the DOPPS. Methods: 26,301 hemodialysis patients from 12 countries in DOPPS phases 1-4 (1996-2011) completed a patient questionnaire. DNa prescription was reported at baseline and patients on sodium modeling were excluded. Outcomes from the self-administered patient questionnaire included mental and physical component summary scores (MCS and PCS) from the Kidney Disease Quality of Life Short Form (KDQoL-SF), cramping, and recovery time (RT) following a dialysis session. Linear regression models were used to examine the associations between DNa and continuous outcomes. For dichotomized outcomes, the Generalized Estimating Equation (GEE) method with logit link function accounting for facility clustering assuming a compound symmetry covariance structure was used. All models were adjusted for DOPPS phase, country, patient demographics (including vintage), comorbidities, labs (including SNa), and 3 facility practice indicators (% catheter use, % spKt/V <1.2, and % serum phosphorus =5.5 mg/dL). Results: 55% of facilities in the present dataset assigned a uniform DNa to at least 90% of patients (non-individualized), resulting in a quasi random assignment of patients to their facility’s chosen DNa and likely reducing treatment-by-indication bias. DNa ranged from 135 to 146 mEq/L in over 99% of non-individualized DNa facilities (median: 140 mEq/L). Restricting to 14,308 patients in non-individualized DNa facilities, higher DNa was associated with slightly better quality of life scores: 0.4 higher MCS (95% CI: 0.0, 0.7) and 0.2 higher PCS (95% CI: -0.1, 0.5) per 2 mEq/ L higher DNa. Patients with a higher DNa tended to be less likely bothered by cramping (OR=0.94 per 2 mEq/L higher DNa, 95% CI: 0.87-1.01). In 2,721 DOPPS 4 patients from non-individualized facilities with data on patient-reported recovery time, higher DNa was associated with a patient having a lower odds of recovery time >6 hours (OR=0.70 per 2 mEq/L higher DNa, 95% CI: 0.55-0.90). Specifically, patients in facilities using a uniform DNa of 138 mEq/L were more likely to take >6 hours to recover from an HD session compared to patients at facilities using a uniform DNa of 140 mEq/L (OR=2.36, 95% CI: 1.67-3.33). Conclusions: In hemodialysis patients from DOPPS facilities using a single uniform DNa for nearly all patients, self-reported outcomes – physical and mental quality of life, cramping, and recovery time from dialysis – were better with higher rather than lower uniform DNa. Slightly raising the DNa prescription may improve the dialysis experience for some patients by relieving cramping and lessening post-dialysis symptoms. This possibility could readily be tested in a clinical trial. Introduction and Aims: Dialysis patients have an extremely high symptom burden. Unfortunately, their physical and psychological symptoms are often under-recognized and under-appreciated. It is prudent that nephrology care providers pay as much attention to these symptoms as they do to the laboratory values that are routinely monitored. The Edmonton Symptom Assessment System (ESAS), which captures symptoms such as pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, shortness of breath, itchiness, and insomnia, has been shown to be a reliable symptom assessment tool in the hemodialysis patients. In this urban tertiary care hemodialysis unit, ESAS has been administered quarterly to patients since September 2010. As part of a continuous quality improvement initiative, the purpose of this study is to describe the prevalence and severity of various symptoms measured by ESAS at baseline and at 1 year after implementation. Methods: This is a retrospective cohort study of patients receiving hemodialysis in an urban tertiary care hemodialysis unit. ESAS scores were measured on a scale from 0 to 10, with 0 meaning no symptom and 10 being the worst. A score of 1 to 3 represents mild symptoms, 4 to 6 moderate and 7 to 10 severe. ESAS scores were tabulated in the Provincial Renal Agency database. The severity of various ESAS symptoms were compared at baseline and at 1 year using paired t-test. Results: A total of 187 patients completed ESAS at baseline and at 1 year. At baseline, the median score ranged from 0 to 4 for the various symptoms with a score of zero for symptoms such as, nausea, depressed, anxiety, and shortness of breath, while tiredness scored the highest at 4. Both the median and mean scores were slightly reduced at 1 year. The difference in mean scores between baseline and 1 year ranged from 0 to -0.80 for the various symptoms. Of which, tiredness, depressed and drowsiness symptoms were statistically significant, -0.57 + 3.19, -0.47 + 0.017, -0.80 + 0.0001, respectively. Fewer patients had severe symptoms at 1 year for pain, tiredness,depressed, anxiety, drowsiness, wellbeing, and shortness of breath although more than 10% continued to report severe pain, tiredness, itchiness or insomnia. Conclusions: The prevalence and severity of various ESAS symptoms were reduced 1 year later. More than 10% of patients continued to report several severe ESAS symptoms. Practitioners caring for hemodialysis patients should continue to strive to target patients with high symptom burden and improve their quality of life. Abstracts p=0,0001) and Sexual function (cc=-0,349 p=0,002). Protein equivalent of nitrogen appearance was found to be negatively correlated with Effects of kidney disease (cc=-0,282 p=0,029) and positively with hematocrit levels (cc=0,358 p=0,005). Serum albumin was found to be positively correlated with Physical component summary (cc=0,257 p=0,025), Role physical (cc=0,378 p=0,001), Work status (cc=0,308 p=0,008) and hematocrit levels (cc=0,262 p=0,021). Conclusions: Deteriorated nutritional status as it is reflected by nPNA and SGA is correlated with health related quality of life in end stage renal disease patients receiving hemodialysis. FP597 DIFFERENCES IN SELF-REPORTED PHYSICAL AND MENTAL WELL-BEING BETWEEN DIABETIC AND NON-DIABETIC US HEMODIALYSIS PATIENTS Introduction and Aims: The Short-Form 36 (SF-36) questionnaire is a validated and well established tool for the assessment of subjective well-being of subjects in the general population (Ware 1992) and has also been validated in the hemodialysis (HD) population (Unruh 2004). Previous reports indicate a lower level of vitality, physical functioning (PF) and general health (GH)in diabetic HD patients (Raimann, ASN Renal Week 2009). The current study aims to investigate all domains captured by the SF-36 and their relationship to diabetic status in a cohort of chronic HD patients. Methods: Voluntarily completed SF-36 questionnaires were obtained in chronic HD patients in Renal Research Institute dialysis facilities. Scores for all parameters of the SF-36 (Ware 2000) were compared in patients with and without diabetes by Mann-Whitney U-Test. Multivariate analysis with backward exclusion of predictors was employed to assess the impact of diabetic status on the two main outcomes, namely 1) Physical Health (Model 1) and 2) Mental Health (Model 2). Model 1 with adjusted for age, gender, black race, diabetes, dialysis vintage, hemoglobin (Hgb), urea kinetic modeling (UKM) volume and pre HD systolic blood pressure (SBP); Model 2 was adjusted for age, gender, diabetes, body mass index, hemoglobin, UKM volume and pre HD temperature. Results: We studied 4732 chronic HD patients (62.2±15.1 years old, dialysis vintage 3.4±4.4 years, 55 % male, 52 % diabetics, 43 % blacks). Univariate analysis showed significant differences between diabetic and non-diabetic patients in all SF-36 subcategories (Table 1). Multivariate analysis revealed small albeit significant association of diabetic status and Physical Health and Mental Health (Model 1: R2=0.06, P<0.001; Model 2 R2=0.02, P<0.001). Conclusions: These findings suggest less subjective wellbeing in HD patients with diabetes mellitus as compared to their non-diabetic fellow patients. These differences are evident both in physical and emotional domains. These differences need to be considered in the care for diabetic HD patients. Achieving recommended metabolic targets and clinical vigilance to timely diagnose secondary complications of diabetes may provide strategies to improve wellbeing in diabetic HD patients. FP597 Table 1: Short-Form 36 a) Physical and b) Mental Component scores (PCS, MCS) in 2463 diabetic and 2269 non-diabetic chronic HD patients. Differences between diabetic and non-diabetic patients were significant (P<0.05) for all parameters. ii | Abstracts FP598 ESTIMATED HEPATIC AND ADIPOSE TISSUE STEAROYL-COA DESATURASE-1 ACTIVITIES ARE ASSOCIATED WITH INFLAMMATION AND ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS Xiaoyan Huang1, Peter Stenvinkel1, Abdul Rashid Qureshi1, Ulf Riserus2, Tommy Cederholm2, Peter Barany3, Olof Heimburger4, Bengt Lindholm4 and Juan Jesus Carrero4 1 Karolinska Institutet, 2Uppsala University, 3Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden., 4Renal Medicine and Baxter Novum, Karolinska Institutet Introduction and Aims: Stearoyl-CoA desaturase (SCD)-1, mainly in the liver and adipose tissue, can introduce a double bond and catalyze the rate-limiting step of generating monounsaturated fatty acids from saturated fatty acids. High hepatic SCD-1 activity has been reported to be associated with low-grade inflammation, total and cardiovascular mortality in the general population. However, the roles of SCD-1 in chronic kidney disease patients have not been addressed. We aimed to investigate the associations between hepatic and adipose tissue SCD-1 activities, inflammation, and all-cause mortality in dialysis subjects. Methods: We recruited 222 dialysis patients (39% women) with median age of 57 (interquartile range: 46-64) years and average 12 (interquartile range: 11-13) months of dialysis vintage in a prospective cohort study. Fatty acid compositions in plasma phospholipids and free fatty acids were assessed by gas-liquid chromatography. SCD-1 were estimated by the ratios of their corresponding products and precursors (16:1 n-7 / 16:0) in plasma phospholipids and free fatty acids, reflecting its activities in the liver and the adipose tissue, respectively. Overall mortality was assessed after 18.4 (interquartile range: 5.5-37) months of follow-up. Results: Estimated hepatic and adipocytic SCD-1 were 0.016 (interquartile range: 0.013-0.022) and 0.15 (interquartile range: 0.10-0.20), respectively. Patients with SCD-1 above the median values were more often women, older, and inflamed. In multivariate analyses, SCD-1 estimated in plasma phospholipids positively associated with interleukin-6 (β = 0.19, p = 0.008) and C-reactive protein (β = 0.17, p = 0.009). Similar associations were observed for SCD-1 estimated in plasma free fatty acids with interleukin-6 (β = 0.27, p < 0.001) and C-reactive protein (β = 0.09, p = 0.18). During follow-up, 61 deaths and 115 kidney transplants occurred. Fully adjusted competing risk models showed that per standard deviation increase in SCD-1 in plasma phospholipids and free fatty acids elevated the mortality risk before kidney transplantation by 31% [hazard ratio (95% confidence interval), 1.31 (1.01, 1.70)] and 41% [hazard ratio (95% confidence interval), 1.41 (1.18, 1.67)], respectively. Conclusions:Estimated hepatic and adipocyte SCD-1 activity are both directly associated with systemic inflammation and all-cause mortality in dialysis patients. In Western populations, elevated SCD-1 index partly reflects high intake of saturated fat and low intake of polyunsaturated fat. Our findings raise the hypothesis that dietary manipulation of SCD-1 activity might be beneficial in the treatment of inflammation in dialysis patients. FP599 MORTALITY COMPARISON OF DIALYSIS MODALITY IN INCIDENT PATIENTS WITH END STAGE RENAL DISEASE: A PROPENSITY SCORE APPROACH Jae Hyun Chang1, Ji Yoon Sung2, Ji Yong Jung2, Hyun Hee Lee2, Wookyung Chung2 and Sejoong Kim3 1 Department of Internal Medicine, Gachon University Gil Hospital, 2Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea, 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea Introduction and Aims: The influence of dialysis modality on survival is controversial. This study assessed the mortality of incident end-stage renal disease (ESRD) patients receiving hemodialysis (HD) versus peritoneal dialysis (PD) by propensity score approaches to overcome for confounding bias from non-random treatment assignment after initiation of dialysis. Methods: We included adult (= 18 years old) incident dialysis patients who started dialysis therapy at Gachon University Gil hospital between 1 January 2000 and 31 December 2008 and still received dialysis treatment 3 months after inception. Results: We identified 745 subjects in the study. After we used propensity method adjusted for the variables, 424 patients (212 in each group) were remained. Mean age was 52 years and 62.7 % were male. The overall 1-year, 2-year, 3-year, 5-year and 7-year survival rates for HD patients were 95.1%, 89.6%, 82.5%, 65.3%, and 47.1% respectively. The equivalent survival rates for PD patients were 93.6%, 83.1%, 73.9%, 48.4%, and 28.3%. The patient’s survival rates were significantly different between modalities ( p = 0.002). In the stratified analysis, we observed that patients on PD experienced better survival than patients on HD when they were non diabetic and modified Charlson comorbidity index = 5. Conclusions: HD patients were higher survival rate than matched PD patients in propensity matched cohort. However, subgroup analyses revealed that, among non-diabetic patients and patients with low comorbidities, those on PD experienced better survival than did those on HD. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Jochen Raimann1, Len A Usvyat2, Viraj Bhalani1, Nathan W Levin3 and Peter Kotanko3 1 Renal Research Institute, 2Renal Research Institute, New York, USA, 3Renal Research Institute, New York USA Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation FP600 EFFECT OF TIMING OF DIALYSIS INITIATION ON MORTALITY IN ESRD PATIENTS Jin Suk Han1, Sejoong Kim2, Jae Hyun Chang3, Ji Yong Jung4, Wookyung Chung3 and Ki Young Na5 1 Seoul National University College of Medicine, Seoul, Korea, 2Seoul National University Bundang Hospital, Seoul, Korea, 3Gachon University Gil Hospital, Incheon, Korea, 4Gachon University Gil Hospital, 5Seoul National University Bundang Hospital, Seongnam, Korea FP601 RELATIONSHIP BETWEEN VARIABILITY OF PRE DIALYSIS SERUM SODIUM AND MORTALITY RISK IN INCIDENT HEMODIALYSIS PATIENTS Jochen Raimann1, Len A Usvyat2, Peter Kotanko3 and Nathan W Levin3 Renal Research Institute, 2Renal Research Institute, New York, USA, 3Renal Research Institute, New York USA 1 Introduction and Aims: The long term stability of the pre-dialysis ( pre HD) serum sodium (SNa+) set point (Keen 2007) has been shown recently (Peixoto 2010). Low absolute levels of pre HD SNa+ (Waikar 2011, Hecking 2011) and, increasing and decreasing trends (Raimann, ASN 2011) have been associated with survival in HD patients. This suggests that stability of pre HD SNa+ confers a survival advantage. This analysis aimed to further investigate whether or not stability of SNa+in the first year on HD is associated with survival in the months 13-18. Methods: Patients who started HD in RRI facilities between 1/1/2001 and 7/30/2008, with at least 3 SNa+ during the first 3 months were included and observed for up to 18 months. Patients were stratified (a) in groups of average SNa+ in the first three months: (1) <137, (2) 137 to 141, (3) > 141 mEq/L; and (b) by the variability of SNa + in the first year as defined by the coefficient of variation (CV): (1) <0.1, (2) 0.1 to 0.2 and (3) >0.2 mEq/L. Cox proportional hazards models were used to compute hazard ratios (HR) with adjustment for age, race, gender, diabetes, comorbidities, Kt/ V; normalized protein catabolic rate, residual renal function (RRF), vascular access, body temperature, urea kinetic volume, dialysate to serum sodium gradient (GNa+), serum albumin, pre HD systolic blood pressure and pre HD weight. Data are presented as mean±SD for descriptive analysis and HR (95% confidence interval) for survival analysis. Results: We studied 4451 incident patients (61.4±15.2 years old, 56 % male, 56 % diabetic patients, 43 % black, 22 % arterio-venous fistula at HD initiation). A higher CV of SNa+ was associated with lower survival in SNa+ groups 1 and 2, and showed borderline significance in SNa+group 3. Lower SNa+ was only associated with lower survival in the groups with a higher CV. Age [HR 1.03 (1.01 to 1.04)], male gender [HR 1.46 (1.07 to 1.99)], presence of RRF [HR 0.49 (0.36 to 0.66)], albumin [HR 0.54 (0.40 to 0.72)] and high GNa+ [HR 1.06 (1.01 to 1.11)] were significantly associated with survival in the months 13-18. Conclusions: Higher variability in pre HD SNa+ is associated with increased mortality at all levels of SNa+. The biological correlate is unclear, but it may possibly be a reflection of present or progressive disease. CHARLSON COMORBIDITY INDEX INDEPENDENTLY PREDICTS VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS André Fragoso1, Ana Pinho2, Anabela Malho3, Ana Paula Silva4, Elsa Morgado1 and Pedro Leão Neves1 1 Nephrology Department, Hospital Faro, Faro, Portugal, 2Nephrology Department of Faro Hospital, Faro, Portugal, 3Nephrology Department, Hospital Faro, Faro, Portigal, 4Serviço de Nefrologia Hospital de Faro E.P.E Introduction and Aims: The Charlson Comorbidity Index (CCI) has been reported to be a strong predictor of survival in incident hemodialysis patients. Vascular Calcification is a well known marker of cardiovascular events and death in hemodialysis patients. The purpose of this study was to examine the usefulness of the CCI as a predictor of vascular calcification. Methods: We prospectively followed for 12 months all patients of a dialysis unit on treatment for more than 3 months by the 31st of January 2009. The CCI score was calculated from ICD-9 CM codes attributed to comorbidity assessment obtained for each patient at the start of dialysis. Patients were classified to 2 CCI score categories according to the median of the score (CCI1<4 ; CCI2 = 4). Vascular calcification was assessed by the Adragão score from the X-ray films obtained through 2009. Laboratory parameters regarding inflammation, nutritional status, anemia and data on intradialytic and extradialytic therapy were also recorded. Results: We followed 169 patients (63.3% males), with a mean age of 61,87±16.32 years on hemodialysis for 73,26±112,14 months. CCI1 patients showed longer hemodialysis time (197,27±64,70 Vs 568,34±44,77 months; p<0,05), a better Adragão Score (1,63±1,88 Vs. 2,96±2,43; p<0,05), higher Pi (4,76±1,53 Vs 4,04±0,97; p<0,05). No differences were found between the two groups regarding CRP, albumin, CaxPi, PTH, Vitamin D therapy and Kt/V. In a logistic regression model, after adjustment for CRP, Gender, Pi and PTH, patients with CCI2 at baseline presented a 2,8-fold risk for development of vascular calcification ( p=0,018). In the same model hemodialysis vintage, as expected, also emerged as a predictor of vascular calcification ( p = 0,009). Finally, a vascular calcification score = 2 represented a 1.3-fold risk for cardiovascular events ( p=0,012). Conclusions: In our population, a higher Charlson Comorbidity Index at the beginning of hemodialysis independently predicted vascular calcification and consequently adverse cardiovascular events. FP603 THE TRANSITION OF PREVALENCE OF CORONARY ARTERY DISEASE AT THE INITIATION OF DIALYSIS OVER THE LAST TWO DECADES Nobuhiko Joki1, Yuri Tanaka1, Masaki Iwasaki1, Shun Kubo1, Toshihide Hayashi1, Yasunori Takahashi2, Koichi Hirahata3, Yoshihiko Imamura2 and Hiroki Hase1 1 Toho University Ohashi Medical Center, 2Nissan Tamagawa Hospital, 3Hirahata Clinic Introduction and Aims: It has been reported that high prevalence of coronary artery disease (CAD) is observed at the initiation of dialysis. Over the last two decades, the medical practice for CKD patients in predialytic phase has dramatically changed. However less is known about the effect of this change on prevalence of CAD. The goals of this study are 1) to clear an evolution of the prevalece of CAD at the initiation of dialysis, and 2) to know the association of it with the change of medical practice, in last 20 years. Methods: Single center longitudinal cross-sectional design study have conducted. From January 1993 to December 2010, 485 ESKD patients were initiated to chronic hemodialysis (HD) in our hospital. The exclusion criteria were 1) the patients with cardiac disease in predialytic phase of CKD such as New York Heart Association (NYHA) level III or IV heart failure, myocardial infarction, coronary revascularization, and low ejection fraction less than 50%, 2) the patients who disagree with screening for coronary heart disease. Finally 222 new hemodialysis patients (63±12 years, 69% male, 56% diabetes) were enrolled into our final database. Then 222 patients were divided 7 era groups equally from past to present according to the date of initial dialysis session. Results: Prevalence of CAD gradually decreased from 44% to 13% ( p=0.01 for trend), as shown in Table. High density lipoprotein cholesterol (HDL-C) concentration increased over time ( p=0.002 for trend), and no dramatic change was observed in low density lipoprotein cholesterol (LDL-C) levels, as a consequence FP601 Table 1. FP603 Table 1. Volume 27 | Supplement 2 | May 2012 doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: The aim of this study was to compare mortality in dialysis patients with early or late start as measured by renal function at starting dialysis by propensity score approaches. Methods: From January 2000 to June 2009, incident adult patients starting dialysis for end stage renal disease were enrolled. Results: We identified 836 subjects in the study. After propensity method adjusted for the variables, 450 patients (225 in each group) were remained. Mean age was 53.7years and 54.4 % were male. At the time of the initiation of dialysis, the mean eGFR was 11.1 mL/min/1.73m2 in the early start group, as compared with 6.1 mL/ min/1.73m2 in the late-start group. There was no significant difference in survival between patients in the late-start group and patients in the early-start group (Log rank tests p = 0.172). A Higher overall mortality risk was seen in early-start group relative to late-start group in those with age = 70 years(HR 3.29; 95% CI 1.01 to 10.7)or albumin = 3.5 g/dL(HR 2.53; 95% CI, 1.02 to 6.28). Conclusions: There was no significant difference in survival between patients in the late-start group and patients in the early-start group by propensity propensity score approaches. FP602 Abstracts ratio of LDL-C/HDL-C significantly decreased ( p=0.005 for trend). In parallel with this, percentage of statin using was increasing dramatically over time ( p=0.001 for trend). Using of ESA also showed a upward slope overtime. Using of renin angiotensin aldosterone system blockade agents also increased dramatically in this 18 years ( p<0.0001 for trend, p<0.0001 for trend respectively). Conclusions: We would like to emphasize that a dramatically descent of prevalence of CAD was found at the initiation of dialysis therapy over the last two decades. One potential story may exist that the upward of statin using could modify lipid metabolism and suppress coronary plaque progression in CKD patients. FP604 FACTORS AFFECTING THE NUMBER OF PATIENTS TREATED WITH EITHER PERITONEAL OR HOME HAEMODIALYSIS IN THE UK Introduction and Aims: The percentage of RRT patients treated with home dialysis (home HD and PD) in the UK has fallen with the introduction of satellite HD units allowing expansion of in centre HD programmes. There is currently wide variation (18 fold) in home dialysis use rates between renal centres and this study examines the centre factors and practice patterns which are associated with this. Methods: A national survey of renal units was performed to identify potential predictors of home dialysis rates. The percentage of all incident RRT patients in 2007-2008 who used either PD or home HD within the first year of RRT was calculated for each health area (Primary Care Trust or Health Board) in the UK (n=192) using the patients’ postcodes and data collected routinely by the UK Renal Registry. Multilevel random intercept linear regression was used. Results: Survey data was available for all renal centres in the UK (n=72). Of the 12,641 patients on RRT at 90 days in 2007-2008 25.7% (n=3,251) used a home dialysis modality. Health area rates were mean (SD) 27% (12) range 0- 67%. Area socio-economic deprivation was negatively associated with home dialysis use with fewer patients using home dialysis in the most deprived areas compared with the most affluent areas (coeff. -12.1 (95% CI: -16.6, -7.6) p<0.001). Distance from the nearest renal unit (each 2km) was positively associated with the percentage of patients on home dialysis (3.9 (2.4, 5.4) p<0.001). The use of acute PD was found to be associated with more patients on home dialysis compared to areas which rarely used this (6.1 (1.7, 10.5) p=0.006); this proved independent of the effect of deprivation and distance to the nearest unit (6.5 (2.5, 10.5) p=0.001). The flexibility to insert a Tenchkoff within 1 week was found to be associated with higher rates of home dialysis use (very difficult to insert vs. very easy -16.4 (-26.7, -6.1) p=0.002) but it did not matter if dialysis access was inserted by nephrologists or surgeons (1.7 (-2.9, 6.3) p=0.5). The inability to provide late presenting patients with dialysis education was associated with fewer patients on home dialysis (-15.8 (-27.6, -4.0) p=0.009) although late presentation rates in themselves were not found to be associated with home dialysis rates (-0.2 (-2.3, 1.8) p=0.8) per SD change. Providing home visits for home dialysis patients was associated with more patients on these modalities (8.4 (1.6, 15.2) p=0.02) but providing same day hospital appointments, having a named nurse, using a private company to provide patient troubleshooting advice and having a system where advice out of hours comes from specialist as opposed to general ward nurses were all not associated with home dialysis rates. Conclusions: The use of acute PD, having a responsive dialysis access service, being able to provide pre dialysis education to late presenting patients and providing home visits were all found to be associated with a higher percentage of incident patients on home dialysis. Area socio-economic deprivation and proximity to a renal unit were associated with lower rates of home dialysis use. FP605 LOW RESISTIN LEVELS IS ASSOCIATED WITH POOR HOSPITALIZATION-FREE SURVIVAL IN HEMODIALYSIS PATIENTS Ki Young Na1, Sejoong Kim2, Wookyung Chung3, Ji Yong Jung3, Jae Hyun Chang3 and Hyun Hee Lee3 1 Snubh, 2Seoul National University Bundang Hospital, Seoul, Korea, 3Gachon University Gil Hospital, Incheon, Korea Introduction and Aims: Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. Methods: We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 ± 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. Results: During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin ii | Abstracts levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. Conclusions:The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients. FP606 OCULAR CHANGES IN PATIENTS OF CHRONIC KIDNEY DISEASE AND RENAL ALLOGRAFT RECIPIENTS Jasvinder Singh Sandhu1, G S Bajwa1, Shyna Kansal1 and Jashan Sandhu2 1 Dayanand Medical College, Ludhiana, India, 2Dmc Ludhiana, India Introduction and Aims: Chronic kidney disease (CKD) affects almost every organ system of body including the eyes. Patients with chronic kidney disease have better survival and improved quality of life especially after transplantation. Visual loss is a rare but potentially devastating complication of organ transplantation. Aim of this study was to determine the ocular changes in patients of CKD on various treatment modalities. Methods: This cross-sectional prospective study was carried out in indoor and outdoor patients of our tertiary care medical college hospital. A total of 125 patients were included and divided into three groups. Group A included 50 patients of stage 3 and 4 chronic kidney disease on conservative treatment. Group B included 50 patients of stage 5 CKD on chronic intermittent hemodialysis and Group C included 25 stable renal allograft recipients of at least 6 months duration. The staging of CKD was based on the estimated GFR using MDRD equation. A detailed ocular examination was carried out in each case. This included visual acuity testing using Snellen’s chart, slit lamp examination, tonometry, direct and indirect ophthalmoscopy and if required the fundus fluoresce angiography in selected cases. Results: The mean age of patients was 50.8±14.3 years with age range of 10 to 80 years and the male: female ratio of 1.9:1. The mean age of renal allograft recipients was lower (37.7±13.6 years) as compared to group A and B. Normal vision defined as Best Corrected Visual Acuity in the better eye of 6/18 or more was present in 72 (57.6%) of patients. Blindness was present in 10 (8%) of patients, 10%, each in group A and B and 4% in group C. Seventy (56%) of patients had diabetes mellitus. Diabetic retinopathy was seen in 69 % of the diabetics and diabetic maculopathy (79%) was the most common findings. Hypertension was present in 3/4th of patients and only half of these had hypertensive retinopathy. The nuclear and cortical cataract (age related) was seen in 52 % and 40% of group A and B patients respectively. One third (30%) of renal allograft recipients had posterior sub capsular cataract. The intraocular pressure (IOP) was within normal limits in majority of our patients with mean IOP of 14.49 mm of Hg. The most important and vision threatening findings were in the posterior segment. The most common being the diabetic and hypertensive retinopathy seen in 96 (38.4%) eyes. Other findings included optic atrophy in 3.6%, exudative retinal detachment in 2.4%; macular coloboma, age related macular degeneration, choroiditis, endophthalmitis each in 0.8% eyes and central serous retinopathy and branch vein retinal occlusion each in 0.4% of total eyes. Herpetic keratitis (8%), central serous chorioretinopathy (4%), fungal endophthalmitis (4%) and cytomegalovirus retinopathy (4%) was seen in renal allograft recipients. Conclusions: A significant number of patients of chronic kidney disease on conservative therapy and chronic intermittent hemodialysis therapy and renal allograft recipients have ocular changes ranging from mild visual loss to total blindness. An early detection of ocular changes can help to prevent and treat visual loss. FP607 TECHNIQUE FAILURE IN HOME HAEMODIALYSISA PROSPECTIVE SINGLE CENTRE EXPERIENCE Anuradha Jayanti1, Milind Nikam1, Leonard Ebah1, Angela Summers1 and Sandip Mitra2 1 Manchester Royal Infirmary, Manchester, UK, 2Manchester Royal Infirmary Introduction and Aims: Home haemodialysis (HHD) is receiving renewed recognition as a preferred modality of renal replacement therapy for all suitable patients with kidney failure. However, selection criteria for this are not well defined. Limited data exist on the outcomes of home haemodialysis training or HHD modality technique survival/failure and its predisposing factors. We sought to a) review all incident and prevalent patients commencing HHD training at our centre who had to switch to an alternative dialysis modality option and b) identify potential risk factors for HHD technique failure. Methods: This is a prospective study of all incident and prevalent patients within the Greater Manchester East Sector Renal Network who commenced HHD training (January 2003-November 2011). All patients entered the programme through open selection criteria, principally led by patient choice and with a dedicated pre-dialysis education and dialysis preparation phase. Demographic data, primary renal disease, co morbidities, dates of entry and exit from the program, carer status, type of vascular access at the start of training and final patient outcomes were extracted from clinical databases. Deaths or transplants were excluded. Results: The numbers of patients receiving dialysis (all modalities) at our centre are approx. 500/year. Over the 9yr study period, 183 patients (mean age 53y) Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Clare Castledine1, Julie Gilg2, Chris Rogers3, Yoav Ben-Shlomo4 and Fergus Caskey5 1 UK Renal Registry, Bristol, UK, 2UK Renal Registry, 3University of Bristol, 4 School of Social and Community Medicine, Bristol University, UK, 5NHS North Bristol, Bristol, UK Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation FP607 Table 1 Reasons for leaving HHD training/modality FP609 FP607 commenced HHD training. 23 patients eventually switched to an alternative modality during this period, whilst training or after being established on HHD. Median modality transition rate was 2 pts/annum (1 to 4) or 3.3% of prevalent cohort per year. The annual numbers of modality switch is depicted in the graph below, alongside numbers of patients active in the program/year. Numbers of patients who switched to alternative modalities were, return to hospital haemodialysis (21; 91.3%), peritoneal dialysis (1; 4.3%) and switch to self-care facility based haemodialysis (1; 4.3%). Age, gender, ethnicity and carer status in the ‘training/ modality failed’ group or access type did not significantly differ between cohorts. The reasons for switch were analysed and comprised mainly of human or social factors (table1). Of the co morbidities reviewed, diabetes (34.7%, p=0.003) and cardiac failure ( p=0.08), were identified as significant medical risk factors. We have sought further information from 19 of 23 patients, who are alive, on issues influencing the change in decision from the pre-dialysis phase through to the current modality. Conclusions: The overall HHD technique failure appears to be quite low. Preparation in the pre-dialysis education phase and initial modality selection involves consideration of several physical factors and patient choice. However, other potentially modifiable psychosocial factors of confidence and self- motivation influence successful outcome. All patients who wish to consider HHD could benefit from more robust psychological screening and preparation prior to or during HHD training. FP608 AN AFFORDABLE MODEL FOR SOLAR-ASSISTED HOME HAEMODIALYSIS. John Agar1, Anthony Perkins1, Rosemary Simmonds1 and Alwie Tjipto1 Geelong Hospital, Barwon Health 1 Introduction and Aims: Haemodialysis (HD) uses significant water and power. After establishing our home nocturnal HD (hNHD) program in 2000 (currently 35 hNHD of a total 120 HD patients), we found we had inadvertently shifted the financial responsibility for both utilities from the facility to the patient. We have previously reported our resource conservation practices for both water and power. We reclaim and reuse reverse osmosis reject water - up to 65,000 L/week (facility) and up to 35,000 L (hNHD) (1) - and have successfully established solar-assisted HD at our 4 station home training unit (HTU). This is currently meeting 94% of all HD-related power requirements of the HTU and has reduced power costs by >75% (2). Our next step is to model home solar installation as a further incentive to encourage/support hNHD. Our model for solar-assisted hNHD is presented. Methods: We have modeled solar-assisted hNHD installation based around an 8hr x alternate night/week (8alt) hNHD, the most commonly-used Australian home HD Volume 27 | Supplement 2 | May 2012 PREVALENCE OF NEPHROGENIC SYSTEMIC FIBROSIS (NSF) IN DIALYSIS PATIENTS: FINAL RESULTS OF THE PRO-FINEST STUDY Sabine Amet1, Vincent Launay-Vacher1, Maurice Laville2, Aurore Tricotel3, Camille Frances4, Benedicte Stengel5, Jean-Yves Gauvrit6, Nicolas Grenier7, Genevieve Reinhardt8, Olivier Clement9, Nicolas Janus1, Laurence Rouillon1, Gabriel Choukroun10 and Gilbert Deray11 1 Service Icar, Nephrology Department, Pitie-Salpetriere Hospital, Paris, France, 2 Nephrology Department, Edouard Herriot Hospital, Lyon, France, 3Drug Monitoring, Afssaps, Saint-Denis, France, 4Dermatology Department, Tenon Hospital, Paris, France, 5Inserm U1018, Paul Brousse Hospital, Villejuif, France, 6 Radiology Department, Pontchaillou Hospital, Rennes, France, 7Radiology Department, Pellegrin Hospital, Bordeaux, France, 8Radiology Department, Haguenau Hospital, Haguenau, France, 9Radiology Department, G.Pompidou Hospital, Paris, France, 10Nephrology Department, South Hospital, Amiens, France, 11Nephrology Department, Pitie-Salpetriere Hospital, Paris, France Introduction and Aims: NSF is a cutaneous and systemic disorder characterized by widespread tissue fibrosis. It has been linked with gadolinium-based contrast agents (GBCA), especially in dialysis patients. The Pro-FINEST study is a national prospective study endorsed by the French Drug Agency (Afssaps), the French Societies of Nephrology, Dermatology, and Radiology. It aims at determining the prevalence of NSF after a Magnetic Resonance Imaging (MRI) examination, +/GBCA, in dialysis patients. Methods: The study is based on a 3-section patient form. Section 1: demographics and dialysis; Section 2: MRI examination; Section 3: any dermatological event (DE). Further investigations are planned in case of DE. When a NSF diagnosis is confirmed, an ancillary study is scheduled, with random selection of 4 patients (same gender, dialysis technique, centre, GBCA and without any DE after MRI). Results: Since 01/2009, 571 patients have been included (109 centres): mean age 63.3 years, 58.5% males. 50.3% received GBCA, 88.9% Gadoterate. 22 patients reported a DE. Dermatological diagnoses did not report any evidence of NSF. Conclusions: No case of NSF has been reported in 571 dialysis patients among whom the majority received a GBCA. When good clinical practices regarding the use of GBCA in a group a risk of NSF are followed, the NSF frequency is nil. Within patients who underwent an injected MRI 2.1% patients received linear GBCA but 93.4% received a macrocyclic GBCA and 88.9% received Gadoterate for which no unconfounded case of NSF has been observed yet worldwide. Almost 76% of the patients who underwent an injected MRI received a right dose of GBCA. FP610 CAN A REDUCED RENAL RESPONSE TO A PROTEIN CHALLENGE IN PREGNANT WOMEN SUFFERING FROM CHRONIC RENAL DISEASE PRECLUDE THE INITIATION OF RENAL IMPAIRMENT? Amelia Bernasconi1, Rosa Waisman2, Ana Patricia Montoya3, Amador Andrés Liste3, Ricardo Hermes3, Graciela Muguerza4 and Ricardo Heguilen3 1 Hospital J.A. Fernandez, 2Hospital J.A. Fernandez, 3Hospital J.A.Fernandez, 4 Hospoital J.A.Fernandez Introduction and Aims: The renal functional reserve (RFR) assessed following an oral protein load (PL) remains almost intact in pregnant women (P) without evidence of renal disease. The reduction of this physiological response in PW suffering nephropathies could become an early marker of renal exhaustion precluding the progression towards more advanced stages of renal dysfunction. doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 regimen. We have used our HTU solar-assisted HD experience which confirmed the hourly power draw of our paired Fresenius 4008B HD machine + Aquauno reverse osmosis home HD system to be 1.285 kWh. While acknowledging that mean solar insolation varies by location, we applied historical Australian Bureau of Meteorology insolation data (Geelong: 38°100 S; 144°220 E, decadal 12 month insolation: 4.2 kW/ m2/day) to our model. Based on an 8alt hNHD model, the mean daily grid-draw required over a full 12 month cycle to cover all hNHD-related power is thus 1.285 × 8 × 3.5 × 52 = 1870.96 kWh/yr. Results: To satisfy all hNHD power needs a modeled array equivalent to a 1.52 kW DAQO™ panel + MacSolar TL1.5K inverter™ (8 x 190W panels: surface area 10.52 sq. metre: mean predicted output 2116.54 kWh/year: anticipated array lifespan 25 yrs: commercial purchase and installation quotation (Jan. 2012) = A$3,206) would be required (3). Conclusions: Home HD and hNHD costs are already known to be substantially less than those of facility- based HD with current Australian data showing home HD to be Au$30,000/year less than facility HD. In this context, the low additional but once-off cost of a home solar installation may offer a further but affordable incentive to our well-established home water conservation options. This may help encourage an ever greater home HD uptake. The option of a concurrent but self-funded upsizing of an installed array to cover domestic use could also be considered at the specific request of individual patients. 1 Hemodialysis International. 2009. 13 (1):32-37. 2 CJASN: doi: 10.2215/CJASN.09810911 3 www.energymatters.com.au/ climate-data/grid-calculate-solar.php. Abstracts FP611 CROSS SECTIONAL EPIDEMIOLOGICAL STUDY IN HEMODIALYSIS PATIENTS Elena Laura Iliescu1 Fundeni Clinical Institute, Bucharest, Romania 1 Introduction and Aims: We evaluated HBV, HCV, HDV and HEV infections in various categories of risk populations and seroprevalence of HBV and HCV infections in population asking for a medical examination. Methods: We conducted a cross-sectional, epidemiological study in a population of 2851 subjects from Subcarpathian region of Romania (17 counties, 34% of area and 42% of population), that were stratified in 4 risk categories: controls (n=2540), very low risk (students; n=44), low risk (doctors and nurses; n=93) and high risk populations (hemodialysis patients; n=174). Results: We report the prevalence data of hepatitis viruses (HBV, HCV, HDV) in 174 hemodialysis patients from 6 dialysis centers located in the South part of Romania. The mean age was 53.71+/-12.71 years and 85/174 (48.85%) from the subjects were male. Distribution of subjects according to the urban/rural provenience was 90/84 (51.72% of the subjects were from urban areas). In hemodialysis patients, HBV and HCV seroprevalence was 7.91%, respectively 39.26%. HCV-RNA was detectable in 20.69% cases. Female sex and rural area were risk factors for HBV infection and ALT level for HCV infection. Conclusions: In conclusion, in Subcarpathian region of Romania the seroprevalence of viral hepatitis infections is still medium to high compared with Europe, but similar to other Romanian regions or Balkans. FP612 EVALUATION OF CHRONIC PAIN IN CKD PATIENTS Valentina Martina1, Maria Antonietta Rizzo2, Paolo Magenta3, Lorenzo Lubatti3, Giuseppe Rombolà4 and Maurizio Gallieni5 1 Nephrology and Dialysis Unit, San Carlo Borrmeo Hospital, Milano, Italy, 2 Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milano, Italy, 3Pain Therapy Unit, San Carlo Borromeo Hospital, Milano, Italy, 4Nephrology and Dialysis Unit, Ospedale Sant'andrea, La Spezia, Italy, 5Nephrology and Dialysis Unit Introduction and Aims: Pain is an important cause of disability and bad quality of life in chronic and acute diseases. Nevertheless, this problem often remains under-recognized. Guidelines by WHO are available for management of pain: they are dictated for patients with no metabolic diseases. Thus, pain therapy for the patient affected by chronic kidney disease (CKD) is not well defined. In CKD patients, pain can be caused by comorbidities, CKD complications, and in dialysis patients by the dialysis procedure itself. In clinical practice, pain in CKD patients may be under-treated because it is very difficult to handle analgesic drugs: in fact, renal failure modifies drug pharmacokinetic and pharmacodynamic profiles. Therefore, there is a strong need to improve knowledge of the problem, quantifying its entity and producing informative material to help patients and healthcare professionals to better face this important issue. In this perspective, the aim of the present study is to evaluate prevalence and characteristics of chronic pain in CKD stage 5D patients. Methods: A CKD specific questionnaire was created adapting the Italian version of "McGill Pain Questionnaire". First, it was submitted to patients during the hemodialysis session. Patients could ask for help to nurses if they were not able to independently complete the questionnaire. They were asked to report pain felt during that dialysis ii | Abstracts FP612 Table 1. Prevalence of pain in CKD-5D patients session. Intensity of pain was reported in a numerical rating scale (NRS), from a minimum of 0 (no pain) to a maximum of 10 (worst pain). It was then asked to the patient to report on a cartoon representing the human body, the point or points where she/he feels the pain. Last, the patient had to complete three NRS at home (the night of dialysis, in the morning and in the evening of the day after dialysis), in order to highlight a possible relationship with the dialysis session. Results: We present preliminary data from 111 patients form an ongoing study of 273 patients in two dialysis units. Patients had a mean age of 67.85 ± 13.92 years, duration of renal replacement therapy of 6.44 ± 8.84 years, with a higher proportion of men (70 vs. 30%). Overall, the majority of patients did not report pain (see table) and about 1/ 10 reported very severe pain. No statistically significant difference in pain score between dialysis (mean NRS 2.75) and non-dialysis day (mean NRS 2.49), although the score was slightly higher on the evening after dialysis (mean NRS 2.98). Pain in the upper limbs (22.5% of patients) was less frequent than in the lower limbs (45% of patients); however, in 90% of patients pain in upper limbs was reported on the same arm where vascular access is present. Preliminary analysis of the modified McGill questionnaire showed that In CKD stage 5D patients the quality of reported pain has a relevant affective component, compared to the sensory, nociceptive component. Conclusions: About half of patients report chronic pain during dialysis, with a relevant affective component. Pain is present in dialysis and non-dialysis days with a similar prevalence and intensity. No apparent association of pain with the dialysis session was found, although pain in the upper limbs appears to be related to the presence of vascular access. FP613 SOCIOPROFESSIONAL OUTCOME AT ADULT AGE OF CHILDREN AFTER KIDNEY TRANSPLANTATION Chantal Loirat1, Chantal Loirat2, Hélène Mellerio3, Marylène Labèguerie4, Béatrice Andriss3, Emilie Savoye5, Mathilde Lassale5, Christian Jacquelinet5 and Corinne Alberti3 1 Pediatric Nephrology, Hôpital Robert Debré, Paris, France, 2Hôpital Robert Debré, Paris, France, 3Inserm, Cic-Ec, Cie 5, Hôpital Robert Debré, Paris, France, 4Inserm, Cic-Ec, Cie5, Hôpital Robert Debré, Paris, France, 5Agence de la Biomédecine, Saint Denis La Plaine, France Introduction and Aims: Little is known about the outcome at adult age of children who received kidney transplantation. The aim of this study was to describe the educational, social and professional outcomes in a nationwide French cohort of adults (>20y) who underwent kidney transplantation before age 16, between 1985 and 2002. Methods: A questionnaire was sent to 624 patients known as alive with an address in France, of whom 374 (60%) responded. Data were compared to French general population (FGP) using indirect standardization. Results: Median age of participants was 27.1y (Q1-Q3: 24.1-31.5), 12.3y (Q1-Q3: 8.7-14.4) at first transplantation, male gender 51.6%, functioning graft 81%, 41.6% =2 grafts, median dialysis duration 2.0y (Q1-Q3: 0.8- 4.8), mean height 165.7cm (men), 152.9cm (women). Disease had started at birth, during childhood or adolescence in 45.5%, 44.1% and 9.3% of participants, respectively. Amblyopia or blindness was reported by 6% of participants, hypoacousia or deafness by 14.6%. One third (31.1%) of patients lived with a partner (vs 52.2% in FGP, p<0.01 for both genders), 27.6% lived alone in an independent lodging (vs 20.3%, p<0.01, difference vs FGP significant only for men, 31.4% vs 19.1%, p<0.01), 35.7% with parents (vs 21.0%, p<0.01 for both genders) and 5.6% in an institution (vs 0.04%, p<0.01).12.5% of men and 11.6% of women had =1 child. The proportion of patients who never attended the normal school system or left it before the end of primary school was significantly higher than in FGP (10.5% vs 3.6%, p<0.01). The proportion of patients with at least one year of school delay during primary school was 3 times higher than in FGP in first year of primary school, 1.5 times in last year (p<0.01). Among patients who concluded their academic training, the highest diploma obtained was similar to FGP, except for a higher proportion without diploma (20.5% vs 12.3%, p<0.01) and a lower proportion with =3 years university diploma (14% vs 21.6%, p<0.01). However, these differences towards FGP were significant only for women. After adjustment to parental highest diploma, the proportion of patients without diploma was similar to FGP, and only the proportion of women with the baccalaureate and of patients of both genders with =3 years university diploma was lower than expected according to parents’ educational level (p<0.01 vs father and mother). Professional categories were also similar to FGP, but unemployment (18.5% vs 10.4%, p<0.01) and fixed term contracts (21.1% vs 11.8%, p<0.01) were more frequent. 15.1% of patients received a disability pension. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 The aim of this study was to evaluate the renal response to PL in PW suffering from kidney diseases such as primary and secondary glomerulonephritis, reflux nephropathy, obstructive nephropathy, autosomal dominant polycystic kidney disease and solitary kidney. Methods: 18 P with chronic renal disease (CKDP) were studied along with 12 P without evidence of renal involvement (NP). After fasting overnight, all the subjects received an oral water load (20 mL/kg of body weight), the urinary output was then replaced orally with equal volumes of water. After two 30 min periods, an 80-g PL was provided. Creatinine clearance (CrC) was measured every 30 min from 1 h before and for 4 h following PL. Participants remained recumbent during the study. Baseline CrC was taken as the average of two 30 min periods before PL and peak CrC as the maximal CrC recorded thereafter. The renal reserve index (RRI) was taken as the rate peak/baseline CrC. All data are expressed as mean 1 SEM unless otherwise indicated. The one way or the repeated-measures ANOVA were used as appropriate. A value of P < 0.05 was accepted as statistically significant. Results: Both groups were similar with regard to age, weight or gestation age. As a result of pregnancy, serum creatinine levels had decreased similarly in both groups. Baseline CrC [ml/min] 122.9 ± 5.0 [NP], and 137.3 ± 10.2 [CKDP], P = NS, increased ( p< 0.05) after PL to 198.6 ± 11 (NP) and to 187.9 ± 13 (CKDP) thus, the renal reserve index (RRI) was 1.64 ± 0.01 (NP) and 1.39 ± 0.04 (CKDP), p<0.05 Conclusions: 1- The ability to increase the CrC as a consequence of gestation is retained in CKDP as well as in NP but renal reserve is dramatically reduced in the former group of individuals. 2- The renal response to PL during pregnancy may allow detecting subtle defects in renal function even when they are not clinically apparent or identifiable with currently available static laboratory methods. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation 47.5% of participants declared having suffered from discrimination (vs 6.2% in FGP, p<0.01), mostly at school (61%) and from employers (28%). Multivariate analysis showed that low educational level (no diploma or < baccalaureate vs = baccalaureate) was significantly associated with short height, presence of comorbidities and low parental educational level. No marital life was significantly associated with hereditary nephropathy, onset of disease at birth, presence of comorbidities and low individual incomes (= vs >1000€/month). Pensioned disability was significantly associated with current dialysis, celibacy and low educational level. Conclusions:Socioprofessional outcome is now within normal limits in a large proportion of adults transplanted during childhood. However, these young adults meet more difficulties to build up their familial and professional life than the general population. FP614 Yogita Aggarwal1 and Jyoti Baharani2 Heartlands Hospital,, 2Birmingham Heartlands Hospital 1 Introduction and Aims: Little is known regarding the difference in clinical demographics and outcome in end-stage renal failure patients who elect to pre-emptively withdraw from dialysis during their end of life and those who have physician initiated dialysis withdrawal in the UK. We report a 10-year retrospective single centre experience of patients who died after dialysis withdrawal between 2000-09 inclusive and received EDTA death codes of either 51 or 54 (51 = death due to the withdrawal of dialysis on patient request, 54 = withdrawal due to medical reasons). Methods: Information was gathered from electronic and paper case notes. Parameters reviewed included patient demographics, primary EDTA renal diagnosis, comorbidties as risk stratified using the Charlson Index(CI), length of time on dialysis, duration of life once dialysis was withdrawn, acute terminal admission precipitant, tolerance of dialysis, dialysis efficiency and performance status as per Karnofsky Score (KS). Results: 72 patients were identified to have died from dialysis withdrawal in the study period. 57% were male and 91% were Caucasian. The mean age at death was 75 years and median age 78 years. 40% had end-stage renal failure (ESRF) from unknown causes, 11% from primary glomerulonephritidis (GN), 3% from diabetes, 33% from renovascular disease, 7% from interstitial nephritis and 6% from genetic causes. The average length on dialysis was 2.5 years, with a mean survival of 15 days post withdrawal. All had a Karnofsky Performance score of 70% or less at time of dialysis withdrawal. For those with EDTA code 51 • 10% of the withdrawal group fell in this category. • 83% of this group had a high risk CI score and 70% had a KI of less than 40% in the last months of dialysis. • 100% had issues with dialysis access and cardiovascular instability post HD. • Average last month dialysis efficiencies showed Kt/V 1.1 and URR 61%. For those with code EDTA code 54 • 90% withdrew from dialysis for medical or other reasons. • 59% had a high risk CI and 45% had a KS of less than 40%. • 14% had documented difficulties on dialysis and the CI for this group was high risk. • 52% failed to rehabilitate from an acute clinical presentation – including falls due to ongoing physical frailty, acute infective episodes, gastrointestinal bleeding, and unstable angina. 100% had high risk CI and KS of less that 50. ? The average dialysis efficiency in the last fortnight of dialysis life was Kt/V 1.45 and URR 68%. • Over 75s with a high risk CI (66 %) were more likely to have a poorer performance status (70% with a KS of less than 50, 40% with a KS < 30) and worse outcome on dialysis (80%). Conclusions: Our experienced showed that withdrawal of dialysis, resulting in death, is initiated for medical reasons rather than patient choice. Patients with high risk CI and low KS have more evidence of dialysis intolerance. The CI and KS can be used in combination to identify patients able to determine dialysis withdrawal. FP615 DRUG COMPLIANCE IN HEMODIALYSIS PATIENTSCORRELATION WITH DEPRESSION AND PARACLINICAL FINDINGS Shiva Tabrizian1, Shahrzad Ossareh2 and Marjan Zebarjadi1 Hasheminejad Clinical Research Development Center, Tehran University of Medical Sciences, 2Department of Medicine, Nephrology Section, Hasheminejad Clinical Research Development Center, Tehran University of Medical Sciences, Tehran, Iran 1 Introduction and Aims: Drug Compliance is one of the major predictors of well being in maintenance hemodialysis (HD) patients. It may be affected by various variables, including the mood and the quality of life of patients and predicts their health status. This study was designed to evaluate the drug compliance of the Volume 27 | Supplement 2 | May 2012 FP616 UNDERSTANDING A NEW ERA FOR DEPRESSION AND ANXIETY IN HEMODIALYSIS PATIENTS Pedro Azevedo1, Francisco Travassos2, Inês Frade1, Manuela Almeida1, José Queirós1, Fernanda Silva1, António Cabrita1 and Rosária Rodrigues2 1 Centro Hospitalar Do Porto, 2Mirandela Hemodialysis Center Introduction and Aims: The association between depression and chronic diseases is very frequent, with poor outcome of both, less adherence to therapy, increased morbidity and mortality. It is estimated that at least 20 to 30% of patients on hemodialysis (HD) suffer from depression. The overlap of depressive and uremic symptoms often precludes the proper diagnosis and treatment of depressive states. The aim of the study was to evaluate the prevalence of depression and anxiety in chronic kidney disease (CKD) patients in HD and explore possible correlations with socio-demographic, clinical and laboratory findings. Methods: We studied patients from two centers of HD, with data collection through Clinic Interview, Clinical Process, application of Hospital Anxiety and Depression Scale (HADS) and the Karnofsky Activity Scale (K). Results: The sample included 127 CKD on HD, with mean age of 65.5 ± 14.8 years, male predominance (n = 69, 54.3%) and 96 (75.6%) autonomous patients (K> 70). The median time on HD was 39.0 months (P25 = 15.0, P75 = 87.0). Of the 26 (20.5%) individuals with psychiatric history, only eight patients remained on psychiatric surveillance and 22 were taking psychiatric medication. With HADS questionnaire we identified 40 (31.5%) patients with depression (16.5% mild, 12.6% moderate and 2.4% severe) and 63 (49.6%) with anxiety: (25.2% mild, 17% moderate and 9.2% severe). Women (p = 0.008, Mann-Whitney Test - MWT), illiterate (p = .01, MWT) and not candidates for renal transplantation (p = 0.008, MWT) were the most depressed, as well as those with lower values of K, inter-dialysis weight and albumin (p <0.001, Spearman correlation). In turn, patients with coronary disease (p = .02, MWT) and HIV positive (p = 0.034, MWT)were those with higher anxiety scores. Some variables were associated with both depression and anxiety, such as: diabetes, blindness, physical inactivity, anorexia, psychiatric history (p <0.01, MWT), consumption of a higher number of drugs (p = 0.002, X2) and HD in the morning shifts (p <0.001, X2). Conclusions: We found a high rate of depression and anxiety. Variables that suggest greater malnutrition, inactivity and poor functional status were significantly associated with higher scores of depression and anxiety. Depression is often underdiagnosed and undertreated. Health Professionals must be aware of this situation, in order to identify it earlier and implement an appropriate treatment strategy. doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 END OF LIFE DECISION-MAKING: WITHDRAWING FROM DIALYSIS – A 10 YEAR RETROSPECTIVE SINGLE CENTRE EXPERIENCE FROM THE UNITED KINGDOM patients of an HD ward and its correlation with the patients quality of life, depression state and laboratory results. Methods: 150 maintenance HD patients were included. Mean age was 56.4± 16.4 years (52.7% female). Mean HD vintage was 4.7±5.2 years. Drug compliance was evaluated via 2 methods; a simplified medication adherence questionnaire (SMAQ), assessing the general compliance with medication and the drug-intake percentage questionnaire (DIPQ) evaluating compliance with phosphate binders. SMAQ classified patients as compliant or non-compliant. DIPQ classified patients as groups 1, 2 or 3, taking >66%, 33-66% or <33% of the administered drug dose, respectively. Quality of life was assessed with SF-36 questionnaire, socioeconomic status by a simplified economic questionnaire (SEQ) and depression by Beck depression inventory (BDI) questionnaire. Mean levels of phosphorus (P), potassium (K), parathyroid hormone (PTH) and plasma protein levels and inter-dialytic weight gain (IDWG) during the last 6 months were recorded from the charts. Results: SMAQ results showed that 75.3% (113) of patients were compliant with medications. Compliant patients were significantly older than non-compliant ones (59.2 ±15.6 vs. 48.0±16.1, p=0.000), had a lower mean PTH level (297.2±256.8 vs. 399.4±277.5, p= 0.041), higher IDWG (2.8±1.0 vs. 2.7±0.7, p= 0.043) and lower BDI scores (12.6±7.8 vs. 19.7±11.3, p=0.000). Non-compliance was more frequent in depressed vs. non depressed patients (44% vs. 18%, p=0.002). Mean SF-36 score was not different between compliant & non-compliant patients (52.5±17.4 vs. 48.4±14.5, p=0.16,). Also compliance status was not different between various socioeconomic (low-, middle- or high-class) and educational levels (illiterate, 8th grade, high-school graduate, =college graduate) ( p= 0.50 & p=0.58, respectively). Mean Protein, K, IDWG were not different between SMAQ groups. DIPQ showed that patients were taking more than 66% of their administered dose of CaCO3 (group 1) in 55.5% of cases, Al(OH)3 in 10.3% and sevelamer in 53.8%. Mean P level was significantly lower in DIPQ group 1 CaCO3 intake compared to other groups ( p=0.000). However the difference was not significant between different Al(OH)3 and Sevelamer DIPQ groups ( p= 0.25 & 0.83, respectively). Mean PTH level was significantly lower in DIPQ group 1 CaCO3 intake compared to other groups ( p=0.02). The difference was not significant between different Al(OH)3 and Sevelamer DIPQ groups ( p= 0.97 and 0.83, respectively). Conclusions: Compliance to drugs was mainly affected by patients mood, being worse in patients with depression and high BDI score. Noncompliance with CaCO3, and not with Al(OH)3 and sevelamer, for which non-compliance was much more frequent, could significantly affect mean P and PTH levels. So management of depression may have a significant effect on compliance with medication and medical management of patients. Mean plasma protein, K and IDWG were not significantly predicted by general medication compliance, and it seems that other factors such as adherence to dietary regimen and water restriction should be studied in this regard. Abstracts Nephrology Dialysis Transplantation FP619 INTEGRATION OF CHRONIC KIDNEY DISEASE SCREENING IN NATIONAL PRIMARY HEALTH CARE NETWORK, PILOT STUDY, IRAN FP617 Hamid Barahimi1, Mitra Mahdavi-Mazdeh2, 3,Mohsen Nafar4, 3and 3 1 Ministry of Health,Transplant and Specific Disease Office, 2Iranian Tissue Bank&research Center,Tums, 3, 4Labbafinejad Hospital; Tehran; Iran FP617 CLUSTERING COUNTRIES BY RENAL SERVICE CHARACTERISTICS: RESULTS FROM THE EVEREST STUDY Cécile Couchoud1, Jager Kitty2, Stengel Bénédicte3 and Caskey Fergus4 Agence de la Biomédecine, 2Amc, Amsterdam, The Netherlands, 3Inserm/Univ Paris Sud, Villejuif, France, 4Southmead Hospital, Bristol, UK 1 Introduction and Aims: Improving our understanding of healthcare organisation and funding is an important step towards addressing geographical variations of ESRD epidemiology and care. For decades health policy makers have used these characteristics to classify healthcare systems to facilitate cross-country health service comparisons – taxation (the Beveridge model), social insurance (the Bismark model) and private insurance – but typologies based on general healthcare organisation may not be most appropriate when grouping countries for renal service comparisons. A systematic approach to the description of renal service regulation, private for-profit share of dialysis centres, modalities of reimbursement and access to RRT services is therefore needed. The aim of this study was to elaborate a typology of the countries according to their renal services organisation and delivery. Methods: During the EVEREST study, national experts in 47 countries were asked to complete a questionnaire relating to organization, financing and structure of renal services in 2003-2005. Based on 14 items, countries were characterized by their coordinate values in the system of axes defined by the principal components of a Multiple Correspondence Analysis. Countries were then grouped with an Ascendant Hierarchical Classification (AHC). AHC is an iterative process: the algorithm starts with as many clusters as data and builds up a tree by successively merging the two nearest clusters. We used pseudo F statistics to choose the threshold to stop the classification. Results: Starting with 47 countries AHC identified 12 patterns of renal service organisation (cf. figure). Some groupings appeared intuitive: Hungary, Russia and Romania or Dutch-speaking Belgium, Luxembourg and France. Other groupings, however, were less obvious. For example, Cluster 9 (Canada, Malaysia, The USA, Chile, Mexico and Tunisia) was brought together on the basis of activity-based reimbursement, competition between providers, the number of patients per nephrologist and the lack of laws relating to home dialysis. Conclusions: A major strength of this study is its use of an appropriate method to classify the countries according to a large set of items. It proposes a clustering of renal services that deviates from all previous efforts based on general health care system characteristics (which often don’t relate to the provision of renal services). The characteristics underpinning the clustering of countries by renal service characteristic do not suggest an obvious typology, but identify interesting aspects of services that group otherwise very different countries together – food for thought for those responsible for national renal service planning. FP618 Introduction and Aims: Chronic Kidney Disease(CKD) , a public health problem , needs extensive effort for prevention, early detection, and treatment . Iran started screening and prevention programs for CKD at national level . Methods: By approval of the pilot project ,since February 2011, the program began as a pilot in 4 cities. Educational committees discussed the protocol with all medical teams in pilot areas in a workshop in MOH ,visited pilot counties and sent the feedback to the Ministry headquarters. According to identifications of risk factors in previous studies in the country, patients with hypertension and diabetes mellitus referred to the family doctor to be tested for serum creatinine and urine analysis. Proteinuria was detected by dipstick urine strips. In one of the cities albumin to creatinine ratio was calculated by nephelometric turbidity measurement of albumin. Based on the flow chart patients who have been identified for the first time or with complications or uncontrolled with medications could be referred to the second level of specialized clinics by internists / nephrologists, nurses and dietitians. To fulfill criteria of CKD,the patients with abnormal tests were requested to attend the clinic A NEW APPROACH FOR MEASURING GENDER DISPARITY IN ACCES TO RENAL TRANSPLANTATION Couchoud Cécile1, Cécile Couchoud2, Bayat Sahar3, Villar Emmanuel4, Jacquelinet Christian1 and Ecochard René4 1 Agence de la Biomédecine, France, 2Agence de la Biomédecine, 3School of Public Health, Rennes, France, 4Hospices Civils de Lyon, France Introduction and Aims: Gender inequity in access to renal transplantation waiting lists, in favor of men, was first shown many years ago and has been found regularly in US data analysis. We use the French ESRD registry data to analyze whether female ii | Abstracts FP619 Figure 1: proposed algorithm of 3 level management of CKD in primary health care etwork. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 gender is associated with either a lower probability of being listed, a longer time until listing, or both. Methods: The effect of gender on access to the French national renal transplantation waiting list was assessed in 9,497 men and 5,386 women aged 18-74 years who started dialysis. We used a semi-parametric regression cure model that combined a logistic regression model to estimate the probability of being listed with a conditional proportional hazards model for estimating time to listing for eligible patients. All the multivariate analyses were adjusted for age, work status, and comorbidities. Some subgroup analyses were conducted for age, diabetes, work status and zone. Results: Women were younger and less likely to work or have associated comorbidities. During the follow-up, 33.8% of the men and 34.1% of the women were placed on the renal transplantation waiting list. Our mixture model shows that after taking potential confounders into account, women had a lower probability of being added to the waiting list (OR =0.69, 95%CI 0.62-0.78) and a longer time to registration (HR 0.89, 95%CI 0.84-0.95). Conclusions: This disparity affects predominantly older women, who do not work, or have diabetes, and is more pronounced in some geographic areas. Abstracts Nephrology Dialysis Transplantation FP619 Table 1: results data of four cities in pilot CKD prevention and care study FP621 GENERALIZED ANXIETY DISORDER (GAD) IN PREVALENT PATIENTS ON HEMODIALYSIS. Bilal El Hayek1, Bilal Hayek2, Eduardo Baamonde3, Elvira Bosch2, Jose I Ramirez2, German Perez2, Ana Ramirez4, Agustin Toledo4, Maria M Lago4, Cesar Garcia-Canton4 and M Dolores Checa4 1 Avericum Hemodialysis Center, Las Palmas, Spain, 2Avericum Hemodialysis Center, 3Centro Hemodiálisis Avericum, 4Servicio de Nefrología FP620 THIRST AND ORAL SYMPTOMS IN PEOPLE ON HEMODIALYSIS: A MULTINATIONAL PROSPECTIVE COHORT STUDY Massimo Petruzzi1, Michele De Benedittis1, Michela Sciancalepore2, Letizia Gargano2, Patrizia Natale3, Maria Cristina Vecchio3, Valeria Saglimbene3, Fabio Pellegrini3, Giorgio Gentile4, Paul Stroumza5, Luc Frantzen5, Miguel Leal6, Marietta Torok7, Anna Bednarek8, Jan Dulawa8, Eduardo Celia9, Ruben Gelfman9, Jorgen Hegbrant10, Charlotta Wollheim10, Suetonia Palmer11, David W Johnson12, Pauline J Ford13, Jonathan C Craig14, Giovanni Fm Strippoli10 and Marinella Ruospo10 1 University of Bari, School of Dentistry and Surgery, Italy, 2Diaverum Italy, 3 Consorzio Mario Negri Sud, Italy, 4University of Perugia, Italy, 5Diaverum France, 6 Diaverum Portugal, 7Diaverum Hungary, 8Diaverum Poland, 9Diaverum Argentina, 10Diaverum Medical Scientific Office, Sweden, 11University of Otago Christchurch, New Zealand, 12University of Queensland, Princess Alexandra Hospital, Australia, 13University of Queensland, School of Dentistry, Australia, 14 School of Public Health, University of Sydney, Australia Introduction and Aims: Thirst and xerostomia, the subjective complaint of dry mouth, may be increased in people on hemodialysis due to reduced salivary and lacrimal secretion, intravascular volume changes, fluid-restriction, endocrine hormone abnormalities, and medication use. It is plausible that prevalence of oral dryness may be increased in people with end-stage kidney disease on hemodialysis. Hemodialysis treatment may also contribute to oral symptoms. Existing data are limited by small sample sizes. In this prospective cohort study, we have conducted a detailed global survey on the prevalence of any oral symptoms in hemodialysis. Methods: ORAL-D is an ongoing multinational cross-sectional and prospective cohort study of oral diseases in which we have consecutively enrolled people on hemodialysis in 30 outpatient clinics selected randomly from a collaborative dialysis network in Europe and South America. A xerostomia inventory and dialysis thirst inventory were both assessed based upon validated methodology by a dental surgeon. We have summarized data using descriptive analyses. Results: Of 1733 hemodialysis patients in the participating clinics, 1308 (75%) completed a self-administered questionnaire on oral symptoms. 557 patients (43%) reported occasional use of candies for dry mouth sensation, 313 (24%) had difficulties swallowing and 635 (49%) needed to sip to aid swallowing, 693 (54%) reported waking up during the night to drink, 479 (37%) reported a dry mouth and 642 (50%) reported dry lips. The mean total xerostomia inventory score was 21.14 (SD 5.47). Thirst, as a symptom, was a reported symptom for 823 patients (64%); 1028 (79%) were thirsty during the day and 667 (51%) during the night. Overall, 425 (33%) patients reported that thirst influenced their social life. The mean dialysis thirst inventory score was 18.42 (SD 5.61). Conclusions: In conclusion, we found oral symptoms were highly prevalent in people receiving hemodialysis, with marked symptoms interfering with daily life. The ORAL-D study will be completed in 2012 and prospectively evaluate the relationship between these reported oral symptoms and major patient level end points including mortality and cardiovascular events at one-year. Volume 27 | Supplement 2 | May 2012 FP622 A SIMPLIFIED FORMULA TO CALCULATE THE CREATININE INDEX IN HEMODIALYSIS PATIENTS: STRONG ASSOCIATION WITH PATIENT CHARACTERISTICS AND MORTALITY IN THE DOPPS Bernard Canaud1, Bernard Canaud1, Brett Lantz2, Ronald Pisoni3, Alexandre Granger-Vallée4, Paungpaga Lertdumrongluk5, Nicolas Molinari6, Jean Ethier7, Michel Jadoul8, Brenda Gillespie9 and Friedrich Port3 1 Lapeyronie University Hospital, Montpellier, France, 2Arbor Research Collaborative for Health, 3Arbor Research Collaborative for Health, Ann Arbor, United States, 4Montpellier Regional University Hospital, Montpellier, France, 5 Srinakharinwirot University, Pakkret, Nonthaburi, Thailand, 6Inserm, Montpellier, France, 7Centre Hospitalier de L’université de Montréal, Montreal, Quebec, Canada, 8Cliniques Universitaires St-Luc, Brussels, Belgium, 9University of Michigan, Ann Arbor, United States Introduction and Aims: Protein energy wasting is quite prevalent in chronic kidney disease patients. Muscle wasting (sarcopenia) is often encountered in long-term hemodialysis (HD) patients resulting from catabolic factors (acidemia, poor protein intake, etc.), resistance to anabolic factors (insulin resistance, growth hormone resistance, etc.) and reduced physical activity. Low muscle mass is associated with increased mortality. Creatinine generation can be used to evaluate muscle mass in HD patients. To overcome the burden of the creatinine kinetic modelling approach to calculate the creatinine index (CI), we developed a simplified formula based on spKt/Vurea, predialysis serum creatinine and anthropometric data. This study examined the relationship of the simplified CI (SCI) with HD patient characteristics and mortality, for HD patients of the Dialysis Outcomes and Practice Pattern Study (DOPPS). Methods: The SCI (mg/kg/24h) formula was derived from a mixed regression repeated measures analyses using a large database. Data were prospectively obtained from monthly urea/creatinine kinetic measurements performed over 20 years in 549 HD patients including 16,547 sets of data. Single pool Kt/Vurea, predialysis serum doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 for the second time exam. Results: As shown in the table 1,during the six month period this pilot program was organized in rural population over 30 years(193,437) suffering from HTN, DM or both(18,455).During the screening pilot program 44.9% of patients attended for laboratory tests. In second step according to the number of potential cases who attended in the laboratory (2480/8131=30.5%) it can be concluded that service provision cannot guarantee full positive impact. However, since 46.4% (671 out of 1446) of the potential cases were documented to have CKD it seems that in any national protocol which is going to being implemented at least two times tests should be mandatory as a cost effective approach. Conclusions: This study showed that the cost-effectiveness of screening programs are more when the screened population is at risk ( HTN and DM) and integration of CKD screening program in primary health care is possible and can detect undiagnosed patients with CKD especially with higher stages of CKD. Introduction and Aims: The prevalence of the Generalized Anxiety Disorder (GAD) in Spain is high, up to 13.7% of outpatients attending a specialized psychiatric care setting. GAD is characterized by excessive anxiety symptoms, worrying, nervous feeling, irritability, concentration difficulties, muscle stress, sleep disturbances and fatigue syndrome. Generalized Anxiety Disorder questionnaire (GAD-7) is a validated tool to identify potential patients suffering from GAD. It was designed in the Primary Care setting for screening and assessing severity of GAD. To describe the prevalence of GAD in patients on hemodialysis and its impact on several clinical and laboratory parameters. Methods: We studied 156 patients on hemodialysis between January and March in 2011, the mean age was 62.0 ± 12.9 years, 67.9% were male, on hemodialysis for a median time of 29.5 months (IQR: 16-53 months), and 47.4% were diabetic. It was used with the following scoring scale of the GAD-7 questionnaire: a) grade 1 (0 to 4 points): anxiety symptoms are not noticed. b) grade 2 (5 to 9 points): mild anxiety symptoms. c) grade 3 (10 to 14 points): moderate anxiety symptoms d) grade 4 (15 to 21 points): severe anxiety symptoms. We divided the population into 2 groups according to the results of GAD-7 questionnaire, considering that a cut-off value > 9 points (grades 3-4) defines moderate-severe GAD. We compared clinical and laboratory parameters between both groups. Results: 20.5% out of the studied patients exhibited a clinically relevant anxiety disorder. In this group, compared with patients not suffering from anxiety disorder, we observed an increased use of psychiatric drugs (62.5% vs 41.9%, p = 0.037) and the prevalence in women was higher (34% vs 14%, p = 0.004). Furthermore, we observed a negative correlation between the GAD-7 questionnaire score and the age (OR: -0.24, p <0.001) as well as with the time on dialysis (OR: -0.18, p = 0.016). We either found no correlation GAD-7 questionnaire score with the related- bone-mineral metabolism parameters, anemia, electrolytes, weight gained between dialysis sessions and the absolute number of drugs taken by these patients. Conclusions: The GAD-7 questionnaire is a simple and easy to use tool for the screening of GAD in patients on hemodialysis. In our study, GAD was associated with increased use of psychiatric drugs and was more common in women. The prevalence of GAD was higher in younger patients and in those with less time on hemodialysis, which was possibly related to their adaptation to a chronic treatment. Abstracts FP622 Table 1: Mean SCI by Patient Characteristic, Unadjusted FP623 PILL BURDEN AND ITS ASSOCIATION WITH MEDICATION POSSESSION RATIO AMONG HEMODIALYSIS PATIENTS WITH HYPERPHOSPHATEMIA Christopher Bond1, Steven Wang1, Thomas Alfieri1, Peter Braunhofer2 and Britt Newsome3 1 Davita Inc, Denver, Co, USA, 2Vifor Pharma, Glattbrugg, Switzerland, Eu, 3 Denver Nephrology, Denver, Co, USA Introduction and Aims: Pill burden can be substantial for hemodialysis (HD) patients and may lead to lower adherence with oral therapies. We sought to determine the relation between the average number of phosphate binder (PB) pills prescribed daily and medication possession ratio (MPR). MPR measures the proportion or percentage of time in a given period that a patient had a PB to take. Methods: Data from the pharmacy management program of a large dialysis provider were used to track prescription fills for PBs among US patients. Patients receiving multiple prescriptions for PB or who switched type of PB during the period were excluded. Patients were tracked from their first PB fill during the period of 1/1/2007 to 6/30/2011 for 1 year or until a censoring event occurred. Censoring events were enrolment in an automatic refill option, a gap of 180 days between fills of all medications in the pharmacy management program, 2 consecutive serum phosphorus levels < 3.0 mg/dL, discontinuation of HD, or death. MPR was calculated as ( prescription days filled in period – excess days) / (days in period), where excess days refers to pills left at the end of the period after allowing for gaps between received prescriptions to be filled prospectively only (ie, an early fill can cover a later gap, but pills received later cannot fill any earlier gap). Mean MPR scores were reported weighted by patient-time contributed. The SAS GLM procedure was used to assess the association between pill burden and weighted MPR. Results: 9345 patients qualified for evaluation. 28% of patients were excluded due to switch in PB therapy or receipt of dual therapy. Overall MPR percentages were low (47.67% to 39.72%) due to low binder adherence and the study’s strict assumptions regarding duration of therapy. MPR declined with increasing pill burden (Table). ANOVA analysis of the weighted MPR scores reflected a significant difference across the strata ( p<0.0001). Conclusions: PB pill burden was negatively related to MPR in this analysis of data from the pharmacy management program of a large dialysis provider. These data suggest that the patients who are prescribed more pills as part of their PB regimen are more likely to have gaps in treatment as measured by prescription refills. Additional analyses tying fills directly to physician orders further demonstrate this relationship. FP624 DIALYSIS TREATMENT TIME, DIALYSIS FREQUENCY, AND DELIVERED SINGLE POOL KT/V AMONG HEMODIALYSIS PATIENTS IN THE CHINA DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS) M Wang1, B Bieber2, M Guidinger3, B Bieber2, M Wang2, L Zuo1, Rl Pisoni2, X Yu4, X Yang4, J Qian5, N Chen6, J Albert2, Y Yan7 and S Ramirez2 1 Peking University First Hospital, Beijing, China, 2Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States, 3University of Michigan, Ann Arbor, Michigan, United States, 4The First Affiliated Hospital Sun Yat-Sen University, Guangzhou, China, 5Department of Medicine, Renji Hospital, 6 Shanghai Ruijin Hospital, Shanghai, China, 7Department of Medicine, Renji Hospital, Shanghai, China Introduction and Aims: Published clinical studies in the management of ESRD in China are limited. In order to understand practice patterns of hemodialysis care in China, a pilot study of China DOPPS was conducted in the three cities of Beijing, Guangzhou and Shanghai. This abstract presents practice patterns for dialysis prescription in China DOPPS as compared to other participating DOPPS countries. Methods: The DOPPS applies stratified random sampling of dialysis facilities and dialysis patients in participating countries thus allowing the collection of nationally representative data. However, for feasibility purposes, the China study was modified to include representative data from each of the three participating cities. For the China DOPPS pilot study, dialysis facilities were randomly selected from a comprehensive roster of dialysis units from the 3 participating cities. Results: These initial results are based on data available from 1379 ESRD patients who were randomly selected from 15 dialysis facilities each in Beijing, Guangzhou and Shanghai (total N=45 dialysis facilities), with 432, 439 and 508 patients from Beijing, Guangzhou and Shanghai, respectively. As shown in the table, the mean # prescribed dialysis sessions per week was lower in China (2.76) versus the 3 other DOPPS region shown (range 2.96-3.03). Up to 27% of patients in China were dialyzed less than 3x/week, which is significantly more common than all other DOPPS countries. The mean dialysis session length in Chinese facilities was nearly as high as that in the Europe, Australia, New Zealand DOPPS samples (EUR/ANZ) and is substantially higher than that observed in North America. The mean blood flow rate of 234 ml/min was somewhat higher than that in Japan but lower than that seen in North America and EUR/ANZ. Mean single pool kt/V in Chinese facilities was lower than that seen in the other DOPPS regions, and with more patients having a single pool Kt/V < 1.2 in China (28%) compared with the 3 other regions. Differences in other practices are presented in detail in related abstracts presented at this meeting. Conclusions: The DOPPS represents a unique opportunity to evaluate practice patterns in three major cities in China, with comparisons to other participating DOPPS countries. Preliminary findings suggest differences in dialysis prescribing practices in China as compared to other DOPPS countries. A longitudinal component of China DOPPS in the 3 major cities is currently being planned, in order to determine the impact of these differences on clinical outcomes. FP624 Table 1. FP623 ii | Abstracts Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 creatinine, and anthropometric data were used in the final SCI equation. In the present study, the SCI was calculated for 37,252 HD patients in DOPPS phases 1 to 4 across 12 countries in 4 regions: Australia and New Zealand (ANZ); United States and Canada (North America, NA); Japan (JP); and 7 European countries (EU). The relationship of SCI with patient characteristics and 1-year mortality were assessed using multivariate Cox models. Results: Unadjusted SCI results are summarized and stratified according to patient characteristics in Table 1. Significantly lower SCIs were observed in patients who were female, older, had lower nPCR, and lower serum albumin. Patients in Japan had the highest average SCI ( p < 0.001). In the United States, blacks had an average SCI 17% higher than non-blacks (21.4 vs. 18.3, p < 0.001; not shown in table). The risk of 1-year mortality was inversely associated with SCI values. In an unadjusted model, the HR of death was 14% higher per 1 mg/kg/24h lower SCI. In a model adjusted for age, gender, race, BMI, nutrition (albumin and normalized PCR), and comorbidities, the HR of death was 8% higher per SCI unit reduction (HR = 0.92, 95% confidence interval = 0.90 to 0.94, p < 0.001). This HR was unchanged by adjusting for spKt/Vurea. Conclusions: A simplified CI formula based on spKt/Vurea and predialysis creatinine offers an easy, reliable, and cost-effective tool for evaluating muscle mass in HD patients. SCI variations may partly explain survival differences by country, as lower SCI values are strongly associated with higher mortality rates. SCI should therefore be considered as an independent risk factor of mortality in HD patients. Future research on CI changes over time may lead to a better prognostic factor than the CI value alone. Publication of this SCI formula and its predictive value beyond only use of serum creatinine measurement will be forthcoming. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation FP625 PREGNANCY: INTENSIFIED HEMODIALYSIS YES OR NO? Bernasconi1, Waisman2, Beresan3, Lapidus3, Rosa Marina Alicia Amelia Marcela Canteli3 and Ricardo Heguilen4 1 2 3 Hospital J.A. Fernandez, Hospital J.A.Fernandez., Hospital J.A.Fernandez, 4 Hospital Juan A Fernández FP626 CLINICIAN BELIEFS AND ATTITUDES ABOUT HOME HAEMODIALYSIS: QUALITATIVE INTERVIEW STUDY Allison Tong1, Suetonia Palmer2, Braden Manns3, Jonathan Craig1, Marinella Ruospo4, Letizia Gargano5 and Giovanni Strippoli6 1 University of Sydney, 2University of Otago Christchurch, New Zealand, 3 University of Calgary, Calgary, Alberta, 4Diaverum Medical Scientific Office, 5 Diaverum, 6Cochrane Renal Group, Sydney, Australia Introduction and Aims: Home hemodialysis is being more broadly advocated as an alternative to standard in-centre haemodialysis in Europe. We evaluated and elicited clinician beliefs and attitudes about home haemodialysis using qualitative research methods. Methods: Semi-structured face-to-face interviews of nephrologists and nurses involved in the care of patients on haemodialysis were performed in dialysis centres within Diaverum AB, a large dialysis provider in Europe, Australia, and South America. Results: Forty-two clinicians from 15 dialysis centres in France, Italy, Portugal, Germany, Sweden, and Argentina participated. Four major themes relating to clinician beliefs about home haemodialysis were identified: external structural barriers (ready access to dialysis centres, inadequate housing conditions, unstable economic environment); centre capacity (availability of alternative treatments, competing priorities, commercial interests); clinician responsibility and motivation ( preserving safety and security, lack of awareness, knowledge, and experience, potential to offer lifestyle benefits, professional interest and advancement); and cultural apprehension (an unrelenting imposition, carer burden, attachment to professional healthcare provision, limited awareness). Conclusions: Despite recognising the potential benefits of home haemodialysis such as patient autonomy, clinicians felt apprehensive and doubted the feasibility of home haemodialysis programs. Close proximity to in-centre haemodialysis facilities minimised perceived demand for home haemodialysis. Other key barriers included commercial interests, financial disadvantage, concerns about patient safety and Volume 27 | Supplement 2 | May 2012 FP627 AEROBIC EXERCISE IMPROVES SIGNS OF RESTLESS LEG SYNDROME IN END STAGE RENAL DISEASE PATIENTS SUFFERING CHRONIC HEMODIALYSIS Mojgan Mortazavi1, Babak Vahdatpour2, Shahrzad Shahidi2, Aida Ghasempour2, Diana Taheri2, Shahaboddin Dolatkhah2, Afsoon Emami Naieni2 and Maryam Ghassami2 1 Isfahan/Iran, 2Isfahan,Iran Introduction and Aims: restless leg syndrome (RLS) is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological management for this syndrome but adverse effect of drugs make a limitation for using them. In this randomized clinical trial we aimed to find a non-pharmacological way to improve signs of restless leg syndrome and patients' quality of life. Methods: twenty-six patients had included into the study and divided into 2 groups of control and exercise. Exercise group used aerobic exercise during their hemodialysis. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results: the difference of means of RLS signs at the first week of study and final week were -5.5 4.96 in exercise group and -0.53 2.3 in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week Conclusions: we suggest using aerobic exercise for improving signs of restless leg syndrome. But no evidence was found for its efficacy on patient's quality of life. FP628 A STAFF SURVEY ON END OF LIFE CARE IN ADVANCED KIDNEY DISEASE. Muhammad Khan1, Khaled Abdulnabi2 and Pearl Pai2 Royal Liverpool and Broadgreen Hospitals nhs Trust, 2Royal Liverpool and Broadgreen University Hospital nhs Trust 1 Introduction and Aims: Improving the end of life care in kidney patients is a priority for the NHS Kidney care. Patients who are within their last 12 months of their life require a high-quality treatment and care, based on increased emphasis on comfort and support rather than cure. The NICE guidelines have identified a number of challenges in order to ensure that such patients receive the appropriate care, and to ensure they can make their wishes known, including the place of death so they can live to the full and to die with dignity. In 2010 to 2011, our regional Kidney Care Network and Cancer Network have put together an implementation group to develop a Pathway for End of Life Care in Kidney Disease. As part of the project, we designed a comprehensive staff questionnaire to find out whether the current level of training, knowledge and staff experience on end of life care met the quality markers for health care providers as suggested by the NICE and Gold Service framework. Methods: A total of 130 questionnaires were distributed to health care workers including consultants (8), renal speciality registrars (6), junior medical staff (6) and band 4 to 7 nurses (110) in three renal units in the northwest of England. The questions cover staff level of confidence, knowledge, training, perceived barrier, and experience regarding the end of life care and tools. Results: 105 questionnaires were returned. 85 were completed in full, but there were a few missing information in the rest of the questionnaires. Seventy two(72%) percent of the respondents were nurses. The majority of the staff (>80%) were aware of the holistic approach of end of life care, including symptoms control, social and psychological support, as well as spiritual input. According to 90 % of the staff, severe COPD, untreated malignancy and intolerance of dialysis were important prognostic indicators of poor outcome as compared to advancing age.A significant number of staff (70%) felt confident in identifying patients in their last 12 months of life by using the ‘surprise question’. Lack of knowledge (82 %), training (65%), communication skill (65%), inappropriate environment (67%), and time (47%) were seen as main barriers for initiating end of life care discussions. Only 55% of staff was aware of the existence of Preferred Priorities for Care (PPC) document and Advance Care Planning. Most of the nursing staff (65%) felt confident in providing psychosocial, spiritual and religious support but there was a lack of confidence (51%) in breaking bad news and initiating discussions regarding withdrawal of dialysis. Staff attitude was largely positive (60%) towards palliative care. However, 90% of the staff admitted to being involved in end of life care discussions in less than 5 patients in the previous one year with little or no experience (77%) in completing the PPC document. doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: Although uncommon, pregnancy occurs in women with end stage renal disease (ESRD) even in those undergoing dialysis (HD). The objective of this retrospective study was to report a 12-year experience in a multidisciplinary team for pregnant women suffering from (ESRD) in a Public Hospital. Secondarily, we reviewed the treatment and outcome of patients (Pts) undergoing intensive HD (>20 h /week). And third, we performed a combined analysis of results to find out when pregnancy is advisable in this population. Data from 31 consecutive pregnancies (P) in HD-requiring pregnant women assisted from January 1, 2000 until January 1, 2012 were analysed. Methods: The haemodialysis schedule was increased from the conventional three times a week to five to six times weekly. Haemodialysis was performed using high flux dialyzer with volume controlled ultrafiltration. Pts were followed up by a multidisciplinary team. Fetal wellbeing was closely monitored throughout pregnancy; ultrasound was performed from the beginning and fetal placental Doppler from 12 wks on. Results: 31 P (3 twin, and 1 triple) in 30 ESRD pts, no one diabetic, age in years (mean 30.4± 1SD) were followed up. 25/30 pts were already undergoing HD at the time of gestation while 5 entered HD because P. Hypertensive Pts. received amlodipine with or without a methyldopa/ labetalol. Polyhydramnios was found in 15 Pts. The gestational age at delivery (26 caesarean sections and 5 vaginal deliveries) was 30.3 ± 0.8 wks., while the fetal weight at delivery was 1347± 149 g. One Pt. presented HELLP syndrome and died post-partum due to disseminated coagulopathy, one Pt. developed severe preeclampsia and died (neurological cause), one Pt. died one year after delivery and three Pts. withdrew dialysis and remained in conservative medical treatment. One of them for a year, another one received a renal allograft and the last remain in haemodialysis. Fetal demise was high, (especially for the multiple pregnancies, surviving only half of the twin). Four fetal deaths were associated with respiratory distress, two with severe polyhidramnios with fetal malformation and finally two died from severe necrotizing enterocholitis. Pregnant women already in HD had better outcome than those who were prompted into HD because of P. The transplanted mother (two pregnancies in HD) developed a chronic transplant nephropathy after three years of transplantation and her current serum creatinine is 3 mg/dl (maybe she has been sensibilized because of pregnancy). Conclusions: Although pregnancy in this population seems to be increasing it is still uncommon, the success rate is low and fetal mortality remains high. There is still no data available about which is the urea level lethal for the fetus, and the exposition period determinant of this mortality. Pts. with chronic renal impairment seems to get benefits of early and intense dialysis, EPO (doses were double increased) and advances in dialysis, obstetrics and neonatal care have improved the outcomes. It remains difficult to advise this women to conceive during HD. Conception and P in HD could sensibilize recipients for future allografttransplantation. psychosocial burden, and lack of clinician awareness and experience in home haemodialysis. To increase utilisation of home haemodialysis, concerted efforts are needed to: promote home haemodialysis as an important option for patients, improve knowledge about the clinical and psychosocial benefits, establish consolidated home haemodialysis training programs, and to provide reassurance about patients' ability to perform home haemodialysis as demonstrated by international experience. Also, the development of funding models that offer adequate reimbursement and financial incentives to dialysis providers and clinicians to implement home haemodialysis may be warranted. Abstracts Conclusions: It is increasingly recognised that there is a need to improve end of life care in advanced kidney patients. However, our survey has revealed significant gaps in the level of staff training and knowledge around different domains of end of life care. To fill this gap, we have developed a series of local workshops, and a resource pack freely available to all renal unit staff. Staff have also encouraged to undertaking e-learning to improve their knowledge. The next step is to set up a register of concern to ensure these patients will receive the necessary supportive therapy and care planning before the end of life FP629 PREVALENCE OF ORAL LESIONS IN HEMODIALYSIS PATIENTS: A PROSPECTIVE MULTINATIONAL COHORT STUDY Introduction and Aims: Oral diseases are common in the general population and are particularly associated with under-privilege in the general population. Oral disease is also association with poorer cardiovascular outcomes in the general population. In light of the heavy treatment burden of advanced chronic kidney disease, it is plausible that the prevalence of oral disease would be increased in in people with end stage kidney disease on hemodialysis. While numerous observational studies are available to examine oral disease in people with end-stage kidney, existing studies are limited by small study design and selective reporting. The aim of this study was to conduct a comprehensive and systematic survey of the prevalence of oral lesions in people on hemodialysis. Methods:ORAL-D is an ongoing multinational cross-sectional and prospective cohort study in which we have consecutively enrolled people receiving hemodialysis in 30 outpatient clinics selected randomly from a collaborative dialysis network. A dental surgeon has conducted a systematic examination of dental, periodontal, mucosal and salivary lesions in enrolled patients based upon standard dental practice methodology. We have summarized data using standard descriptive statistical analyses. Results: Of 1744 hemodialysis patients in the participating clinics, 1308 (75%) received a complete oral survey and examination. Of these, (mean age 66.81 years (SD 13.85), 323 (27%) were completely edentulous, 371 (40%) reported attrition and dental erosion (bruxism), and 21 (2%) had enamel hypoplasia. The decay/missing/ filled teeth (DMFT) score was 23.94 (8.58). Salivary pH was 7.39 (0.85) with a high prevalence of patients with high buffer capacity (868, 69%), and only 96 patients (8%) with low buffer capacity. The salivary flow rate before dialysis was 0.69 (0.64), versus 0.76 (0.74) post dialysis. 469 patients (36%) were found to have mucosal lesions (any), 172 had candidiasis (15%), 46 had unrecognized neoformations (4%), and 17 had gingival overgrowth (2%). 538 patients (45%) reported mouth dryness, 72 (6%) had oral burning and 57 (5%) reported mouth. Finally, periodontitis was present in 496 (58%) of 873 dentate patients undergoing periodontal evaluation. Conclusions: In conclusion, oral lesions were highly prevalent in people receiving hemodialysis. The ORAL-D will be completed in 2012 and prospectively analyze the relationship between exposure to any oral lesion and the risk of major patient level endpoints including mortality and cardiovascular events at 1 year. Additional study is required to determine the effects of dental examination and education on oral and cardiovascular health in people with advanced kidney disease. FP630 PREVALENCE OF CHRONIC KIDNEY DISEASE (CKD) AND IDENTIFICATION OF ASSOCIATED RISK FACTORS IN A RURAL AREA BY MASS SCREENING MD. Abdul Muqueet1, MD. Abdul Muqueet2, Mahmud Javed Hasan3, M. Abul Kashem4 and Pradip Kumar Dutta4 1 Assistant Professor, Nephrology Dept. MMC, 2Department of Nephrology, 3 Assistant Professor, Nephrology Dept. Cbmcb, 4Associate Professor, Nephrology Dept. Cmc Introduction and Aims: The prevalence of chronic kidney disease (CKD) is increasing rapidly worldwide, and is now recognized as a global public health problem. Population-based studies evaluating the prevalence of kidney damage in different communities have been limited in developing countries. We conducted a population –based screening study in a rural area of Mymensingh that aimed to identify the prevalence and associated risk factors of chronic kidney disease in a rural ii | Abstracts area of Mymensingh populations. Objectives: The study was performed to investigate the prevalence and the risk factors of chronic kidney disease (CKD) in a rural population residing in Mymensingh, Bangladesh. Specific objectives were to find out the association of demographic variables with prevalence of CKD and to evaluate the association of risk factors with prevalence of CKD. Methods: This prospective study was carried out at rural area of Bhabakhali union of Mymensingh Sadar in Mymensingh District during the period of April, 2009 to March, 2010. The required numbers of subjects were included in the study purposively. The demographic variables included in the study were age, sex, marital status, religion, occupation, socioeconomic status, monthly income. The clinical variable was hypertension. The risk factors were Body Mass Index (BMI), smoking habit, hypertension, and diabetes mellitus. Data pertaining to biochemical investigations such as urine for albumin, serum creatinine and random serum glucose were also recorded. Subjects with suspected of CKD had to undergo repeat serum creatinine and urinary albumin testing three months after the initial testing to diagnose true CKD. Results: One thousand two hundred forty residents(n=1240)(of which 650 were males and 590 were females ,aged between 18 and 65 years),after giving informed consent and with complete data ,were entered into this study. The mean age was 37.1 Years(±10.9). and the lowest and highest ages were 18 and 65 years ,respectively and 52% were male . Total of 235 and 242 participants were screened as having CKD by Cockcroft-Gault and MDRD equations respectively, which evidenced an over-all CKD prevalence of 19%(Cockcroft-Gault) and 19.5%( MDRD equations)respectively. Stage 3 CKD was found to be predominant in both Cockcroft-Gault (12.8%) and MDRD equation (13.2%). The risk factors thought to be associated with CKD demonstrates that hypertension (19.3%) diabetes (4.9%) and others (1.3%). Participants who were screened as suspected CKD in 1st visit were advised to have their serum for creatinine estimation and urine for albumin detection 3 months after the first check up date . A total of 235(97.1%) out of 242 cases attended complying to the advice. Of the 206(88%) of patients in Cockcroft-Gault and 210(89.4%) in MDRD equation were diagnosed as having CKD in 2nd follow up visit (3 months after the 1st visit). Conclusions: It appears that one out of three people in this at-risk population has undiagnosed CKD and poorly controlled CKD risk factors. This growing problem poses clear challenges to this developing country. Therefore, CKD should be addressed through the development of multidisciplinary teams and improved communication between traditional health care givers and nephrology services. Attention to CKD risk factors must become a priority. FP631 PERITONEAL DIALYSIS VS. IN-CENTER HEMODIALYSIS: A SYSTEMATIC REVIEW OF THE ECONOMIC LITERATURE Frank Xiaoqing Liu1, Les Noe2, Tiffany Quock3, Nancy Neil4 and Gary Inglese1 1 Baxter Healthcare Corporation, Mcgaw Park, USA, 2Icon/Oxford Outcomes, Eugene, USA, 3Icon/Oxford Outcomes, San Francisco, USA, 4Decision Research, Eugene, USA Introduction and Aims: The incidence of end stage renal disease (ESRD) continues to increase globally due to an aging population, extended life expectancy, and complications from diabetes. As a result, the demand for dialysis therapy to treat patients with ESRD places a heavy burden on the global health care system. The purpose of this study is to comprehensively review existing peer-reviewed publications comparing the costs for patients receiving any type of peritoneal dialysis (PD) vs. in-center hemodialysis (ICHD). Methods: We queried PubMed and EMBASE (2004 to Oct 2011) using a combination of MeSH headings related to healthcare economics, costs, reimbursement, pricing, and the various dialysis modalities. Original research publications with text and/or abstracts in English which reported costs associated with PD and ICHD were included in our review. Results: Our search identified 83 original research articles comparing the costs of PD vs. ICHD. Most of these studies considered the costs of PD vs. ICHD in Western Europe, North America, Australia/New Zealand, and/or Asia. A few studies presented information for countries in Africa, Eastern Europe, the Middle East, or Latin America. The reported utilization of PD varied greatly between countries; for example, an estimated 80% of dialysis patients in Hong Kong use PD compared with only 8% in the United States, despite the fact that PD is a significantly less costly dialysis modality (vs. ICHD) in most developed countries. In Australia, for instance, the estimated health system expenditure per patient per year (PPPY) was $53,112 for PD vs. $79,072 for ICHD (2008-2009 AUD). In the United Kingdom, a 2008 study found that the least costly dialysis modality was continuous ambulatory peritoneal dialysis (CAPD, €20,764/year), followed by automated PD (APD, €21,655) vs. ICHD (€35,023). In the United States, a study using 2009 USRDS data estimated the PPPY cost of PD and ICHD at $53,446 and $73,008, respectively. However, in Japan, national health expenditures were lower for ICHD ($42,098) vs. PD ($49,215; 2003 USD). Furthermore, there are a number of reports that patients receiving PD (vs. ICHD) are more likely to continue workforce participation. Conclusions: Our results are consistent with prior published reviews which found that PD is less costly compared with ICHD in most developed countries. However, variations in equipment, dialysis solution, and labor costs may make PD a more expensive alternative, especially in less developed areas. Available published studies vary widely in terms of methodology (including economic perspective and Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Marinella Ruospo1, Massimo Petruzzi2, Michele De Benedittis2, Michela Sciancalepore3, Letizia Gargano3, Mariacristina Vecchio4, Valeria Saglimbene4, Patrizia Natale4, Fabio Pellegrini4, Giorgio Gentile5, Paul Stroumza6, Luc Frantzen6, Miguel Leal7, Marietta Torok8, Anna Bednarek9, Jan Dulawa9, Eduardo Celia10, Ruben Gelfman10, Jorgen Hegbrant1, Charlotta Wollheim1, Suetonia Palmer11, David W Johnson12, Pauline J Ford13, Jonathan C Craig14 and Giovanni Fm Strippoli1 1 Diaverum Medical Scientific Office, Sweden, 2University of Bari, School of Dentistry and Surgery, Italy, 3Diaverum Italy, 4Consorzio Mario Negri Sud, Italy, 5 University of Perugia, Italy, 6Diaverum France, 7Diaverum Portugal, 8Diaverum Hungary, 9Diaverum Poland, 10Diaverum Argentina, 11University of Otago Christchurch, New Zealand, 12University of Queensland, Princess Alexandra Hospital, Australia, 13University of Queensland, School of Dentistry, Australia, 14 School of Public Health, University of Sydney, Australia Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation cost-years), as do country-specific reimbursement and cost structures for dialysis, making specific comparisons difficult. More high-quality studies with consistent parameters are needed in order to make robust comparisons of total healthcare costs associated with PD vs. ICHD. FP632 FP633 Table 1. PRACTICE PATTERNS FOR VASCULAR ACCESS AND ANEMIA MANAGEMENT: FINDINGS FROM THE CHINA DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS) POPULATION Introduction and Aims: Published clinical studies in the management of ESRD in China are limited. In order to understand practice patterns of hemodialysis care in China, a pilot study of China DOPPS was conducted in the three cities of Beijing, Guangzhou and Shanghai. The DOPPS, a multinational prospective cohort study of dialysis practices in the ESRD population, is currently in its 16th year and is operational in 12 countries. This abstract presents practice patterns in anemia and vascular access management in China DOPPS as compared to other participating DOPPS countries. Methods: The DOPPS includes a 2-stage random sampling of dialysis facilities and dialysis patients in participating countries thus allowing the collection of nationally representative data. However, for feasibility purposes, the China study was modified to include representative data from each of the three participating cities. Dialysis facilities were randomly selected from a comprehensive roster of dialysis units from the3 participating cities. Results: A total of 1379 ESRD patients were randomly selected from 15 dialysis facilities each in Beijing, Guangzhou and Shanghai (total N=45 dialysis facilities), with 432, 439 and 508 patients from Beijing, Guangzhou and Shanghai, respectively. DOPPS participants from China tended to be younger with a mean age of 59.3 as compared to (62.2 and 64.3 for US and Japan, respectively). A relatively high percentage of participating patients from China were dialyzed for 4 years or longer (42.5%) as compared to the US (35.6%), whereas 64.1% of patients in Japan were dialyzed for 4 or more years. The majority of Chinese patients had a BMI of 18-24 kg/m2 (71.6%), similar to that observed in Japan (71.4%) and more frequently than in the US (33.7%). Glomerular diseases were the most common cause of ESRD in the China DOPPS population (46.0%), similar to that observed in Japan (44.8%), whereas diabetes mellitus was the leading cause of ESRD in the US (43.3%). Marked variations in practices were observed across DOPPS countries. In particular, use of AV fistulas for dialysis access was seen in 88.0% of patients in the China DOPPS, as compared to 90.7% in Japan and 59.3% in the US. On facility-level analysis, the median percentage of patients dialyzed with a fistula was 88%, slightly lower than Japan (93%), but higher than all other DOPPS countries. Female gender, shorter vintage and presence of diabetes mellitus were more common among patients dialyzed with a catheter in China. Hemoglobin levels were below 10g/dl in a relatively high percentage of China DOPPS patients (36.9%), similar to that observed in Japan (34.4%), but more frequently than that seen in the US (9.0%). Markers of iron stores suggest a higher mean TSAT in China (31%), similar to the US (30%) but higher than that seen in Japan (24%). Conclusions: The DOPPS represents a unique opportunity to evaluate practice patterns in three major cities in China. Preliminary analyses suggest differences in patient populations and clinical practices. A longitudinal component of China DOPPS in the 3 major cities is currently being planned to evaluate the association between practice patterns and clinical outcomes. FP633 EFFECTIVENESS OF COGNITIVE- EXISTENTIAL GROUP THERAPY ON INCREASING HOPE IN WOMEN UNDER MAINTENANCE HEMODIALYSIS Ossareh1, Najjar2, Bahmani3 Maryam Motamed Bahman Shahrzad and Abdolah Shafiabadi4 1 Department of Medicine, Nephrology Section, Hasheminejad Clinical Research Development Center, Tehran University of Medical Sciences, Tehran, Iran, 2 Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran, 3 University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, 4Allameh Tabatabayi University, Tehran,Iran Introduction and Aims: Hopefulness has been introduced as one of the most important predicting factors of compliance in patients under maintenance hemodialysis (HD) and has a critical role in increasing patient adaptation to the social and mental consequences of HD. The aim of this study was to assess the effectiveness of “cognitive- existential group therapy” on increasing hopefulness in women under maintenance HD. Volume 27 | Supplement 2 | May 2012 Methods: This was an experimental, case- control study on 22 maintenance HD women, 22-55 years of age, with no previous recorded history of psychiatric disease. The minimum education level was primary school. The patients were randomly divided into case and control groups. Personal characteristics questionnaire and Miller hope scale were filled before and after intervention. Miller questionnaire evaluates 48 aspects of hope, with scores between 48 (total hopelessness) to 280 (complete hopefulness). Treatment intervention included an integration of existential and cognitive therapy, consisting 12 sessions of 90 minutes group therapy twice per week. The contents of the sessions (shown in table) were designed to address the main predictors of human anxiety including loneliness, responsibility, uncertainty, love and death and acceptance of these anxieties and also to diagnose and treat the cognitive biases leading to hopelessness. Therapy had 6 goals of promoting a supportive environment, facilitating grief, reframing negative thinking, enhancing coping and problem solving, fostering hope and setting life priorities for the patients. Pre- and post-intervention tests were performed and compared with each other through paired T- test using SPSS15 software. Results: The was a significant difference in hope score in the case group before and after intervention with cognitive- existential group therapy (164.75 ± 21.41 vs. 189.37 ± 33.91, respectively, p=0.023). Hope score did not change significantly in the control group over time (162.0 ± 28.29 vs. 150.9 ± 27.72, P=0.078). Conclusions: This study showed that cognitive- existential group therapy can increase hopefulness in maintenance HD female patients. Decrease in hopelessness in maintenance HD patients, may lead to better compliance with dialysis and increase the patients’ quality of life. Further study on both sexes and a larger group of patients is suggested. FP634 BIOCHEMICAL VARIABLES AND SURVIVAL IN PATIENTS WITH TYPE 1 DIABETES ON RENAL REPLACEMENT THERAPY Jaakko Helve1, Mikko Haapio2, Per-Henrik Groop2, Carola Grönhagen-Riska3 and Patrik Finne3 1 Helsinki University Hospital, Department of Medicine, Helsinki, Finland, 2Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland, 3Finnish Registry for Kidney Diseases, Helsinki, Finland Introduction and Aims: End-stage renal disease is one of the most serious complications of type 1 diabetes. There is no excess mortality in patients with type 1 diabetes and normal kidney function compared to general population, whereas in patients with type 1 diabetes and end-stage renal disease (ESRD) standardized mortality ratio is 18-fold. Yet, data are limited regarding factors that predict survival of patients with this complication. Our aim was to estimate the effect of biochemical variables on survival of type 1 diabetes patients on renal replacement therapy (RRT). Methods: We included in this incident cohort study all patients with type 1 diabetes entering chronic RRT (n=656) in Finland between 2000 and 2008. Patients were followed up until death or end of follow-up on 31 December 2008. All data came doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 J Qian1, B Bieber2, M Guidinger3, B Bieber2, N Chen4, Y Yan5, Rl Pisoni2, M Wang6, L Zuo6, X Yu7, X Yang7, M Wang2, J Albert2 and S Ramirez2 1 Shanghai Society of Internal Medicine, Shanghai, China, 2Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States, 3University of Michigan, Ann Arbor, Michigan, United States, 4Shanghai Ruijin Hospital, Shanghai, China, 5Renji Hospital, Shanghai, China, 6Peking University First Hospital, Beijing, China, 7The First Affiliated Hospital Sun Yat-Sen University, Guangzhou, China Abstracts FP635 PREDIALYTIC MEDICATION AND SURVIVAL IN PATIENTS WITH TYPE 1 DIABETES ON RENAL REPLACEMENT THERAPY Jaakko Helve1, Mikko Haapio2, Reijo Sund3, Per-Henrik Groop2, Carola Grönhagen-Riska4 and Patrik Finne4 1 Helsinki University Hospital, Department of Medicine, Helsinki, Finland, 2Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland, 3National Institute for Health and Welfare (Thl), Service Systems Research, Helsinki, Finland, 4Finnish Registry for Kidney Diseases, Helsinki, Finland Introduction and Aims: Patients with type 1 diabetes on renal replacement therapy (RRT) have more comorbidities and considerably higher risk of death than patients on RRT in general. During the predialytic phase of diabetic kidney disease, medication is one of the most important ways to attempt to improve prognosis. However, data on medication are scarce in patients with type 1 diabetes on RRT and no specific recommendations are available. The aim of this study was to examine the use of medication during predialytic phase of kidney disease and its association with survival among patients with type 1 diabetes on RRT. Methods: We recorded medication of 496 patients with type 1 diabetes before and after chronic RRT start between 1 January 2000 and 31 December 2006. Patients were followed until death, recovery of renal function, loss to follow-up, moving abroad, or to the end of follow-up on 31 December 2009. Data came from the Finnish Registry for Kidney Diseases and from the Finnish Prescription Register. We evaluated use of angiotensin-converting enzyme inhibitors, angiotensin reseptor blockers, calcium channel blockers, beta blockers, statins, vitamin D, erythropoiesis stimulating agents, and phosphate binders. Association between medication use and survival was assessed by Cox proportional hazards regression. Results: During follow-up 206 patients died, two moved abroad, and renal function was regained in two. Use of medication increased as renal failure proceeded except for a decreased use of antihypertensive medication after RRT start. Almost 70% of the patients used calcium channel blockers and beta blockers before initiating RRT. When adjusted for age and gender, decreased relative risk of death was associated with use of calcium channel blockers (RR 0.71, 95% CI 0.53-0.95) and vitamin D (RR 0.70, 95% CI 0.52-0.94) during four-month period before start of RRT, but the association lost statistical significance after further adjustment for comorbidities, systolic blood pressure, serum albumin, and body mass index. Conclusions: This observational study showed that use of medication is abundant among patients with type 1 diabetes during predialytic phase of renal disease. However, no strong correlations between predialytic medication and survival were observed. This may be due to confounding by indication, which cannot be entirely circumvented in an observational study. FP636 PSYCHOLOGICAL AND EXERCISE INTERVENTION IN DIALYSIS STUDY Michael Cai1, Sanjeev Baweja2, Amy Clements3, Annette Kent3, Rachel Reilly4, Nicholas Taylor4, Stephen Holt3 and Lawrence Mcmahon3 1 Eastern Health, Melbourne, Australia, 2Northern Hospital, 3Monash University, 4 Eastern Health Introduction and Aims: Depression and reduced quality of life is common in prevalent haemodialysis patients. Exercise intervention and psychological intervention has been shown improve quality of life in patients without chronic kidney diseases. The aim of the study was to assess whether a combined psychological intervention and exercise programme would improve patient’s quality and life and physical activity. Methods: This was a pilot intervention-control study. All haemodialysis patient in a ii | Abstracts single centre were screened for eligibility. Patients with pre-existing psychiatric illnesses requiring psychiatric input were excluded from the study. Intervention patients received three months of cognitive behavioural therapy (CBT) and three months of combined CBT and exercise intervention. Assessment was performed at baseline, at 3 months and 6 month. The primary endpoint was the change in QOL as measured by SF-36v2. Secondary endpoints include cardiac depression scale (CDS). Additional physical assessments (6 minute walk distance (6MWD), muscle strength, and physical activity as measured by Activpal recorder) were also performed on intervention patients. Results: 27 patients were enrolled in the intervention arm, 17 patients were enrolled in the control arm. 8 patients completed intervention. Majority of the dropout occurred within the first 3 months of the study. 39% of patient had a CDS score of greater than 95, indicating major depression. The baseline QOL was lower than the population mean across all domains. Patients who completed intervention had a higher baseline quality of life compared to those who droppedout. In patients who completed intervention, there was a significant improvement in the physical functioning domain (P=0.04), a trend towards better physical composite score (P=0.09), and an improvement in 6MWD (P=0.05) between baseline and 6 month assessment. No QOL improvement was observed in patients who dropped out of the study or in controls. Conclusions: Depressive symptoms and reduced QOL are prevalent in haemodialyis patients. A combined psychological intervention and exercise programme may be effective in improving the well being of haemodialysis patients. FP637 HIGHER INTERDIALYTIC WEIGHT GAIN BUT ALSO ITS DECLINES ARE ASSOCIATED WITH POORER OUTCOMES IN INCIDENT HEMODIALYSIS PATIENTS Len A Usvyat1, Mary Carter2, Frank M. Van der Sande3, Jeroen Kooman3, Jochen Raimann4, Nathan W Levin5 and Peter Kotanko5 1 Renal Research Institute, New York, USA, 2Sustainable Kidney Care Foundation, New York, USA, 3Maastricht University Hospital, 4Renal Research Institute, 5 Renal Research Institute, New York USA Introduction and Aims: Higher interdialytic weight gain exerts an additional stress on the cardiovascular system and is generally associated with poorer outcomes. We aim to understand whether changes in interdialytic weight gain are associated with patient outcomes in incident hemodialysis patients. Methods: We studied all incident hemodialysis (HD) patients treated in RRI clinics who had their first in-center treatment between 1/2000 and 12/2010. Only patients who survived first 12 months of dialysis were included. Patients’ interdialytic weight gain as percent of post-dialysis weight (IDWG) was computed as an average of first 3 months. Slope of IDWG was computed on a per patient basis using simple linear regression between months 4 and 12 from the start of treatment. Patients were stratified based on the average IDWG in the first 3 months (baseline group 1: <2%; group 2: 2 to 4%; group 3: >4%) and based on the average annualized change in IDWG from the simple linear regression (declined: < -1 percentage point/ year; stable: -1 to 1 percentage point/year; increased: >1 percentage point/year). Patients were then stratified into 9 groups of baseline IDWG levels and IDWG changes. For patients whose IDWG increased or declined, only patients with the p-value of the IDWG slope <0.05 were included. Patient survival was assessed in months 13 to 18 from the start of dialysis. Cox proportional hazards model adjusted for age, gender, race, ethnicity, diabetic status, access type, BMI, presence of residual renal function, albumin, systolic blood pressure, body temperature, nPCR, eKt/V, creatinine, and urea distribution volume was constructed to assess associations of IDWG as well as IDWG changes and survival. Results: We studied 3698 patients; additional information is presented in table 1. Comparing patients only based on their starting IDWG levels suggests that patients with IDWG>4% have the highest HR=1.92 (95% CI: 1.35-2.74; p<0.05) compared to IDWG 2 to 4% or <2% (no difference was observed between IDWG<2% or 2 to 4%) a year later. Comparing patients only based on their IDWG slope suggests that patients with IDWG declines have the highest HR=1.41 (95% CI: 0.98-2.02, p=0.06) compared to patients with stable or increasing IDWG. Combining starting IDWG levels and its trend, suggests that patients who start with IDWG>4% and either decline or stay stable have the highest significant HR. IDWG in the baseline period was positively and significantly associated with nPCR (r=0.14, p<0.001); slope of IDWG in months 4 to 12 was positively and significantly associated with slope of nPCR during the same period (r=0.30, p<0.001). This suggests strong relationship between nutrition and IDWG. Adjustment for nPCR slope in the survival analysis modified the results so that the slope of IDWG was no longer a significant predictor of outcomes. FP637 Table 1. Number of patients Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 from the Finnish Registry for Kidney Diseases. Biochemical variables were measured before as well as 3 to 15 months after the initiation of RRT. Observed biochemical variables in blood or plasma were creatinine, albumin, urea, ionized calcium, phosphorus, hemoglobin, C-reactive protein, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, trigycerides, and HbA1c. Main outcome measure was crude and adjusted relative risk of death according to biochemical variables. Results: Of the 656 patients with type 1 diabetes included in the study, 209 died during follow-up, two moved abroad, and renal function was regained in two. Serum creatinine, albumin, and C-reactive protein predicted mortality when measured before RRT and adjusted for potential confounders. After RRT start the strongest predictors were HbA1c, albumin, phosphorus, and blood urea. Higher hemoglobin level predicted better survival, but the association was only borderline significant after multivariate adjustment. Increase of the predialytic phosphorus concentration and decrease of the albumin level after RRT start indicated impaired survival. Conclusions: Among type 1 diabetes patients entering chronic RRT, management of hypoalbuminemia and inflammation appear beneficial. During RRT, potential measures to reduce mortality include treatment of anemia, hyperglycemia, and hyperphosphatemia and effective dialysis to lower serum urea. These variables can also be used to estimate patients’ risk of death. In addition, a change in the levels of these variables may provide additional prognostic information. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation FP638 Figure 1: Results from Cox proportional hazards models: hazard ratios for death for each of the 9 categories. Error bars denote 95% confidence intervals. Conclusions: Higher IDWG in the first 3 months of dialysis may exhibit a more significant stress on the cardiovascular system and we observed that incident patients with higher IDWG experience higher mortality. Nutrition is also an important consideration and declines in IDWG appear to have negative associations with outcomes due to epiphenomenon of malnutrition. Proper pre-dialysis care and further analysis into causes of death and reasons for increases or declines in IDWG is necessary. increase of NLR in months4 to 12 was associated with mortality (HR=3.02, 95% CI: 1.72-5.32, p<0.05) compared to thereference group (stable NLR); no difference between declining and stable NLR levels wasobserved. In patients with baseline NLR<5, increases in NLR were associated with poorer survival. In patients starting with NLR>5, there were no statistically significant difference in mortality risk irrespective of whether NLR was stable in the next 9 months or changed. The highest mortality risk (HR=4.05; P<0.05) was observed in patients who started with low NLR (<2.5) but subsequently increased during the first year. Conclusions: Increases in NLR in incident hemodialysis patients starting with NLR<5 are associated with increased mortality risk; in patients starting with high NLR (>5) there appears to be no difference in survival irrespective of the trend of NLR, possibly due to the small sample size in this particular category (N=35). NLR dynamics may serve as a novel risk indicator in incident HD patients. FP638 INCREASES IN NEUTROPHIL-TO-LYMPHOCYTE RATIO ARE ASSOCIATED WITH POORER OUTCOMES IN INCIDENT HEMODIALYSIS PATIENTS Len A Usvyat1, Rakesh Malhotra2, Georges Ouellet3, E. Lars Penne4, Jochen Raimann5, Stephan Thijssen1, Nathan W Levin6 and Peter Kotanko6 1 Renal Research Institute, New York, USA, 2Renal Research Institute, Beth Israel Medical Center, 3Hospital Maisonneuve-Rosemont, 4Vu Medical Center, 5Renal Research Institute, 6Renal Research Institute, New York USA Introduction and Aims: Neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive measure of inflammation in hemodialysis (HD) patients. We aimed to understand whether increases in NLR are associated with outcomes in incident HD patients. Methods: We studied all incident hemodialysis (HD) patients treated in RRI clinics who had their first in-center treatment between 1/2000 and 12/2010. Only patients who survived the first 12 months on dialysis were included. NLR was computed as neutrophil count divided by lymphocyte count. Patients' baseline NLR was computed as an average over the first 90 days. Slope of NLR was computed on a per patient basis using simple linear regression of all available NLR values between months 4 and 12 from the start of HD. Patients were stratified based on their baseline NLR (group 1: <2.5; group 2: 2.5 to 5; group 3: >5) and based on the average NLR rate of change calculated from the slope term of the simple linear regression (declined: <-1 per year; stable: -1 to 1 per year; increased: >1 per year). Patients were then stratified into nine groups of baseline NLR levels and NLR changes. For patients whose NLR increased or declined, only patients with statistically significant NLR slopes (P<0.05) were included. Patient survival was assessed in months 13 to 18 from the start of HD. Cox proportional hazards models adjusted for age, gender, race, ethnicity, diabetic status, access type, BMI, presence of residual renal function, albumin, systolic blood pressure, body temperature, nPCR, eKt/V, creatinine and urea distribution volume were constructed to assess associations of NLR as well as NLR changes and survival. Results: We studied 1589 incident HD patients; their stratification is presented in table 1. In a Cox Proportional Hazards model that includes only the baseline NLR levels and not the trend of NLR, baseline NLR was not associated with mortality risk in months 13 to 18. In a model that includes the NLR slope but not the baseline values, an FP638 Table 1 Number of patients in each categorye Volume 27 | Supplement 2 | May 2012 FP639 PREDICTORS OF HEMODIALYSIS PATIENT OUTCOMES IN THE FIRST YEAR: RESULTS FROM AN INTERNATIONAL STUDY Michael Etter1, Adam Tashman2, Adrian Guinsburg3, Aileen Grassmann4, Claudia Barth5, Cristina Marelli3, Daniele Marcelli4, Frank M. Van der Sande6, Gero Von Gersdorff7, Inga Bayh4, Jeroen Kooman6, Laura Scatizzi4, Maggie Lam1, Mathias Schaller8, Stephan Thijssen9, Ted Toffelmire10, Yuedong Wang11, Penny Sheppard 9, Len A Usvyat9, Nathan W Levin12 and Peter Kotanko12 1 Fresenius Medical Care Asia Pacific, 2Renal Research Institute, New York, New York, USA, 3Fresenius Medical Care Latin America, 4Fresenius Medical Care Europe, 5Curatorium for Dialysis and Kidney Transplantation (Kfh), 6 Maastricht University Hospital, 7University Hospital of Cologne, Cologne, Germany, 8University Hospital Cologne, 9Renal Research Institute, New York, USA, 10Fresenius Medical Care Canada, 11University of California at Santa Barbara, 12Renal Research Institute, New York USA Introduction and Aims: Mortality in hemodialysis (HD) patients is highest in the first year after HD initiation. Understanding what factors contribute to early patient outcomes is crucial for quality improvement. Comparison of factors associated with patient survival on an international level may shed additional light on variables that may otherwise go unnoticed. Methods: The MONitoring Dialysis Outcomes (MONDO) consortium consists of hemodialysis databases from RRI clinics in the US, Fresenius Medical Care (FMC) clinics in Europe [17 countries], Asia [5 countries], Latin America [1 country], and KfH clinics in Germany. They were queried to locate incident hemodialysis patients who started treatment between 1/2000 and 12/2010 and survived the first six months. Patient demographic, laboratory, and clinical parameters available in each respective database were averaged over the first six months on HD. Multivariate logistic regression models were constructed to predict patient survival based on the aforementioned parameters in months 7 to 12 from HD initiation. Significance of predictor variable was assessed using an alpha threshold of 0.10. Databases were analysed separately, however the same statistical methods were employed. Results: We studied 4,073 patients from Europe, 1,592 patients from Asia, 4,512 patients from Latin America, and 2,775 patients from the USA. Across all databases lower age and higher serum albumin levels were associated with reduced mortality. Diabetes mellitus was associated with poorer outcomes in all non-US databases; male gender was associated with poorer outcomes in all non-European databases; phosphorus levels were not associated with outcomes in any of the databases; higher post-dialysis weight was related to survival in Europe and Latin America but not in doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 FP637 Figure 1: Results from Cox proportional hazards models: hazard ratios for death for each of the 9 categories. Error bars denote 95% confidence intervals. Abstracts Nephrology Dialysis Transplantation FP640 Table 1. FP639 Figure 1: Summary of factors that contribute to patient outcomes. the USA and Asia; and higher systolic blood pressure was associated with better outcomes only in the European database. Other factors were not available in all databases but are summarized in figure 1. Conclusions: Lower age and higher albumin levels were associated with better survival in all databases. Some factors were associated with survival in some databases but not others. Further analysis of this data can shed light on establishing ultimate laboratory and clinical thresholds in treatment of diverse populations of dialysis patients. We did not have a uniform set of variables across all regional databases, and to circumvent this issue, models were fit separately for the different regions. A future goal will be to maintain a complete global database containing all clinical parameters, so that one multivariate regression model can be fit to the data, controlling for the applicable region. FP640 INEQUALITIES IN TRANSPLANT WAITING LIST ACTIVATION FOR PATIENTS ON DIALYSIS IN THE MIGLIORDIALISI STUDY SAMPLE Luca Neri1, Victor A. Andreucci2, Lisa A. Rocca-Rey3, Silvio V. Bertoli3 and Diego Brancaccio2 1 Department of Occupational and Environmental Health, University of Milan, 2 Fondazione Italiana Del Rene, Onlus, 3Multimedica Hospital, Castellanza (Va) Introduction and Aims: The demand for kidney transplants has always exceeded organ supply. Policy makers have long recognized the need to ensure that the organ allocation system is efficient and equitable. Transplantation rates are associated with patient’s health status, socioeconomic and geographical factors. However few studies assessed the association of individual and center factors on transplant waiting list activation rates. We aimed to evaluate the association between individual, center-related and contextual factors on kidney transplant waiting list activation for patients on dialysis. FP640 ii | Abstracts Methods: The MigliorDialisi Study provided individual-level information collected in 1,238 patients across 54 dialysis centers in 2008 with a self-reported survey and clinical chart review. Center-related administrative data were collected with a retrospective survey module administered to the medical director of each center in 2011. Contextual factors (e.g. urbanization and hospital beds) have been drawn from ISTAT records. We report a preliminary analysis evaluating the association of individual-level factors and listing rates after adjustement for center-related factors and estimated the comprehensive contribution of higher level factors on enlistment rates through multilevel analyisis (random Intercept mixed logistic regression). Results: Sample characteristics are reported in tables 1a and 1b. Centers from the Northern regions (n=26) contributed with 64% of patients (780), while centers located in Center-Italy (n=7) and in the Southern regions (n=21) contributed 11% and 25% of patients respectively. The crude enlistment rate was 26% (95% CI: 9%-54%, figure 1) distributed as follows: 21%, 34% and 33% in the North, Center, and South respectively. The center-related variance in the unadjusted models was s2=0,38 (SE=0,14, p=0,002). After adjustement for gender and age, and in the fully adjusted model, the center-related variance remained significantly greater than zero (s2=0,36, p=0,007 and s2=0,44, p=0,02). In the fully adjusted model the variance explained by unmeasured center-related factors accounted for about 12% of total variability in enlistment likelihood. Individual factors associated to enlistment rates are displayed in table 2. Conclusions: We identified several patient-related factors associated to the probability of waiting list activation. However a significant part of variation in enlistment probability is accounted for by unmeasured center-related and contextual factors. At study completion we will incorporate center-specific and contextual factors into a random-intercept random-slope mixed model to assess their association with the probability of waiting list activation. Table 2 Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 FP640 Table 2. Abstracts Nephrology Dialysis Transplantation FP641 THE IMPACT OF A HOME NOCTURNAL HAEMODIALYSIS PROGRAM ON THE GROWTH OF FACILITY HAEMODIALYSIS: A RETROSPECTIVE REVIEW (JANUARY 2000 – DECEMBER 2011) FP642 Table 1. Crude and adjusted all-cause mortality risk before kidney transplantation (competing risk models) associated to proportions of plasma phospholipid polyunsaturated fatty acids (per 1% of increase) in dialysis patients. Alwie Tjipto1, Rosemary Simmonds2 and John Agar2 Geelong Hospital, 2Geelong Hospital, Barwon Health 1 FP642 FP642 Figure 1: Spearman’s rank correlation between linoleic acid, Mead acid and serum interleukin-6 concentrations in dialysis patients. ESSENTIAL POLYUNSATURATED FATTY ACIDS, INFLAMMATION AND MORTALITY IN DIALYSIS PATIENTS Xiaoyan Huang1, Peter Stenvinkel1, Abdul Rashid Qureshi1, Ulf Riserus2, Tommy Cederholm2, Peter Barany3, Olof Heimburger4, Bengt Lindholm4 and Juan Jesus Carrero4 1 Karolinska Institutet, 2Uppsala University, 3Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden., 4Renal Medicine and Baxter Novum, Karolinska Institutet Introduction and Aims: Polyunsaturated fatty acids are essential nutrients with anti-inflammatory and cardioprotective properties. The association of dietary polyunsaturated fatty acids intake with inflammation and mortality in dialysis subjects is unclear. We investigated the association of essential dietary polyunsaturated fatty acid intake, reflected by plasma fatty acid composition, with inflammation and mortality in dialysis patients. Methods: In the present prospective cohort study, we recruited 222 dialysis subjects (39% women) with median age of 57 years and average 12 months of dialysis vintage. Plasma phospholipid polyunsaturated fatty acids were assessed by gas-liquid chromatography. Overall mortality was assessed after 18.4 (10th to 90th percentiles: 2.3–60) months of follow-up. Results: Linoleic acid (18:2 n-6), Mead acid (20:3 n-9; an indication of linoleic acid deficiency), a-linolenic acid (18:3 n-3), and long-chain n-3 polyunsaturated fatty acids (sum of eicosapentaenoic, docosapentaenoic and docosahexaenoic acids) represented 19.7, 0.26, 0.26, and 7.64 % of all fatty acids in plasma, respectively. Linoleic acid negatively (β=-0.21, p =0.004) but Mead acid positively (β=0.25, p <0.001) associated with interleukin-6 in multivariate analyses. Neither a-linolenic acid nor long-chain n-3 polyunsaturated fatty acids were independently associated with interleukin-6. During follow-up, 61 deaths and 115 kidney transplants occurred. Fully adjusted competing risk models showed that every percent increase in the proportion of plasma linoleic acid was associated with 12% reduction in mortality risk before transplantation (hazard ratio 0.88, 95% confidence interval 0.79-0.99). Mead acid was directly associated with mortality. Neither a-linolenic acid nor long-chain n-3 polyunsaturated fatty acids predicted outcome. Conclusions: The proportion of plasma phospholipid linoleic acid is inversely associated with interleukin-6 and all-cause mortality in Swedish dialysis patients. We raise the hypothesis that dialysis patients could benefit from increased intake of vegetable oils, the primary source of linoleic acid in the Western-type diet. Because of small proportions, the levels of Mead acid and a-linolenic acid were multiplied by 10 to show meaningful risks estimates, thus depicting the risk associated to 0.1% increase; Model 1 is adjusted for sex, age, diabetes, cardiovascular disease and dialysis modality; Model 2 is adjusted for factors detailed in model 1 plus protein-energy wasting and interleukin-6. Abbreviations: CI, confidence interval; HR, hazard ratio; LC n-3, long-chain n-3 polyunsaturated fatty acids (the sum of eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids). Figure 1 Spearman’s rank correlation between linoleic acid, Mead acid and serum interleukin-6 concentrations in dialysis patients. FP643 FP641 Graph 1: Volume 27 | Supplement 2 | May 2012 SEXUAL DYSFUNCTION IN WOMEN WITH END-STAGE KIDNEY DISEASE REQUIRING HEMODIALYSIS: A MULTINATIONAL CROSS-SECTIONAL STUDY Mariacristina Vecchio1, Suetonia Palmer2, Giorgia De Berardis3, Jonathan Craig4, Giuseppe Lucisano5, David Johnson6, Fabio Pellegrini5, Antonio Nicolucci5, Michela Sciancalepore5, Valeria Saglimbene5, Letizia Gargano7, Carmen Bonifati7, Marinella Ruospo7, Sankar D Navaneethan8, Vincenzo Montinaro9, Paul Stroumza7, Marianna Zsom7, Marietta Torok7, Eduardo Celia7, Ruben Gelfman7, Anna Bednarek-Skublewska7, Jan Dulawa7, Giusi Graziano5, Giorgio Gentile10, Juan Nin Ferrari7, Antonio Santoro11, Annalisa Zucchelli11, Giorgio Triolo12, Stefano Maffei12, Jörgen Hegbrant7, Charlotta Wollheim7, Salvatore De Cosmo13, Valeria M Manfreda14 and Giovanni Fm Strippoli7 1 Consorzio Mario Negri Sud, Italy, 2Department of Medicine, University of Otago, Christchurch, New Zealand, 3Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, 4School of Public Health, University of Sydney, Australia, 5Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Consortium, S. Maria Imbaro, Italy, 6Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia, 7 Diaverum Medical-Scientific Office, Sweden, 8Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Oh, United States, 9); Department of doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: In Australia, as elsewhere, the ever-rising dialysis population is placing increasing strain on an already stretched health system. Yet, while Australian NHD has been shown to consume fewer resources, provide better patient outcomes and cost ~Au$25,000/patient/year less than facility HD, NHD patients only make up a small fraction of most Australian dialysis units. To review the influence of the introduction of a home nocturnal haemodialysis (NHD) program from January 2000, on the distribution of patients between home (NHD) and facility (FHD) over the 11 subsequent years in a single dialysis service. Methods: Retrospective review (Jan 2000 to Dec 2011) of the HD modality (FHD vs. NHD) among the patients in our renal service. A peritoneal dialysis (PD) program is also provided by the service but since PD numbers have remained static at ~15% of all dialysis, they are therefore excluded from further analysis. Results: The 11 year increase in the total hemodialysis population (69 to 119) is predominantly accounted for by an increase in NHD from 3 to 33, with only a relatively small rise in FHD (66 to 86). The rise in FHD patients all occurred during the first 3 years (2000 to 2003) while the NHD program was being established (see graph 1). Since 2003, FHD numbers have not altered while NHD has continued to grow, the growth of NHD over the study period being highly significant ( p = 0.0013). Conclusions: Our NHD cohort now makes up 28% of our total HD population with all HD program growth having been delivered through NHD since 2003. This has resulted in significantly lower healthcare costs while synchronously maintaining a high(er) quality of care. Abstracts Nephrology Dialysis Transplantation Emergency and Organ Transplantation, University of Bari (Ba), Italy, 10University of Perugia, Italy, 11Department of Nephrology, Dialysis, Hypertension, Policlinico S. Orsola-Malpighi, Bologna (Bo), Italy, 12Scdo Nefrology and Dialysis, Azienda Ospedaliera Cto/Crf/M. Adelaide, Torino, 13Unit of Endocrinology, Scientific Institute Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy, 14Ospedale “a Perrino, Brindisi, Italy FP644 EVOLUTION OF THE MANAGEMENT OF CHRONIC KIDNEY DISEASE IN FRANCE BETWEEN 1998 AND 2009: THE ORACLE STUDY Nicolas Janus1, Nicolas Janus2, Vincent Launay-Vacher2, Laurent Juillard3, Adrien Rousset4, François Butel4, Sandrine Girardot-Seguin4, Gilbert Deray5, Thierry Hannedouche6, Myriam Isnard7, Yvon Berland8, Philippe Vanhille9, Jean-Paul Ortiz10, Gérard Janin11, Philippe Nicoud12, Malik Touam13, Elfie Bruce2, Laurence Rouillon2 and Maurice Laville3 1 Pitié-Salpêtrière Hospital, Paris, France, 2Service Icar, Nephrology Department, Pitie-Salpetriere Hospital, Paris, France, 3Nephrology Department, Edouard Herriot Hospital, Lyon, France, 4Roche Pharma, Boulogne-Billancourt, France, 5 Nephrology Department, Pitie-Salpetriere Hospital, Paris, France, 6Nephrology Department, Hopitaux Universitaires de Strasbourg, Strasbourg, France, 7 Nephrology Department, Aura Auvergne, Chamalieres, France, 8Nephrology Department, Conception Hospital, Marseille, France, 9Nephrology Department, Valenciennes Hospital, Valenciennes, France, 10Nephrology Department, Saint-Roch Private Hospital, Cabestany, France, 11Nephrology Department, Chanaux Hospital, Mâcon, France, 12Nephrology Department, Pays Du Mont-Blanc Hospital, Chamonix, France, 13Nephrology, Aura Paris, Paris, France Introduction and Aims: In 1998, a French study showed that the referral of patients with chronic kidney disease (CKD) to a nephrologist was delayed and that a large proportion of patients started dialysis (33 %) as unplanned treatment. Eleven years later, the French National Study ORACLE aims to describe the course of CKD patients from their first visit in Nephrology to their first dialysis session. Methods: Multicenter retrospective study on all patients who started dialysis (haemodialysis or peritoneal dialysis) between April and July 2009 in France. Data were collected at the first visit in nephrology and at the first dialysis session. GFR was estimated using Cockcroft-Gault (CG) and aMDRD formulae. Patients with a previous history of dialysis or renal transplantation were not included. Key data were compared with those of the first study conducted in 1998. Results: 720 patients from 69 centres have been included. The majority of these patients (48.5%) were sent to a nephrologist by their general practitioner (GP) (versus 47% in 1998). At the first nephrology visit, estimated GFR was 31.8 ml/min (CG) (versus 22.7 in 1998) and 26.7 ml/min/1.73m2 (aMDRD). In addition, a CG or aMDRD < 30 was observed in respectively 52.4% (versus 73% in 1998) and 63.6% of patients at this first visit. CKD stage 5 was found in 16.1% (CG) (versus 43% in 1998) and 23.6% (aMDRD). Finally, the time between the first nephrology visit and the first dialysis session was 48 months (versus 35 months in 1998). Conclusions: Nephrologist-referral of CKD patients improved from 1998 to 2009 in France. Patients are referred by their GP with higher GFR and fewer patients are referred in Stage 5 CKD. This would allow a better renal care of those patients, including preparation for dialysis, and possibly an increased time to dialysis. ii | Abstracts FP644 FP645 THE COURSE OF RENAL DISEASE IN DIABETIC PATIENTS IN FRANCE THE ORACLE STUDY Nicolas Janus1, Laurent Juillard2, Adrien Rousset3, François Butel3, Sandrine Girardot-Seguin3, Gilbert Deray4, Thierry Hannedouche5, Myriam Isnard6, Yvon Berland7, Philippe Vanhille8, Jean-Paul Ortiz9, Gérard Janin10, Philippe Nicoud11, Malik Touam12, Elfie Bruce4, Laurence Rouillon4 and Maurice Laville2 1 Pitié-Salpêtrière Hospital, Paris, France, 2Nephrology Department, Edouard Herriot Hospital, Lyon, France, 3Roche Pharma, Boulogne-Billancourt, France, 4 Service Icar, Nephrology Department, Pitie-Salpetriere Hospital, Paris, France, 5 Nephrology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, 6Nephrology Department, Aura-Auvergne, Chamalières, France, 7 Nephrology Department, Conception Hospital, Marseille, France, 8Nephrology Department, Valenciennes Hospital, Valenciennes, France, 9Nephrology Department, Saint-Roch Pivate Hospital, Cabestany, France, 10Nephrology Department, Chanaux Hospital, Macon, France, 11Nephrology Department, Pays Du Mont-Blanc Hospital, Chamonix, France, 12Nephrology Department, Aura-Paris, Paris, France Introduction and Aims: Diabetes is a growing concern in the general population and is a common cause or co-morbidity of patients with chronic kidney disease (CKD). The French National Study ORACLE aims to describe the course of CKD patients from their first visit in Nephrology to their first dialysis session. In this sub-group analysis, we focused on CKD patients with diabetes. Methods: Multicenter retrospective study on all patients who started dialysis (haemodialysis or peritoneal dialysis) between April and July 2009 in France. Data were collected at the first visit of nephrology and the first dialysis session. GFR was FP645 Table 1. Demographics of ORACLE patients at first visit and at first dialysis session Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: Existing descriptive data for sexual dysfunction in women on hemodialysis are limited by suboptimal study design. We aimed to conduct a large cross-sectional study to evaluate the prevalence and correlates of female sexual dysfunction in advanced kidney disease. Methods: 1472 women with end-stage kidney disease on hemodialysis were recruited to a multinational, cross-sectional study conducted within a collaborative dialysis network in Europe and South America. Sexual dysfunction was identified by the Female Sexual Function Index. Correlates of self-reported sexual dysfunction were identified by regression analyses. Results: 659 of 1472 women completed questionnaires (45%). Over half (362/659 [55%]) lived with a partner and 232/659 (35%) reported being sexually active. 555/ 659 (84%) of respondents reported sexual dysfunction. Women with a partner (282/ 362 [78%]) were less likely to report sexual dysfunction than those without a partner (273/297 [92%]) ( p<0.001). Sexual dysfunction was independently associated with age, depressive symptoms, lower educational attainment, menopause, diabetes, and diuretic therapy. Nearly all women who were not wait-listed for a kidney transplant and living without a partner (249/260 [96%]) reported sexual dysfunction. Over half (128/232 [55%]) of sexually active women reported sexual dysfunction, which for these women was associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy. Conclusions: Although defining sexual dysfunction in women is controversial, this descriptive study suggests most women on hemodialysis experience sexual problems. Additional research on the relevance of sexual dysfunction to symptom burden and quality of life in these women is now required. Abstracts Nephrology Dialysis Transplantation estimated using aMDRD formula. Patients with a previous history of dialysis or renal transplantation were not included. All patients presenting both type 1 and type 2 diabetes were included in the analysis. Results: 278 patients with diabetes from 69 centres have been included (38.6 % of the whole cohort). 39.6% and 24.8% were referred to a nephrologist by their general practitioner and endocrinologist, respectively. At the first nephrology visit, GFR was 25.9 ml/min/1.73m2 (aMDRD) (table). In addition, aMDRD < 30 and <15 was observed in 62.9% and 21.6% respectively. The mean time between first visit in nephrology and first dialysis session was 39.9 months. Conclusions: Although diabetes is a risk factor for CKD, diabetic patients are still referred to a nephrologist when GFR is already low and despite the fact that most oral antidiabetic drugs cannot be used whenever GFR is reduced. It seems important to diagnose CKD earlier, and to refer the patients to a nephrologist in order to optimize drug therapy and postpone dialysis with appropriate diabetes and hypertension management. of dialysis. A multivariate analysis found that mortality was linked to older age, lower body mass index, lower haemoglobin concentration, cardiovascular disease, cancer, and unplanned chronic dialysis initiation (table). Specific causes of mortality were not collected. Conclusions: A number of comorbidities present at the first visit are linked with progression and time to dialysis. Early referral to a nephrologist with an appropriate monitoring and treatment of those comorbidities should be beneficial on progression. Timely referral and preparation of dialysis may reduce the proportion of unplanned dialysis and may decrease mortality rate after starting dialysis. FP647 DIALYSIS MODALITY AND SOCIO-ECONOMIC STATUS IN AUSTRALIA Blair Grace1, Philip Clayton2, Alan Cass3 and Stephen Mcdonald2 Anzdata Registry, Adelaide, Australia, 2Australia and New Zealand Dialysis and Transplant Registry, 3The George Institute for Global Health 1 THE COURSE OF CHRONIC KIDNEY DISEASE IN FRANCE RESULTS OF THE ORACLE STUDY Nicolas Janus1, Vincent Launay-Vacher2, Laurent Juillard3, Adrien Rousset4, François Butel4, Sandrine Girardot-Seguin4, Gilbert Deray2, Thierry Hannedouche5, Myriam Isnard6, Yvon Berland7, Philippe Vanhille8, Jean-Paul Ortiz9, Gérard Janin10, Philippe Nicoud11, Malik Touam12, Elfie Bruce2, Laurence Rouillon2 and Maurice Laville3 1 Pitié-Salpêtrière Hospital, Paris, France, 2Service Icar, Nephrology Department, Pitie-Salpetriere Hospital, Paris, France, 3Nephrology Department, Edouard Herriot Hospital, Lyon, France, 4Roche Pharma, Boulogne-Billancourt, France, 5 Nephrology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, 6Nephrology Department, Aura-Auvergne, Chamalières, France, 7 Nephrology Department, Conception Hospital, Marseille, France, 8Nephrology Department, Valenciennes Hospital, Valenciennes, France, 9Nephrology Department, Saint-Roch Private Hospital, Cabestany, 10Nephrology Department, Chanaux Hospital, Mâcon, France, 11Nephrology Department, Pays Du Mont-Blanc Hospital, Chamonix, France, 12Nephrology Department, Aura-Paris, Paris, France Introduction and Aims: In France, the referral of patients with chronic kidney disease (CKD) to a nephrologist is usually delayed and a large proportion of patients start dialysis (34.2%) as unplanned treatment. The French National study ORACLE aims to describe the risk factors for declining renal function and to identify risk factors for mortality in chronic dialysis patients. Methods: Multicenter retrospective study in a cohort of patients who started dialysis (haemodialysis or peritoneal) between April and July 2009 in France. Data were collected at the first visit with a nephrologist and at the first dialysis session. All patients were followed during 1 year after initiation of chronic dialysis for the survival study. GFR was estimated using aMDRD formula. Patients with a previous history of dialysis or renal transplantation were not included. Statistical analysis included multiple linear regression (decline of renal function), and a COX model (survival analysis) was performed with SAS statistical software, version 8.02 (SAS, Inc., Cary, NC). Results: 720 patients from 69 centres have been included. The mean time and decline of GFR between their first visit in nephrology (T0) and the first dialysis session (TD) was 48 months and -4.3 ml/min/1.73m2/year, respectively. Multivariate analysis found that a rapid annual decline of GFR was associated at T0 with age (elderly), initial aMDRD, low haemoglobin concentration, hypertension, diabetes, cancer and dyslipidaemia. 15.4% of the patients died during follow-up after initiation FP646 Table 1. Cox Model Analysis Volume 27 | Supplement 2 | May 2012 Introduction and Aims: Survival and quality of life varies between dialysis modalities, but associations between socio-economic status (SES) and modality have not been investigated in Australia, a country with universal access to healthcare. Methods: Using the national registry (ANZDATA), we investigated treatment modalities of adult, non-Indigenous patients who commenced chronic renal replacement therapy (RRT) in Australia, 2000-2009. Patients’ postcodes of residence, ordered into deciles using standard indices of area SES were used as a measure of SES. Associations between SES and treatment modality (functioning transplant, PD and HD) were investigated using multinomial regression at commencement, and after 90 days of RRT. Uptake of home HD was investigated using competing risk regression, and vascular access for HD patients (catheter versus other) using logistic regression. Results: Out of 16,815 incident RRT patients, HD was the most common initial treatment (73%), decreasing to 60% after 90 days as some patients changed to PD or received transplants. Patients from advantaged areas were slightly more likely to commence on HD (RR per decile 1.07, 95%CI 9.91-1.122). SES did not predict HD use independently of remoteness (P = 0.06). Use of PD increased with remoteness (P<0.0001), and remote postcodes generally have lower SES. SES was not associated with HD catheter use (logistic regression, P = 0.3), or with the uptake of home HD (sub-hazard ratio 1.09, 95%CI 0.98-1.21). Conclusions: Usage of PD in Australia was greater among patients living in areas of lower SES and in more remote areas, and there was no association between home HD use and SES. FP648 WHEN 'NO' DOESNT MEAN NO. PATIENTS WHO OPT FOR CONSERVATIVE MANAGEMENT AND THEN CHANGE THEIR MIND REGARDING DIALYSIS TREATMENT- EXPERIENCE OF A SINGLE UK CENTRE Jyoti Baharani1 Birmingham Heartlands Hospital 1 Introduction and Aims: At our centre we currently care for 50 active patients on the conservative management (CCM) programme. The initial decision not to undertake dialysis when the need arises is a very difficult and emotive one and inevitably some patients change their mind. Such patients ultimately start their treatment as an emergency and do not have the benefit of permanent vascular access. No definitive information exists on these pockets of patients, in particular on their demographics and survival rates. Methods: We have analysed data from a group of patients (who had opted for active CCM) over the last 5 years who changed their mind and commenced haemodialysis. We examined the patient demographics, cause of renal failure and the outcome of these patients. We identified 22 patients over the last 5 years who had chosen CCM and changed their mind regarding dialysis treatment. The demographics of these patients were obtained relating to age, sex, ethnicity, social circumstances, eGFR and co-morbidity scores. Information was also gathered about which form of access was used for dialysis treatment and survival rates. Results: Of the 22 patients identified the male: female ratio was 1:1. Ethnic origin was; 73% European, 23% Asian (all female) and 4% Afro Caribbean with a mean age of 80 years (range 75 to 88 years) Cause of renal failure was as follows:-41% Diabetic Nephropathy -27% Hypertension –14% Renovascular Disease - 5% FSGS - 5% Myeloma and 8% Unknown. 60% of the patients were highly dependent with Karnofsky scores of under 40. 63% of patients were in the high risk group when stratified using the Charlson index of co-morbidity. GFR at start of dialysis therapy ranged from 3.9 mls/min to 16 mls/min with a mean of 8mls/min. At the time of follow up, 11 of this group are still alive. Survival rates for the deceased range from 0 months to 29 months (mean 11 months survival). 70% started dialysis with no form of permanent vascular access. Conclusions: dialysis education programme will change their mind and opt for dialysis. In our experience, it is difficult to predict which patients will change their mind. For those who commence dialysis; survival is in keeping with those who opt for dialysis at an early stage. In our centre, this may be due to patients still receiving doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 FP646 Abstracts all aspects of care for ESRF in a dedicated renal environment rather than being discharged to primary care. The majority of patients who changed their mind about receiving RRT started treatment with no form of permanent vascular access. This presents many potential problems for both the patient and the renal unit providing the care, relating to infection, admissions and adequacy of treatment. Further investigations are required into social circumstances, reasons for change of mind particularly within the Asian Female population. FP649 DIALYSIS SPECIALISTS ACHIEVED HIGHER GUIDELINE ADHERENCE RATE COMPARED WITH NON-SPECIALISTS Introduction and Aims: The quality of dialysis care provided by specialists is expected to be superior to that by non-specialists. However, little is known about the actual differences of patient management skills between dialysis specialists and non-specialists. We hypothesized that guideline adherence rate of patients treated by dialysis specialists should be higher than that by non-specialists. To test this hypothesis, we compared guiideline adherance rate bewteen specialist treated patients and others by analyzing nationwide cohort of Japanese Society for Dialysis Therapy (JSDT). Methods: Design: Cross-sectional study of a prospective cohort: Japanese Renal Data Registry (JRDR). We used the standard analysis file (JRDR-09003) for this study. Settings: 3603 registered dialysis facilities in Japan. Participants: 227047 chronic hemodialysis (HD) patients excluding home HD.Primary outcomes: Guideline adherence rate of anaemia, CKD-MBD and Kt/V. Achievement of guidelines were defined as Hb > 11.0g/dl for anaemia; both 8.4 € Ca € 10.0mg/dl and 3.5 € iP € 6.0 mg/dl; Kt/V3 1.2, respectively. Secondary outcomes: Hb, Ca, iP, i-PTH, blood flow rate (Qb), minutes per session, times per week. Primary explanatory variable: Management by dialysis specialist. Here, dialysis specialists are JSDT-certified specialists who have received training for at least five years. Statistics: For between group analyses, kai-square test and t-test were applied. Generalized linear model were applied and adjusted by age, sex, BMI, DM, vintage, albumin and CRP. Results: Total number of dialysis specialists was 4369. Of 3603 dialysis facilities, 1477 (41.0%) were managed by specialists. Of 227047 patients, 119154 (52.5%) were treated by specialists. Table 1 shows differences between specialsit treatment and non-specialist treatment. On univariate analyses, specialists care showed higher guideline adherence rate of anaemia (28.9 vs 27.9%, P<0.0001), CKD-MBD (46.2 vs 45.6%, P<0.0001) and Kt/V (73.0 vs 69.8%, P<0.0001) compared with non-specialists care. After multiple adjustments, specialist care was still a significant factor for guideline adherence of CKD-MBD and Kt/V, though no longer significant in guideline adherence of anaemia management. Conclusions: Specialist care was associated with better management of CKD-MBD and Kt/V in chronic dialysis patients. FP650 OUTCOMES OF DEMENTIA AMONG DIALYSIS PATIENTS: A NATIONWIDE POPULATION-BASED STUDY IN TAIWAN Chih-Chiang Chien1, Jhi-Joung Wang2, Jyh-Chang Hwang2, Hsien-Yi Wang2 and Wei-Chih Kan2 1 Departments of Nephrology, Chi-Mei Medical Center, 2Chi-Mei Medical Center Introduction and Aims: Studies suggest a high prevalence of cognitive impairment or dementia in patients with end-stage renal disease (ESRD). However, the risk for dementia and its prognostic significance in ESRD remain unclear. This study aimed to determine the prevalence, correlations and dialysis-related outcomes of dementia in national-based databank on chronic hemodialysis patients. Methods: We analyzed data from Taiwan National Health Insurance Research Database (TNHIRD) and collected from 1999-2008 with a cohort of 51238 patients with aged?18 yrs old to determine the dialysis outcomes and dementia. Dementia was defined based on ICD-9 code (290-290.9, 294,331). We used logistic regression to determine the baseline correlates of dementia and Cox proportional hazards models to determine the relative risk (RR). The cumulative survival years were estimated between dementia and non-dementia patients in ESRD with hemodialysis. Results: Overall, 1.7% of this cohort had diagnosis of dementia (M/F=0.81) based on databank screening, and dementia prevalence was much increasing by age (10 times over 75 yrs compared to aged 18∼44 yrs of baseline) (Fig. 1). In the cross-sectional analyses, risk factors for dementia including age, dialysis modality, cerebrovascular disease, diabetes, hypertension, coronary artery disease, peripheral artery disease, chronic pulmonary obstructive disease as well as gastrointestinal bleeding were all FP649 Table 1. Differences between specialist treatment and non-specialist treatment FP650 Fig 1.: Prevalence of dementia by different age groups among ESRD dialysis patients. Values are mean ± SD or percentage. ii | Abstracts FP650 Fig 2.: Crude overall survival curves for incident ESRD patients stratified by with and without dementia at the start of dialysis. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Yoshiyuki Furumatsu1, Tetsuya Kitamura1, Naohiko Fujii2, Satoshi Ogata3, Hidetomo Nakamoto4, Kunitoshi Iseki5 and Yoshiharu Tsubakihara6 1 Fujiidera Keijinkai Clinic, 2Hyogo Prefectural Nishinomiya Hospital, 3Hiroshima International University, 4Saitama Medical School, 5University Hospital of the Ryukyus, 6Departments of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation relevant of co-morbidities. The cumulative survival rate declined by following years in dementia compared to non-dementia with statistically significant of each (1-year 1.13, 5-year 1.93, 9-year 2.56, log-rank test, p<0.001) (Fig. 2). By adjusted above confounding factors with multivariate regression, dementia was associated with an increased risk of death [RR 1.53, 95% confidence interval (CI) 1.40–1.67]. Conclusions: Dementia is associated with adverse outcomes and many co-morbid disorders among ESRD patients. The associated dementia is much higher by aged group and also correlated with high mortality. The routine screening for cognitive impairment among dialysis patients in order to identify those at risk for associated adverse outcomes are warrant. FP651 nephrologists insisted on the need for a dedicated nursing team delivering an effective educational program and PD management and care. The nephrologists’ confidence in managing PD complications was quite similar to what it is for HD: on a scale of 1 to 10, the mean value was 7/10 related to PD vs 8/10 related to HD. Nearly one fifth (21%) had fear of insufficient dialysis quality with PD, 16% hesitated proposing PD after a difficult experience, 32 % thought that technical failures were frequent and discouraging. Finally, 55% had fear of encapsulating peritoneal sclerosis. Conclusions: This inquiry revealed that nephrologists from French speaking Belgium believe PD could and should be implemented in the country. Enhanced nephrologists motivations, and implementation of specific trainings for younger nephrologists and of patient’s pre-dialysis education programs were identified as potential key success factors to increase PD penetration. DOES HIGH SENSITIVITY TROPONIN T MODIFY LONG TERM RISK STRATIFICATION IN DIALYSIS PATIENTS? FP653 Introduction and Aims: Cardiac troponin T (TnT) level, the main diagnostic criterion of myocardial infarction, has been recognized as an important predictor of mortality in hemodialysis (HD) patients. Recently, a high-sensitivity troponin T (hs-TnT) assay has been developed in order to improve the detection limit, to further enhance the accuracy of the test and to shorten diagnosis delay in acute coronary events. However, decreasing the detection limit could modify the reference values and change the signification of low levels of circulating TnT in particular population such as HD patients. The aim of this study was to evaluate whether use of hs-TnT assay modify long term risk stratification in HD patients. Methods: We measured Troponin T using standard and high-sensitivity assays in 231 HD patients (129 men/102 women), free of acute coronary syndrome, as part of a routine monthly evaluation (June 7 to August 3, 2006). Median age of patients was 73 years (interquartile range, 19). Patients were followed prospectively for mortality until February 2011 (median follow-up, 4.25 years). Bland and Altman plot was used to assess agreement between hs-TnT and TnT. Adjusted hazard ratio (HR) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Discrimination performances of TnT and hs-TnT as predictors in Cox models were assessed using c-index for censored data. Results: Bland and Altman analysis revealed that hs-TnT assay yields slightly higher values than TnT (bias ± SD, 0.022 ± 0.019 μg/L). Both elevated TnT and hs-TnT were associated with increased mortality [HR adjusted for age and gender 1.98 (CI, 1.18 – 3.34; p=0.01) and 1.71 (CI, 1.01 – 2.89; p=0.04), respectively for the third tertile of TnT and hs-TnT versus the first tertile]. TnT and hs-TnT lead to similar c-statistic values (0.39 and 0.40, respectively). Conclusions: High-sensitivity TnT, which has been related to earlier biomarker of acute coronary syndrome, is also a significant predictor of mortality in HD patients and allows long term risk stratification. FP652 PERCEPTIVE OBSTACLES TO PERITONEAL DIALYSIS IMPLEMENTATION: AN OPINION POLL AMONG THE FRENCH-SPEAKING BELGIAN NEPHROLOGISTS Jean-Marc Desmet1, Vasco Fernandes2, Frédéric Collart3, Nathalie Spinogatti4, 5, Jean-Michel Pochet6, Max Dratwa3, Eric Goffin7 and Joëlle Nortier8 1 Vésale Hospital, Montigny-Le-Tilleul, 2Curry Cabral Hospital, 3Brugmann Hospital, Brussels, 4Centre Hospitalier de Charleroi, Charleroi, 5Clinique St Elisabeth, Namur, 6Clinique St Elisabeth, Namur, 7Cliniques Universitaires St Luc, Brussels, 8Erasme Hospital, Brussels, Belgium Introduction and Aims: Although peritoneal dialysis (PD) is recognized as an effective renal replacement therapy (RRT) alternative to haemodialysis (HD), its prevalence is around 15 % in most of the industrialized countries. In the French speaking part of Belgium, PD is clearly underused with a prevalence of 8.7 % in 2009. The main objectives of this work were to evaluate the nephrologists’ perceived obstacles to PD implementation and reflect on possible actions towards PD development. Methods: A computer based 33 item questionnaire was sent by e-mail to all nephrologists affiliated to the French speaking association (inquiry management software Checkmarket®, Turnhout, Belgium). The inquiry was sent on May 27, 2009 and completed on July 5, 2009. Reminders were sent to non-responders on June 4, 2009 and June 14, 2009. For each question, Chi square test was used to analyse the differences between groups. Results: Among 120 adult nephrologists targeted by this inquiry, 97 completed the online questionnaire (response rate 80.8 %). Among them, 29 % had little experience of PD (treating less than 5 patients) and 39 % reported no specific formation. However, 88% of responders claimed PD prevalence should be around 20-25%. Half of the responders would choose PD as a first RRT option if they required RRT for themselves. The 3 main reasons given to PD’s low prevalence were an easy access to HD, patient’s refusal and lack of nephrologist’s motivation. Almost all the Volume 27 | Supplement 2 | May 2012 NEPHROLOGY REFERRAL AND DIALYSIS INITIATION – STILL ROOM FOR IMPROVEMENT Diana Silvia Zilisteanu1, Mihai Voiculescu1, Elena Rusu1, Camelia Achim1, Raluca Bobeica1, Sonia Balanica1 and Teodora Atasie1 1 Fundeni Center of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. Introduction and Aims: Late referral to nephrologist of chronic renal failure patients ( pts) can lead to urgent unprepared dialysis start, with increased morbidity and mortality. We assess morbidity and mortality in pts late referred (LR) versus pts early referred (ER) to nephrologist. Methods: We retrospectively assessed 296 pts (males = 160, mean age = 54,1 +/15,6 years) admitted in our center for dialysis initiation. Patients were assigned to LR group if referred less than three months before dialysis initiation, otherwise considered in ER group. At hospital admission, all patients were routinely investigated for uremia complications. Survival rates were evaluated at 3 months and 12 months after dialysis commencement. Results: In 129 cases pts were LR, while in 167 cases were ER. Mean interval between the time of referral and start of dialysis was 0,9 +/- 0,6 months in LR group and 23 +/- 2 months in ER group ( p<0,0001). Hemodialysis was the preferred method either in the LR group (79,9%), or in the ER group (65,3%). As regards the vascular access type, central venous catheter (CVC) was used in 93 pts (72,1%) from LR group, and in 78 pts (46,7%) from ER group; arteriovenous fistula (AVF) was used in in 10 pts (7,8%) from LR group, and in 31 pts (18,6%) from ER group; peritoneal dialysis (PD) was used in in 26 pts (20,2%) from LR group, and in 58 pts (34,7%) from ER group. Three months survival after dialysis initiation was lower in LR group (81%) compared to ER group (88%), but without statistical significance ( p=0,12); the difference was significant when analysed 12 months survival: 75% in ER group 1 versus 51% in LR group ( p=0,02). When analysed survival stratified by dialysis modality and access type, we found highest mortality in pts emergently included in hemodialysis via CVC when compared to pts initiated using AVF ( p=0,001) or with pts included in PD ( p<0,0001). When analysed uremia complications according to referral pattern, we found no significant difference between LR and ER groups. When considered dialysis modality, complications were significantly more frequent in pts dialysed using CVC compared to pts dialysed by AVF or PD: fluid overload was present in 36% versus 13% pts ( p<0,0001), pericarditis was present in 27% versus 14% pts ( p=0,008), cardiac failure in 54% versus 28% pts ( p,0,0001), arrhythmia in 33% versus 15% pts ( p<0,0001), pleural effusion in 35% versus 13% pts ( p<0,0001), neurological disorders in 3% versus 8% pts ( p<0,0001), hemorrhagic syndrome in 26% versus 7% pts ( p<0,0001). As to the mean values of the biological parameters, we found statistically significant differences between the CVC group and FAV/DP group on the hemoglobin level (8 +/- 1,9 g/dl versus 8,8 +/- 1,7 g/dl, p=0,001), serum creatinine (13,4 +/- 6 mg/dl versus 9,9 +/3,7 mg/dl, p<0,0001), albumin concentration (3,2 +/- 0,8 g/dl versus 3,7 +/- 0,6 g/dl, p=0,007). No significant differences were noticed between the CVC group and AVF/ DP group concerning the calcium level (7,7 +/- 1,4 mg/dl versus 7,8 +/- 1,4 mg/dl, p=0,59), serum phosphate (7 +/- 2,3 mg/dl versus 6,5 +/- 1,9 mg/dl, p=0,25), kalemia (5,2 +/- 1,7 mEq/l versus 5 +/- 1 mEq/l, p=0,31), and natremia (133 +/- 7,7 mEq/l versus 134 +/- 15,2 mEq/l, p=0,49). Conclusions: A significant number of ER patients are emergently included in hemodialysis using CVC; this category is most vulnerable and present the highest morbidity and mortality irrespective the referral pattern. Even in LR cases, a significant proportion of cases were included in peritoneal dialysis. FP654 IMPACT OF A NEW DIALYSIS UNIT DEVELOPMENT ON PATIENTS REFERRING TO HOSPITAL HEMODIALYSIS IN FRANCE Sens Florence1, Schott Anne-Marie2, Labeeuw Michel1, Colin Cyrille2 and Villar Emmanuel1 1 Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Department of Nephrology and Renal Transplantation, Pierre Benite, France, 2Hospices Civils de Lyon, Pole Imer, Eam 4128, Lyon, France Introduction and Aims: Dialysis organization in France differs from other European countries. Until 2003, 3 dialysis modalities coexisted: in-center hemodialysis doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Nils Kuster1, Nils Kuster1, Laure Patrier2, Anne-Sophie Bargnoux1, Marion Morena1, Anne-Marie Dupuy1, Stéphanie Badiou1, Bernard Canaud3 and Jean-Paul Cristol1 1 Laboratoire de Biochimie, Chru Montpellier, 2Service de Néphrologie-Hémodialyse Et Soins Intensifs, Chru Montpellier, 3Service de Néphrologie-Hémodialyse Et Soins Intensifs, Chru Montpellie Abstracts FP655 FP656 CROSS SECTIONAL OBSERVATIONAL STUDY OF SYMPTOM BURDEN AND HEALTH-RELATED QUALITY OF LIFE IN PREVALENT HAEMODIALYSIS PATIENTS IN IRELAND. Aoife Lowney1, Eanna Lowney1, Rosie Grant2, Marie Murphy3, Liam Casserly4, Tony O' Brien3 and William D Plant1 1 Cork University Hospital, 2Kerry General Hospital, 3Marymount University Hospice, 4Midwestern Regional Hospital Introduction and Aims: Life expectancy for many ESKD (End Stage Kidney Disease) patients is similar to, or worse than, that with common cancers. Maintenance dialysis therapy may offer a survival advantage but often fails to restore health. This cross-sectional observational study aims to characterise the symptom burden and health related quality of life (QOL) of patients with ESKD undergoing maintenance haemodialysis. Methods: Two validated clinical tools - the Palliative Outcome Scale (POS-S Renal) and the EQ5D were administered to prevalent haemodialysis patients in three haemodialysis units. The POS-S scores 0-4 for severity of 17 symptoms, experienced in the previous week. The EQ5D captures health-related QOL with endpoints in 5 domains. A Visual Analogue Scale (VAS) records the respondent’s self-rated health on a vertical scale where the endpoints are labelled ‘Best imaginable health state’ and ‘Worst imaginable health state’ Response rate was 89% (n=200). Results: The most commonly reported symptoms are detailed below. Mean age was 64 years ± 15.58. Median age was 66 years(range 24-91). The summary findings relating to the EQ5D, which aims to capture health-related QOL are shown below. These indicate a particularly significant disruption of the ability to perform usual Activities of Daily Living. Median VAS was 68 (IQR 50-80). Whether co-morbidity data and symptom burden correlate significantly with these findings isthe subject of ongoing research. Conclusions: This structured clinical evaluation demonstrates the burden of symptoms in the maintenance haemodialysis population, and the impact of both disease and disease modifying treatment on QOL. This burden would support closer integration of renal and palliative care services. Descriptive data such as these should inform strategies for integrated management protocols. FP656 RENAL REPLACEMENT TERAPY IN ALBANIA Ariana Strakosha1, Ariana Strakosha2, Nevi Pasko3, Sulejman Kodra1 and Nestor Thereska1 1 University Hospital Center "Mother Tereza", 2University Hospital Center "Mother Tereza"Tirana Albania, 3University Hospital Center"Mother Tereza"Department of Clinical Biology Introduction and Aims: Chronic kidney disease (CKD)has became the leading cause of mortality in Albania associated with an increasing health cost.During the last decade Albania has undergone under deep political and economic changes.An enormous support of nephrology community by central authorities has resulted in gradual increasing number of patients treated with renal replacement therapies (RRT) (hemodialysis,peritoneal dialysis and renaltransplantation),though not in equally manner. This study is the first report of the National Registry of CKD in Albania that aims to present the incidence and the prevalence of patients treated for end stage-renal disease(ESRD). Methods: This is the multicentre ,cross-sectional study.From January 2007,all patients belonging to the participating centers were included in the analysis after having given their informed consent. Clinical data were collected using SIGANA software Results: There were a total of 592 patients [365(62.2%)M and 224(37.8%)F]treated for end-stage renal disease,with e total prevalence of 126.5pmp.Four hundred four(68.2%) patients were treated with hemodialysis,51(8.6%)with peritoneal dialysis,and 137(23.1%) with renal transplantation.The total prevalence for HD and PD was 92pmp.The prevalence of transplanted patientswas 31.3pmp.The increase in the number of patients treated with renal replacement therapies (RRT)during the last decade correlated very closely with the increase in the healthcare spending for person.Most renal transplantations have been performed in Turkey(45.2%),lees in Greece (22.0%),Albania (18.2%),Italy (8.4%),Pacistan(3.2%),Austria (2.1%),and Hungary (0.5%).Most recipients received the transplanted kidney from a living donors86.7% were consanguineous,and 13.3% were not. Conclusions. The nephrology reality in Albania is still expanding,but certainly inadequate to the real needs of the populations.Based on this surveillance program it should be possible to adopt future national disease prevention strategies. ii | Abstracts FP656 Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 (corresponding to hospital hemodialysis), autodialysis and home hemodialysis. A new modality was set up in order to reduce recourse to in-center hemodialysis: hemodialysis medical care unit (MCU). It was inclined to accommodate patients requiring a noncontinuous medical supervision during dialysis or who refused or could not be treated in auto- or home dialysis. Our aim was to analyze changes in recourse to in-center hemodialysis (ICH) and to self-sufficient hemodialysis (SSH, merging auto and home hemodialysis) as a result of the expansion of MCU. Methods: We included all prevalent adults dialysis patients treated at January, 1st 2004 or at January, 1st 2009 in six French regions (Auvergne, Bretagne, Champagne-Ardenne, Languedoc-Roussillon, Limousin and Rhône-Alpes) included in the French REIN registry at both dates. We first compared patients’ characteristics and crude recourse rates to each dialysis modality according to given year. We then conducted two logistic regressions: the first compared patients’ characteristics and treatment year (2004 versus 2009) of ICH versus other modalities treated patients; the second compared characteristics and treatment year of SSH versus other modalities treated patients. Peritoneal dialysis patients were merged to SSH patients in a sensitivity analysis. Results: In the six regions, 6781 patients were treated by HD in 2004 versus 7976 in 2009. One noted a clear increase in the age (65.8 vs. 68.5 years, p<0.001) and frequency of many comorbidities: hypertension (78.5 vs. 82.7%, p<0.001), diabetes (25.1 vs. 38.8%, p<0.001), chronic heart failure (20.7 vs. 24.1%, p<0.001), cardiac arrhythmias (17.7 vs. 21.3%, p<0.001) and chronic lung disease (9.0 vs. 10.2%, p=0.013). Rates of coronary artery, cerebrovascular and peripheral vascular diseases did not significantly change (respectively 25.8, 10.7 and 25.7%). The crude recourse rate to ICH did not significantly change (55.5 vs. 55.4%, p=0.881), whereas SSH decreased (28.6 vs. 23.3%, p<0.001) and dialysis medical care units showed a wrong progression (5.9 vs. 12.4%, p<0.001). Multivariate analysis comparing ICH with other modalities (SSH and MCU) treated patients showed a reduction, at equal age and comorbities, in recourse to hospital hemodialysis in 2009 as compared to 2004 (RR=0.72, p<0.001). Concerning the comparison of SSH with other modalities (ICH and MCU) treated patients, this showed a stability of self-sufficient hemodialysis recourse from 2004 to 2009 (RR=0.99, p=0.784). The consideration of peritoneal dialysis patients did not significantly modified results (RR respectively 0.78 ( p<0.001) and 0.99 ( p=0.784). Conclusions: The expansion of hemodialysis medical care units in France appears to have resulted, at equal age and comorbidities, in a reduction of patients’ orientation to hospital hemodialysis. That is in favor of a trend to reduction of individual medical costs. However, considering the ageing of the dialyzed population and the increase of its comorbidities, crude recourse rates to hospital units did not show the reduction expected by health authorities. Nephrology Dialysis Transplantation Abstracts Nephrology Dialysis Transplantation FP657 RELATIONSHIP BETWEEN INFLAMMATION AND COGNITIVE PSYCHOMOTOR FUNCTION IN DIALYSIS PATIENTS Josipa Radic1, Josipa Radic2, Dragan Ljutic1, Vedran Kovacic1, Mislav Radic1, Katarina Dodig-Curkovic3, Milenka Sain1 and Ivo Jelicic1 1 University Hospital Split, Split, Croatia, 2University Hospital Split, Split, 3 University Hospital Osijek, Osijek, Croatia FP658 BONE TURNOVER MARKERS ASSOCIATE MORE STRONGLY WITH CARDIOVASCULAR MORTALITY THAN ALL-CAUSE DEATH IN MAINTENANCE HEMODIALYSIS PATIENTS. Naohiko Fujii1, Takayuki Hamano2, Chikako Nakano3, Sayoko Yonemoto4, Ayako Okuno4, Masaya Katayama5 and Yoshitaka Isaka3 1 Hyogo Prefectural Nishinomiya Hospital, 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, USA, 3Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan, 4Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan, 5Rokushima Second Clinic, Hyogo, Japan Introduction and Aims: Alkaline phosphatase (ALP) is reported to be associated well with cardiovascular (CV) mortality and all-cause death in both maintenance hemodialysis (MHD) and predialysis patients, as well as in the general population. It is, however, inconclusive whether bone formation markers bone-specific ALP (BSAP) and bone resorption markers such as serum N-terminal telopeptide of type I collagen (NTX), and tartrate-resistant acid phosphatase 5b (TRAP5b) can predict prognosis of MHD patients. While TRAP5b is reported to be not interfered with residual renal function, serum NTX is interfered since NTX is excreted by the kidney. The present study was to elucidate the predictive value of these three markers and parathyroid hormone (PTH) in MHD patients. Methods: In this single-centred prospective observational study, we enrolled 128 MHD patients in May 2006 and followed-up until November 2011. We measured 1-84 PTH (whole PTH). TRAP5b and BSAP were measured by DS Pharma Biomedical. We used Cox proportional hazards model employing each of the four parameters (BSAP, NTX, TRAP5b, and PTH) to evaluate the predictors of outcomes, defined as CV and all-cause death, respectively. All analyses were adjusted for age, sex, diabetic status, and dialysis vintage. Additional adjustment for phosphate and albumin was performed for CV and all-cause death, respectively. Results: During a median follow-up of 4.1 (IQR 2.4-5.6) years, 40 patients died, 18 of whom died of CV diseases. When the third quartile (Q3) was set to the reference, the hazard ratios (HRs) for all-cause mortality in the quartiles (Q1-Q4) of the four parameters were (2.0, 2.5, 1, 2.7*) for PTH, (1.6, 1.1, 1, 2.8) for NTX, (1.9, 2.3, 1, 3.5*) for TRAP5b, (0.8, 0.8, 1, 0.6) for BSAP, respectively. The HRs for CV death were (3.1, 2.8, 1, 5.6*) for PTH, (1.6, 1.5, 1, 4.3) for NTX, (2.1, 1.6, 1, 6.0*) for TRAP5b, (6.4, 1, 3.5, 2.4) for BSAP, respectively. (* represents statistical significance of P<0.05) Conclusions: The associations between all-cause mortality and PTH or bone resorption markers were J-shaped with highest HR in the highest quartile (Q4). The Volume 27 | Supplement 2 | May 2012 FP659 OUTCOME PREDICTION OF DIFFERENT DIALYSIS MODALITIES IN ITALY: APPLICATION OF A MULTISTATE MODEL. Maurizio Nordio1, Aurelio Limido2, Maurizio Postorino3 and Michele Nichelatti4 P. Cosma Hospital, Camposampiero, Italy, 2Nephrology and Dialysis Unit, Azienda Ospedaliera Fatebenefratelli E Oftalmico, 3Cnr-Ibim, 4Service of Biostatistics, Niguarda Ca’ Granda Hospital – Milan, Italy 1 Introduction and Aims: Renal replacement therapy is a dynamic process in which patients begin a dialysis modality that may be changed, they may be transplanted and eventually die. Standard survival analysis is not suitable to describe this process since multiple transitions occur, thus we applied a multistate model in order to compare mortality of peritoneal dialysis (PD) patients versus hemodialysis (HD) patients. Methods: A cohort of 32928 patients starting HD or PD in the period 1/1/1999- 31/ 12/2009 in Italy with a complete follow-up was enrolled from the Italian Registry of Dialysis and Transplantation. Of each patient were considered modality and date of the first renal replacement treatment and of any change, gender, age, primary renal disease, main comorbidities, death and date of death. The following transitions were taken into account: from PD to death, from PD to HD, from PD to kidney transplantation (Tx), from HD to death, from HD to PD, from HD to Tx. Death was the absorbing state. In the multi-state model, shifting between the states was set up in a transition intensity matrix. The probability of being in any of the states was calculated as a transition probability matrix. The effects of the renal replacement modalities were modelled using a non-parametric model. Results: 84% of patients underwent HD as first dialysis modality and 16% PD. Ten-year mortality probability was 75% for HD patients and 47% for PD patient, in the same period transplantation probability was 16% for HD patients and 37% for PD patients. The ten-year probability of shift from HD to PD was 2%, while the probability of shift from PD to HD was 16%. PD as first dialysis modality was associated with younger age (HR=0.5), absence of diabetes (HR=0.8), absence of heart failure (HR=0.57) and of cardiovascular diseases (HR=0.71), while HD was associated with older age (HR=1.1), diabetes (HR=1.2) and heart failure (HR=1.13). The shifts both from HD and PD to Tx were associated to younger age and absence of comorbidities. Conclusions: The results show that the outcomes of PD and HD cannot be compared by using observational data because of a heavy selection bias. At first instance PD seems to have a better outcome in term of death and Tx, but patients treated with this modality are younger and healthier than HD patients. Moreover standard survival analysis may be misleading, since Tx is dependent on dialysis modality and uninformative censoring is systematically violated. FP660 STUDY OF VIRAL LOAD DYNAMICS IN CKD 5D PATIENTS WITH HEPATITIS C VIRUS Miroslava Khil1, Irina Dudar2, Vladimir Khil3 and Irina Shifris2 Institute of Epidemiology and Infectious Diseases Ams of Ukraine, Kyiv, Ukraine, 2 Institute of Nephrology Ams of Ukraine, Kyiv, Ukraine, 3Main Military Hospital of Ukraine, Kyiv, Ukraine 1 Introduction and Aims: CKD 5D patients is a high risk group of hepatitis C virus (HCV) infection. The course of chronic HCV-infection among CKD 5D patients has lighter character as compared with normal renal function patients. The blood level of viruses (viral load) is a factor which determining the outcome of chronic HCV-infection. There is unresolved the problem of understanding the factors which promoting low viral load in CKD 5D patients. The aim of this study is exploration of viral load dynamics in HCV-infected CKD 5D patients and evaluating the impact of hemodialysis (HD) on viraemia level. Methods: In 38 CKD 5D HCV-positive patients the RNA HCV level was determining. The viraemia is measured mutually (before and after dialyzer) at baseline and in two hours, at HD-end, and in 48 hours, immediately before next HD. The viral presence in ultrafiltrate is determined at the beginning and at the end of HD. It has been used dialyzers with two kind of membrane: Polysulfone and Helixone, effective surface 1.6-1.8 (m). Quantity assay of RNA HCV is performed by PCR ( polymerase chain reaction). RNA separation from serum is carried out on commercial kits “Ribo-Sorb”. Reverse transcription reaction is performed by kits “Reverta-L”. Amplification of nucleonic acids is executed on MyCycler equipment (BioRad, USA). doi:10.1093/ndt/gfs227 | ii Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Introduction and Aims: Cognitive impairment is frequent in dialysis patients. Uremia is associated with inflammation and release of cytokines by lymphomonocytes. Inflammation may be an important mechanism underlying cognitive decline in the general population but little is known about influence of inflammation on cognitive and psychomotor functions in dialysis patients. The aim of the study was to investigate whether plasma interleukin-6 (IL-6) and C-reactive protein (CRP) are related to poorer cognitive and psychomotor function in dialysis patients. Methods: To evaluate whether inflammation is associated with cognitive and psychomotor motor functions a selected population of 33 dialysis (25 hemodialysis patients and 8 patients on continuous ambulatory peritoneal dialysis) patients aged 60.33±10.35 years were investigated. Assessment of cognitive and psychomotor functions was performed by Symbol Digit Modalities Test (SDMT) and Complex Reactiometer Drenovac (CRD series), a battery of computer generated psychological tests to measure short-term memory (CRD-324), simple convergent visual orientation (CRD-21) and convergent thinking (CRD-11). Results of cognitive motor tests were given as total time of test solving (TT) and total number of errors (NE) committed during any of the test. Higher CRD-series tests scores (TT and NE) indicate poorer cognitive and psychomotor performance. Serum level of CRP and interleukin-6 were measured after cognitive psychomotor testing. Results: There were significant correlations between IL-6 and SDMT score (r= -0.350, p= 0.047). Also, a significant correlations between IL-6 and NE for test CRD-324 (r=0.391, p= 0.014) and test CRD-11 (r=0.405, p= 0.016) were found. There were no significant correlations between CRP and cognitive and psychomotor performance in any of tests used in this study. Conclusions: The results suggest a relationship between elevated baseline plasma IL-6 and cognitive and psychomotor performance. These findings in dialysis patients are consistent with the hypothesized relationship between brain inflammation, as measured here by plasma IL-6, and neuropathologic disorders in general population. Further studies are warranted, with higher numbers of participants in a prospective research model, to investigate improvement in cognitive and psychomotor function after reducing inflammation. association with CV death was also J-shaped but the effect sizes of all these biomarkers were higher for CV mortality than all-cause mortality. This implies the validity of the concept of chronic kidney disease-mineral bone disorders (MBD). The significant association of TRAP5b instead of NTX suggests that TRAP5b rather than NTX should be used as a prognostic resorption marker. In our study, the association between all-cause mortality and BSAP was not significant possibly due to a low statistical power. The observed association between lower BSAP levels and higher CV mortality is compatible with a recent bone biopsy finding (JBMR 2010) showing that low bone formation rate is associated with higher coronary artery calcification score. Abstracts FP661 EVALUATION OF AN ISOLATION PROGRAM OF HEPATITIS C VIRUS INFECTED HEMODIALYSIS PATIENTS IN SOME HEMODIALYSIS CENTERS IN EGYPT Mohamed Momtaz1, Amin Roshdy Soliman1 and Mona I El Lawindi1 Cairo University, Cairo / Egypt Introduction and Aims: The measures used for reduction of the prevalence of hepatitis C virus (HCV) infection in our dialysis unit include: strict adherence to universal infection control precautions, regular testing of all patients for HCV antibodies and separation of anti HCV positive patients from the negative patients on designated machines. The aim of the study was to analyze the prevalence of HCV infection and seroconversion rate among hemodialysis patients. Methods: The incidence and prevalence of HCV infection in dialysis unit with 170 patients was studied from 2004 to 2011. Detection of HCV antibodies was performed in all hemodialysis patients every 6 months, and in those who were scheduled for kidney transplantation, upon initiation of hemodialysis or transfer to another hemodialysis facility. Implementation and adherence to strict infection control procedures was conducted to prevent transmission of blood-bornepathogens including HCV. Isolation of anti HCV posi?tive patients and using designated machines for their dialysis was implemented since January 2007. Results: The overall prevalence of anti HCV among long term hemodialysis patients decreased from 65.6% in 2004 to 39.2% in 2011. Following the application of the above mentioned procedures there was no seroconversion from anti HCV negative to anti HCV positive in our dialysis unit since 31 December 2009. Conclusions: In dialysis units with a high HCV prevalence, strict isolation in combination with implementation of infection control measures, could eliminate nosocomial transmission and obtain a long-term reduction in prevalence of HCV infection. Although isolation and use of designated machines for anti HCV positive patients is not recommended following the clinical guidelines of "Kidney Disease: Improving Global Outcomes" (KDIGO, 2008), it might be beneficial, when there is a high prevalence of HCV positive hemodialysis patients. FP663 DECREASED SERUM ADRENAL ANDROGEN DEHYDROEPIANDROSTERONE SULFATE AS AN INDEPENDENT PREDICTOR OF MORTALITY IN HEMODIALYSIS PATIENTS 1 Introduction and Aims: Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality in hemodialysis (HD) patients. Several studies demonstrated nosocomial transmission of HCV among HD patients. We aimed to evaluate the isolation program of HCV seropositive patients among a group of Egyptian haemodialysis patients to decrease the incidence of HCV seroconversion. Methods: Eighty three HCV seronegative patients who were receiving regular haemodialysis in different four haemodialysis units in Egypt. The first group included forty six patients on regular hemodialysis in two centers following strict isolation of the HCV seropositive patients, and the second group includedsixty eight patients on regular hemodialysis in the other two centers not following this strict isolation. All these patients were followed up over a period of 42 months. Results: There was a significantly higher incidence of HCV seroconversion of patients on hemodialysis in units not following strict isolation of HCV seropositive patients (42.9 %) than those on regular hemodialysis in units following strict isolation (14.8 %). Conclusions: In HD units with a high prevalence of HCV+ patients, strict isolation of HCV+ patients in combination with implementation of universal prevention measures can limit spread of HCV infection in HD patients. FP662 DECREASING PREVALENCE OF HEPATITIS C VIRUS INFECTION IN HEMODIALYSIS PATIENTS:FOLLOWING KDIGO GUIDALINES Pavlina Dzekova-Vidimliski1, Svetlana Pavleska-Kuzmanovska1, Lada Trajceska2, Igor Nikolov1, Gjulsen Selim1, Saso Gelev3, Vili Amitov1 and Aleksandar Sikole1 1 University Clinic of Nephrology, 2University Clinic of Nephrology-Skopje, Macedonia, 3University Clinic of Nephrology, Skopje, Fyr Macedonia ii | Abstracts Tetsuo Shoji1, Ryusuke Kakiya1, Tomoshige Hayashi1, Naoko Tatsumi-Shimomura2, Yoshihiro Tsujimoto2, Tsutomu Tabata2, Hideaki Shima1, Katsuhito Mori1, Shinya Fukumoto1, Hideki Tahara1, Hidenori Koyama1, Masanori Emoto1, Eiji Ishimura1, Yoshiki Nishizawa1 and Masaaki Inaba1 1 Osaka City University Graduate School of Medicine, Osaka, Japan, 2Inoue Hospital Introduction and Aims: Endocrine and metabolic abnormalities are possible factors affecting survival of hemodialysis patients. Serum dehydroepiandrosterone sulfate (DHEA-S), an adrenal androgen with anabolic properties, is known to be lowered in ill patients and predicts poor outcome in the general population and in those with cardiac disease. The aims of this study were to examine a possible change in DHEA-S level in hemodialysis patients and its association with mortality in this population. Methods: We performed an observational cohort study in 494 prevalent hemodialysis patients (313 men and 181 women) in urban area of Osaka, Japan. The main exposure was baseline DHEA-S level in December 2004 and the key outcome was all-cause mortality during the subsequent 5 years. In addition, DHEA-S levels were compared between the hemodialysis patients and 122 matched healthy controls. Results: Median (IQR) DHEA-S levels were 771 (447-1351) ng/mL and 414 (280-659) ng/mL for male and female hemodialysis patients, respectively, and these values were almost half the healthy control levels. Among the hemodialysis patients, DHEA-S was lower in women, those with higher age, pre-existing CVD, lower serum albumin, and higher C-reactive protein. During the follow-up, we recorded 101 deaths. A low DHEA-S level was a significant predictor of all-cause mortality independent of potential confounders in male, but not in female hemodialysis patients. Conclusions: We have demonstrated that serum DHEA-S level is decreased in hemodialysis patients, and that a low DHEA-S concentration is a novel independent predictor of mortality in male hemodialysis patients. Volume 27 | Supplement 2 | May 2012 Downloaded from https://academic.oup.com/ndt/article-abstract/27/suppl_2/ii268/1935047 by guest on 29 May 2020 Results: After HD the viral load levels has reduced by 0,7-1,9 log10 copies/ml and is average 2,8 × 104 copies/ml in hemodialysis-end (from 6,75 × 10 2 to 5,65 × 10 4) compared to 7,3 × 10 5 copies/ml (from 1,57 × 10 3 to 1,16 × 10 6) at the beginning of procedure; this decreasing was significant (?<0,01). HCV titer was decreasing in all patients (from 5% to 95%, p = 0,001), than increasing and virtually renewal to baseline level after 48 hours with following decreasing during successive HD session. The grade of HCV-RNA decreasing during hemodialysis was constant with insignificant variations of decrease rate. Simultaneously with viraemia level determination in pair analysis before and after dialysis we notice a significant RNA H?V decreasing, immediate after dialysis by 0,5-1,1 log10 copies/ml, which may be indirectly confirms viral adsorption to dializer membrane. We didn’t detect significant differences of viral load dynamics using dialyzers with different kind of membranes (Polysulfone and Helixone). The penetration HCV through dialyzer membranes is disputable problem. In spite of HCV varione diameter is 30-60 nm, i. e. more than in several times exceeds the pore size of dializer, and therefore virus passing through membrane is impossible, the number of authors is reported the presence of viruses in ultrafiltrate. In this study we didn’t detected RHA HCV in any ultrafiltrate samples and this exclude viral eradication on dialyzer membrane as possible explanation of viraemia decreasing. Conclusions: Hemodialysis is decreasing RNA HCV level. Dyalizer membrane is impermeable for HCV. Received data is not explained the phenomena of viral load decreasing during hemodialysis. We are continuing researches, which might be explains the influence of hemodialisys procedure on course of chronic viral hepatitis C in CKD 5D patients. Nephrology Dialysis Transplantation