Dialysis. Epidemiology, Outcome Research, Health Services 2

Nephrology Dialysis Transplantation 29 (Supplement 3): iii272–iii286, 2014 doi:10.1093/ndt/gfu158 DIALYSIS. EPIDEMIOLOGY, OUTCOME RESEARCH, HEALTH SERVICES 1 SP598 SALT RESTRICTION AND ALL-CAUSE MORTALITY IN JAPANESE HEMODIALYSIS PATIENTS FROM JSDT REGISTRY Tatsuyoshi Ikenoue1, Kiyomi Koike2, Shingo Fukuma3, Satoshi Ogata4, Yoshiharu Tsubakihara4, Kunitoshi Iseki4 and Shunichi Fukuhara3 1 Fujidera Keijinkai Clinic, Fujiidera, Japan, 2Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan, 3Department of Healthcare Epidemiology, School of Public Health, Kyoto University Faculty of Medicine, Kyoto, Japan, 4Committee of the Renal Data Registry, the Japanese Society for Dialysis Therapy, Tokyo, Japan Introduction and Aims: Although some guidelines recommend salt restriction, few studies have examined the association between salt restriction and clinical outcomes in hemodialysis (HD) patients. Methods: We conducted a retrospective cohort study of 88,115 adult patients enrolled in the Japanese Society for Dialysis Therapy (JSDT) registry (2008) who had received HD for at least two years and were considered anuric. The primary outcome measure was all-cause mortality at one year, and the secondary outcome was cardiovascular (CV) mortality. Estimated salt intake was the main predictor, and was calculated from interdialytic weight gain and pre- and postdialysis serum sodium levels according to the validated method of Kimura and Ramdeen. Nonlinear logistic regression was used to determine the association of salt intake with mortality, adjusting for age, gender, body mass index, vintage of HD, dialysis time, Kt/V, protein catabolic rate normalized to body weight, comorbid conditions, type of vascular access, serum potassium, phosphate, calcium, CRP level, and endotoxin level in dialysate. Cubic splines were plotted and the reference was median salt intake. Salt consumption was categorized by intake levels of 2 g per day and the association with mortality examined. Results: Median [25th-75th percentile] salt intake at baseline was 6.4 [4.6-8.3] g per day. At one year, all-cause mortality occurred in 1,845 (2.1%) patients, including cardiovascular mortality in 821 (0.9%). We observed an association between low salt intake and clinical outcomes (all-cause and CV mortality) (Fig.1). We observed the highest all-cause mortality in the low salt group (<6g/day) (Fig.2), and no association between all-cause mortality and high salt intake. Further, we observed similar associations between salt intake and CV mortality. Conclusions: Low salt intake is associated with all-cause and CV mortality. These findings do not support current clinical guidelines, which recommend restricting salt intake to less than 6g per day. Introduction and Aims: Epidemiologic data have demonstrated elevated cancer risk in hemodialysis (HD) patients. The aim of the present study was to evaluate the demographic, clinical and biochemical determinants of cancer development in HD patients. Methods: The MONitoring Dialysis Outcomes (MONDO) consortium consists of HD databases from Renal Research Institute (RRI) clinics in the US, Fresenius Medical Care (FMC) clinics in Europe, Asia Pacific (AP), Latin America (LA), KfH clinics in Germany, Imperial College, London, UK, Hadassah Medical Center, Jerusalem, Israel, and University of Maastricht, The Netherlands. We extracted data for only those patients who survived at least 12 months after the start of HD. Ninety-four HD patients with pre-existing cancer were excluded from the analysis. We used available variables to construct regression models to predict cancer development during 2 year follow-up. Candidate predictors included demographic characteristics (age, sex), comorbidities (diabetes, hypertension, cardiovascular disease (CVD), coronary artery disease (CAD), smoking), body mass index (BMI), dialysis parameters (eKtV, urea reduction ratio (URR), vascular access, erythropoietin dosage, intra-dialytic weight gain (IDWG), normalized protein catabolic ratio (nPCR)) and laboratory tests (albumin, hemoglobin (Hgb), sodium, potassium, calcium, phosphorus, ferritin, serum creatinine (sCR), white blood cell count, platelets, and total cholesterol). Continuous variables were converted into categorical ones based on optimal clinical cut off points in a preprocessing step. Categorical variables were pre-screened using Chi-square test (P < 0.1). Stepwise forward method was used for variable selection in the multiple logistic regression. Results: 22024 HD patients were studied (Eastern Europe: 4830, Western Europe: 367, Northern Europe: 1937, Southern Europe: 7189, Western Asia: 2115, Northern America: 5586). The mean (SD) age was 63.2±15.0 years, 58.7% were males. The overall incidence of cancer was 0.84% (185 cases), and 0.3% (57 cases) of HD patients had cancer-related death. The incidence of cancer was highest in Eastern Europe (1.6%, 78 cases) and lowest in Western (0.3%, 1 case) and Northern Europe (0.3%, 5 cases). Men older than 75 years had trend towards higher cancer incidence as compared to older female (1.2% vs 0.7%; P =0.07). The multivariable logistic regression model to predict two-year risk of cancer retained the following variables: age, BMI, ferritin, albumin, Hgb, eKtV, vascular access, CAD, diabetes, and IDWG. The model, significant predictors, and unstandardized β coefficients with 95% CI are presented in Table 1. Conclusions: Our study identifies clinical relevant risk factors to predict cancer in HD patients. This risk assessment model could help clinicians to stratify patients for cancer screening, surveillance, prevention and early therapeutic intervention. Further studies are needed to validate our model in an externally derived cohort to evaluate its generalizability. SP598 SP599 PREDICTORS OF CANCER IN CHRONIC HEMODIALYSIS PATIENTS: RESULTS FROM THE MONITORING DIALYSIS OUTCOMES (MONDO) INITIATIVE SP599 SP600 Rakesh Malhotra1, Aileen Grassmann2, Daniele Marcelli2, Roberto Pecoits-Filho3, Cristina Marelli4, Len Usvyat5, Bernard Canaud6, Peter Kotanko5 and MONDO Consortium 1 Rutgers-NJMS, Newark, NJ, 2FMC, Bad Homburg, Germany, 3Pontifícia Universidade Católica do Paraná, Curitiba, Brazil, 4FMC Latin America, Buenos Aires, Argentina, 5Renal Research Institute, New York, NY, 6Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany FRAIL ELDERLY PATIENT OUTCOMES ON DIALYSIS (FEPOD) PART 1: DESCRIPTIVE ANALYSIS OF SECONDARY OUTCOMES Edwina Brown1, Os Iiyasere1, Lina Johansson1, Joanna Smee1, Les Huson2 and FEPOD 1 Investigators 1 Hammersmith Hospital, London, United Kingdom, 2Imperial College London, London, United Kingdom © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Abstracts Nephrology Dialysis Transplantation Introduction and Aims: Assisted peritoneal dialysis (aPD) is now more available as an alternative to hospital haemodialysis (HD) for frail older patients but the lack of outcome data comparing HD with aPD has limited its use. FEPOD part 1 reported no significant difference in the primary outcomes of quality of life and physical functioning, except for higher prevalence of possible depression in the aPD group. This report describes the secondary outcomes for the study group. SECONDARY OUTCOMES: Hospitalisation, falls, symptom burden, cognition and patient satisfaction. Methods: aPD patients and HD patients were recruited from 11 centres. The HD patients were matched to recruited aPD participants by age, sex, diabetes status, time on dialysis, ethnicity and Index of Deprivation. The MiniMental State Examination (MMSE) and the Trail Making Form B were used to assess global cognitive function and executive function respectively. Falls and symptom burden were assessed using a falls questionnaire and the Palliative Outcome Symptom scale (renal) respectively. Patient satisfaction was measured using the Renal Treatment Satisfaction Questionnaire Results: 106 patients (52 HD; 54 aPD) were recruited. 35 % of the study group had at least one hospital admission in the preceding three months. 42% of all admissions were dialysis related. 28% of the study group had at least one fall in the preceding three months.83.3% of them occurred at home, with the HD group sustaining more fractures than the aPD group (26.7% HD vs. 6.7% aPD, p=0.329). Lethargy, pain and poor mobility were predominant in the study group. The median number of reported symptoms were 9 (IQR 7 - 11) in the HD group and 10 (IQR 7.75 to 13) in the aPD group. 42.3% of HD patients reported no improvement in symptoms since starting dialysis, as against 25.9% of the aPD group. 10.5% of the study group had abnormal MMSE scores (<24). There was no statistical difference in MMSE scores between HD patients and aPD patients [mean MMSE - 27 (HD), 28 (aPD), p=0.120]. In contrast, 36.8% had executive dysfunction (trail making B test time > 300 seconds). Executive dysfunction was more prevalent in the aPD group [54.2% aPD vs. 27.7% HD, (p = 0.089)]. Despite the above outcomes, 91.5% of the study group would recommend their therapy to others (mean total renal treatment satisfaction scores - 49.6 HD vs. 50.3 aPD, p=0.722). Conclusions: There is a high prevalence of falls, symptom burden, executive dysfunction and hospitalisation in frail elderly dialysis patients, irrespective of dialysis modality. This should be considered during discussions about renal replacement modalities (including non-dialytic care). FEPOD part 2, the longitudinal phase of the study, will provide information on the influence of dialysis modality on the trajectory of these outcomes. SP601 A COMPARISON OF STROKE INCIDENCE BETWEEN PATIENTS INITIATING HEMODIALYSIS AND PERITONEAL DIALYSIS IN KOREA Hyunwook Kim1, Shina Lee2, Jung-Hwa Ryu2, Seung-Jung Kim2, Duk-Hee Kang2, Kyu Bok Choi2 and Dong-Ryeol Ryu2 1 Wonkwang University College of Medicine Sanbon Hospital, Gunpo, Republic of Korea, 2School of Medicine, Ewha Womans University, Seoul, Republic of Korea Introduction and Aims: We aimed to compare the stroke incidence between incident hemodialysis (HD) patients and peritoneal dialysis (PD) patients using the Korean Health Insurance Review & Assessment Service database, which enabled us to perform a population-based complete survey. Methods: We initially identified all of the incident dialysis patients who had started HD or PD and whose age was 18 years or older between January 1, 2005 and December 31, 2008 in Korea. Among them, the patients who were dead or developed any kind of strokes within 90 days from the date of dialysis were excluded; the remaining eligible 30,828 patients were included in the final analyses. Patients who underwent kidney transplantation, who were dead during follow-up period, or who survived until December 31, 2009 were censored. Results: During the median follow-up period of 24.7 months, incidence rates of total stroke (P=0.0014), hemorrhagic stroke (P=0.0017), and ischemic stroke (P=0.0341) were significant higher in HD patients than those in PD patients by log-rank test. In addition, after adjustments with baseline characteristics in multivariate Cox analysis, hazard ratio of hemorrhagic stroke in HD patients was significantly higher than that in PD patients (HR, 1.217; 95% CI, 1.032-1.434; P=0.0194), while there were no significant differences in hazard ratios of total stroke and ischemic stroke between HD and PD patients. Conclusions: The risk of hemorrhagic stroke in Korean HD patients was increased compared to PD patients. The possible causes should be evaluated and a countermeasure will be needed. SP602 and hospitalization in the first year on HD in a large international sample of incident HD patients. Methods: The MONitoring Dialysis Outcomes [MONDO] initiative is an international consortium of hemodialysis (HD) databases [Usvyat, Blood Purif 2013; von Gersdorff, Blood Purif 2014]. Databases from Renal Research Institute in the US and Fresenius Medical Care Europe [17 countries] were queried to identify all incident patients with in-center treatments [01/2006-12/2012] who survived at least 30 days on HD. Clinical and laboratory parameters were computed over the first 30 days (baseline), death and hospitalizations were observed in days 31 to 365 (follow up period). Poisson regression models were constructed to explore associations between baseline parameters and hospitalizations in the follow up period. Results: We studied 31,870 patients [RRI 8,330; FMC Europe 23,540]: 59% male, 88% white, mean age 64.0 years and 57% started HD using a non-definitive vascular access. Factors related directly to hospitalization during first year were (estimate, 95CI) white race (0.049, 0.001/0.098 compared to all others), catheter as vascular access (0.388, 0.344/0.432), diabetes (0.1, 0.057/0.143), preexisting cancer (0.171, 0.077/0.266), hospitalization in first 30 days (0.443, 0.406/0.480), preSBP < 100 mmHg (0.503, 0.340/ 0.666), neutrophil to lymphocyte ratio [NLR] (0.007, 0.004/0.010) and Hemoglogin [g/ dL] (0.016, 0.001/0.032). Factors related inversely to hospitalization during first year were gender (male -0.148, -0.192/-0.105), Body Mass Index [BMI, kg/m2] (-0.006, -0.009/-0.002), preSBP > 140 mmHg (-0.112, -0.153/-0.070), albumin [g/dL] (-0.342, -0.381/-0.304), serum Na [mmol/L] (-0.011, -0.016/-0.006) and Urea Reduction Rate [URR%] (-0.002, -0.005/-0.0001). Conclusions: Several modifiable factors in the first 30 days of dialysis predicted subsequent hospitalizations in the first year of dialysis: catheter use, preSBP, Hemoglobin, NLR, BMI, albumin, serum Na and URR. Efforts towards improved pre-dialysis care and planned dialysis start should be made to achieve better outcomes in this population. SP603 FUNCTIONAL STATUS IS A STRONGER PREDICTOR OF QUALITY OF LIFE THAN AGE AMONG HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (DOPPS) Rachel Brock1, Mia Wang2, Angelo Karaboyas2, Rachel A Fissell3, Takeshi Hasegawa4, S V Jassal5, Donna Mapes2, Hal Morgenstern1, Hugh Rayner6, Bruce M Robinson2 and Francesca Tentori2 1 University of Michigan, Ann Arbor, MI, 2Arbor Research Collaborative for Health, Ann Arbor, MI, 3Vanderbilt University School of Medicine, Nashville, TN, 4Showa University Fujigaoka Hospital, Yokohama, Japan, 5University Health Network, Toronto, ON, Canada, 6Birmingham Heartlands Hospital, Birmingham, United Kingdom Introduction and Aims: Both quality of life (QoL) and functional status (FS) are lower in hemodialysis patients than in the general population, and both are associated with increased mortality. Loss of FS has been shown to adversely affect QoL in multiple disease states. Older age is associated with poorer FS. We evaluated the hypothesis that poor FS is associated with low QoL and investigated whether this association was independent of age. Methods: 8,688 patients from DOPPS phase 4 (2009-2011) were included in this study. FS was measured near the start of follow-up, using combined measurements of 5 activities of daily living (ADL) and 8 instrumental ADL. Higher FS score reflected higher levels of functional independence (maximum = 13). QoL was measured at the same time based on the physical component summary (PCS) and mental component summary (MCS) scores of the KDQOL-36 questionnaire. The associations between FS and QoL, by age category, were assessed cross-sectionally, using linear mixed models to HOSPITALIZATIONS DURING THE FIRST YEAR ON HEMODIALYSIS ARE ASSOCIATED WITH EARLY PREDICTORS Adrian Guinsburg1, Cristina Marelli1, Aileen Grassmann2, Daniele Marcelli2, Len Usvyat3,4, Bernard Canaud2 and Peter Kotanko3 1 Fresenius Medical Care, Buenos Aires, Argentina, 2Fresenius Medical Care, Bad Homburg, Germany, 3Renal Research Institute, New York, NY, 4Fresenius Medical Care, Waltham, MA Introduction and Aims: Mortality and morbidity during first 90 days on HD are indicators of pre-dialysis care and patient status at HD initiation. Here we explore the association between early predictors, i.e. factors captured in the first 30 days on HD, Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 SP603 Figure 1: Mean physical component summary (PCS) and mental component summary (MCS), by functional status (FS) score and age category. doi:10.1093/ndt/gfu158 | iii Abstracts Nephrology Dialysis Transplantation adjust for comorbid conditions, laboratory values, and other patient characteristics, and to account for facility clustering. Results: Overall, 35% of patients were completely functionally independent (FS=13). This proportion was 49% for age <55, 36% for age 55-75, and 18% for age ≥75. Patients with better FS reported higher PCS and MCS overall and in each age group (Figure). QoL was much more strongly correlated with FS than age; e.g., older patients with high FS had much higher QoL scores than younger patients with low FS. In adjusted models, patients with FS=13 had mean PCS score 14.9 (95CI%: 14.2-15.6) higher and mean MCS score 10.8 (95CI%: 9.9-11.7) higher than patients with FS < 8; positive associations of FS with PCS and MCS were also observed within each age group. Conclusions: In the international DOPPS cohort, quality of life was strongly associated with functional independence, irrespective of age and comorbidity. Interventions aimed at maintaining or improving functional independence may have a positive impact on quality of life, especially among older dialysis patients who are more likely to develop functional impairment. SP604 ASSOCIATION BETWEEN ADIPONECTIN AND MORTALITY IN HEMODIALYSIS PATIENTS FROM THE MADRAD STUDY Connie Rhee1, Hamid Moradi1, Steven Brunelli2, Jennie Jing1, Tracy Nakata1, Danh Nguyen1, Csaba Kovesdy3, Gregory Brent4 and Kamyar Kalantar-Zadeh1 1 University of California Irvine, Orange, CA, 2Brigham and Women's Hospital, Boston, MA, 3Memphis VA Medical Center, Memphis, TN, 4VA Greater Los Angeles Healthcare System, Los Angeles, CA Introduction and Aims: In the general population, circulating adiponectin has anti-atherogenic, anti-inflammatory, and insulin-sensitizing properties and is associated with decreased cardiovascular morbidity and mortality. Hemodialysis patients have disproportionately higher adiponectin levels, and prior studies examining the relationship between adiponectin concentration and mortality have been inconsistent. Methods: We conducted a prospective study examining the association between baseline serum adiponectin level and all-cause mortality in 501 hemodialysis patients from 13 DaVita dialysis centers from the Malnutrition, Diet, and Racial Disparities in SP604 Figure 2: Adiponectin as a Continuous Predictor of Mortality Using a Spline Model Adjusted for Case-Mix+Laboratory Covariates. Kidney Disease cohort (entry period October 2011 to February 2013 with follow-up through August 2013). Associations between adiponectin categorized into tertiles were examined using unadjusted, case-mix, and case-mix + laboratory adjusted Cox proportional hazards models. Results: Among 501 patients who underwent adiponectin measurement (mean ± SD 26.9 ± 17.6 mcg/ml; range 5.3-100.0 mcg/ml), the mean ± SD age of the cohort was 55.2 ± 14.9 years, of whom 44% were female, 40% were African-American, and 47% had diabetes. Compared with the lowest adiponectin tertile, the highest adiponectin tertile was associated with increased all-cause mortality risk in adjusted, case-mix, and case-mix + laboratory adjusted models (Table 1). The second adiponectin tertile was associated with numerically greater risk, but estimates were not statistically significant. In sensitivity analyses that examined adiponectin as a continuous variable, we observed that incrementally higher adiponectin level was associated with increased death risk (Table 2; Figure 2). Conclusions: Higher circulating adiponectin levels in hemodialysis patients are paradoxically associated with higher all-cause mortality. Future studies are needed to confirm findings and to elucidate mechanistic pathways. SP605 SP604 SP604 FIRST DIALYSIS MODALITY AND THE RISK FOR DIALYSIS TECHNIQUE AND NON-DIALYSIS TECHNIQUE RELATED INFECTIONS Anouk T Van Diepen1, Tiny Hoekstra2, Joris I Rotmans2, Mark G De Boer2, Saskia Lecessie2,2, Marit M Suttorp2, Dirk G Struijk1,3, Els W Boeschoten4, Raymond T Krediet1 and Friedo W Dekker2 1 Academic Medical Centre, Amsterdam, Netherlands, 2Leiden University Medical Centre, Leiden, Netherlands, 3Dianet, Amsterdam-Utrecht, Netherlands, 4Hans Mak Instituut, Naarden, Netherlands Introduction and Aims: Infectious complications among dialysis patients are a major cause of morbidity and non-cardiovascular mortality. Dialysis modality has been hypothesized to be a potential immunomodulatory factor. The objective of this study was to investigate the association between dialysis modality and the risk for overall and specific infectious complications and to distinguish the risk for dialysis technique and non-dialysis technique related infections. Methods: Our study was conducted in The Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) cohort that consists of 2052 incident dialysis patients. From this cohort, data on infectious complications of patients from 2 university teaching hospitals and 3 regional hospitals were retrospectively collected using strictly pre-specified criteria. Information about the incidence and nature of infections was collected from dialysis start until death, modality switch, withdrawal from the study, transfer to another dialysis center, kidney transplantation, or at the end of study follow up. Age-standardized incidence rates for infections were calculated. Poisson regression was used to calculate incidence rate ratios that were adjusted for age, sex, diabetes, BMI, Kahn co-morbidity score, primary kidney disease, ethnicity, malignancy, chronic pulmonary disease and educational level. Results: In total, 452 patients with complete medical records were included, of whom 285 started with haemodialysis (HD) and 167 with peritoneal dialysis (PD). The median follow-up time on the first dialysis modality was similar on HD and PD: 1.8 and 2.0 years. During the first 6 months, the age-standardized infection incidence rate was significantly higher on HD: 1.72 infections/dialysis year (95% CI: 1.62-1.81) compared to 1.40 infections/dialysis year (95% CI 1.21-1.58) in PD patients. Overall, PD patients had a higher infection risk (Adjusted IRR: 1.65, 95%CI: 1.39-1.96), which could be attributed to a fourfold increased risk for dialysis technique related infections. However, the risk for non-dialysis technique related infection was lower in PD patients (Adjusted IRR: 0.56, 95%CI: 0.42-0.75). Conclusions: PD patients carry a higher risk for overall infectious complications, while non-dialysis technique related infections are more frequent in HD patients. An interaction between dialysis modality and the immune system is expected to explain this difference, but future studies are needed to test this assumption. SP604 Figure 1: Kaplan Meir Survival Curves for Adiponectin Level. iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation SP606 ECULIZUMAB IMPROVES SURVIVAL IN ATYPICAL HEMOLYTIC UREMIC SYNDROME (aHUS) PATIENTS Scott Johnson1, Gus Khursigara2, Joseph Yen2, Jimmy Wang2, Nancy Silliman2 and Camille Bedrosian2 1 Medicus Economics LLC, Boston, MA, 2Alexion Pharmaceuticals, Inc., Cheshire, CT Introduction and Aims: Patients ( pts) with aHUS are at constant risk of sudden death and progressive organ damage due to chronic, systemic complement-mediated TMA. Pre-eculizumab (ECU), up to 40% of aHUS pts died or progressed to ESRD within 1 year following a clinical manifestation. The overall 5-year survival rate for all pts on chronic dialysis is 39% (1). aHUS and TMA registries report mortality rates of identified pts not receiving, but eligible for, ECU treatment, which are 8% (at 1-year follow-up) (2), 13% (mean follow-up 17.8 months) (3), and 32% (median follow-up 4.4 years) (4), despite receiving supportive care including PE/PI. ECU is the only approved treatment for aHUS. Efficacy and safety were initially evaluated in 2 prospective trials (Trial 1, Trial 2; N=37) with long-term extensions in pts aged ≥12 years with aHUS (5). We aimed to determine if ECU improved survival in pts enrolled in the extended ECU pivotal clinical trials. Methods: A Markov model was developed to track progression through 3 CKD stages (CKD 0-2, CKD 3a-4, or CKD 5 [ESRD]), plus transplant and death. We used observed data from the ECU treatment period in the prospective trials to estimate ECU treatment outcomes in the model. We used data from the pre-ECU treatment period in the prospective clinical trials to parameterize the likelihood of CKD progression and transplant for pts receiving supportive care. We assumed all aHUS pts with ESRD have a mortality rate consistent with pts in the UK Renal Registry (89.8% 1-year age-adjusted survival). The model assumes 3 causes of mortality: age, ESRD/dialysis, and TMA-related causes other than renal disease. Results: The pre-treatment data had an average/max/min of 352/702/1 days of observation for N=37 pts prior to the trial baseline. eGFR declined by 5.5 ml/min/ 1.73m² per every 6 months for pts on supportive care. Treatment with ECU resulted in mean increase of eGFR at 6 months (32 and 6 ml/min/1.73m² for pts with progressing TMA and long duration of disease, respectively) (4). The model estimated an 8.6% and 25.6% mortality rate at 1 and 3 years, respectively, for pts receiving supportive care. There was 1 reported death during ECU treatment with median follow-up time of 37 months, resulting in a 1.4% annual mortality rate with ECU. ECU reduced the risk of mortality by 83% and 89% at 2 and 3 years, respectively, compared with the same pts, assuming they continued to receive only supportive care (relative risk of 17% [95% CI: 2%, 132%; P=0.1070] at 2 years and 11% [95% CI: 1%, 83%; P=0.0138] at 3 years). Conclusions: ECU substantially improves survival in aHUS pts compared with predicted outcomes for trial pts who would have continued to receive only supportive care. By completely blocking ongoing and uncontrolled complement activity, ECU treatment reduces the mortality rate in aHUS pts by 89% at 3 years. REFERENCES:1. ERA-EDTA Registry Annual Report 2009.2. Noris et al, Clin J Am Soc Nephrol, 2010.3. Coppo et al, PLoS ONE 2010.4. Hoving et al, Blood, 2010.5. Legendre et al, NEJM, 2013. SP607 HIGH-DOSE HAEMODIALYSIS AND HOME DIALYSIS INCREASE LIFE-YEAR AND QUALITY-ADJUSTED LIFE-YEAR GAINS IN THE UNITED KINGDOM population. This analysis also shows that treating increasing the in-center HD patient population results in health losses. SP608 HAEMODIALYSIS IN PATIENTS AGED OVER 80 YEARS Til Leimbach1, Joachim Kron1, Jutta Czerny1, Birgit Urbach1, Sabine Aign1 and Susanne Kron2 1 KfH-Nierenzentrum Berlin-Köpenick, Berlin, Germany, 2Charite Universitätsmedizin Berlin, Berlin, Germany Introduction and Aims: In Germany every fifth incident dialysis patient currently is 80 years of age or older. The question arising is no longer, if to treat these patients but how. Methods: Single centre data of all dialysis patients aged over 80 years were analyzed with regard to survival, social circumstances, vascular access and predialysis nephrology care. Results: Between 2001 and 2012 76 patients over 80 years of age started chronic ambulatory haemodialysis treatment. One-year survival was 87 %, 3-year survival 52 %, 5-year survival 27 % and 10-year survival 9 %, respectively. Patients (n = 55) with more than 3 month of nephrological care prior to dialysis (3 to 161 month, median 31 month) survived significantly longer then patients (n=21) having had less than 3 month contact to nephrologists. On 31th December 2012 there were 38 patients (18 female and 20 male) aged ≥ 80 years (median age 84 years, 80 - 95 years) in the chronic haemodialysis program, thus accounting for 19% of all dialysis patients of this centre. The median duration on dialysis was 50 months (1 - 155 months). All patients had two or more comorbidities.33 patients (87%) lived at home (9 patients single, 24 with spouse), 2 patients lived with relatives and 3 patients were nursing home residents. Concerning vascular access 31 patients (82%) had a native av-fistula, 3 (8%) a graft and 4 patients (10%) a catheter. The respective vascular access had been used for 43 month (1 - 155 month). 10 access complications occurred in 8 patients, in 4 cases a new vascular access had to be established (3 grafts, 1 catheter). Consequentially, one access was lost in 39 patient years on dialysis. Compared to all in-centre patients (one loss in 37 patient years) the elderly suffered less access failures overall. Prior to starting dialysis 30 patients (79%) had been in long-term nephrological care (3 - 161 month, median 45 month) and 3 patients were referred late (< 3 month prior first dialysis). In 5 patients dialysis was started following emergency referral to hospital. 31 patients (82%) started the first dialysis treatment with a functioning shunt access, 4 (10%) with a permanent catheter and 3 (8%) with a temporary catheter. Conclusions: The life expectancy and social status of patients starting dialysis aged 80 years or older were nearly comparable to the general population of the same age. Long-term predialysis nephrology care is of most importance for successful dialysis treatment in the elderly especially in Octogenarians and Nonagenarians. Early establishment of a functioning vascular access and careful scheduling of first dialysis treatment reduce complications and increase both survival and quality of live. The use of catheters can be avoided in almost all patients over 80 years. SP609 FRAIL ELDERLY PATIENT OUTCOMES ON DIALYSIS (FEPOD): PART 1 - A CROSS-SECTIONAL COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND HAEMODIALYSIS Murat Arici1, Usman Farooqui1, Catrin Treharne2, Frank Xiaoqing Liu3 and Suzanne Laplante3 1 Baxter Healthcare Corporation, Compton, United Kingdom, 2Abacus International, Oxfordshire, United Kingdom, 3Baxter Healthcare Corporation, Deerfield, IL Edwina A Brown1, Os Iyasere1, Lina Johansson1, Joanna Smee1, Les Huson2 and FEPOD 1 Investigators 1 Hammersmith Hospital, London, United Kingdom, 2Imperial College London, London, United Kingdom Introduction and Aims: Increasing evidence are showing that high dose haemodialysis (more frequent and/or longer duration hemodialysis (HD)) can improve clinical and humanistic outcomes. We compared the expected health gains (measured as life-years LYs - and quality-adjusted life-years - QALYs - gained) if high dose HD and other home dialysis modalities were used in a greater proportion of the dialysis patients than currently observed. Methods: A Markov model was built for the UK environment. Various combinations of high dose HD (in-center or at home) and peritoneal dialysis (PD) were compared to the current usage (i.e., 83% conventional in-center HD; 14% PD; 3% conventional home HD; 0% high dose home HD). Inputs included: incidence, prevalence, transplant rates (UK renal registry); complications, utilities and transition between modalities (medical literature); survival (PD & conventional HD: ERA-EDTA registry; high dose HD: medical literature). The model was run for 5 years with the prevalent dialysis population and an incident cohort entering the model each year in years 2-5. Results: Over the 5-year period, the scenario where all patients received in-center conventional HD generated a loss of 678 LYs (-0.6%) and 838 QALYs (-1.2%) for the cohort. Treating all patients with high dose HD in-center or at home, although likely unrealistic, increased the cohort’s LYs by 4.5-4.8% and QALYs by 10.7-26.7%. All other (less extreme) scenarios led to increasing LY and QALY gains with increasing usage of home modalities. A more realistic scenario where 10% of patients received high dose HD at home and PD usage was back to years 2005-2008 levels, i.e., 25%, generated 963 LY (+0.8%) and 1827 QALY (+2.6%) gains. Conclusions: This analysis shows that high dose HD, especially when performed at home has the potential to significantly increase the health gains of the dialysis Introduction and Aims: Haemodialysis (HD) is the most common dialysis modality for frail older patients although many tolerate this poorly and have transport problems. Assisted peritoneal dialysis (aPD) is increasingly available to enable home treatment. There is no data about patient outcomes on aPD compared to HD. This study has been designed in 2 parts. Part 1 is a cross-sectional study obtaining a snapshot view of patient well-being on aPD compared to HD. Part 2 is a prospective longitudinal study determining patient outcomes over 2 years. This report focuses on the results of Part 1. PRIMARY OUTCOME: Comparison of quality of life and physical function of prevalent frail older patients on aPD and HD Methods: aPD patients (defined as requiring assistance to perform PD by paid or unpaid carer) and HD patients (requiring hospital transport) were recruited from 11 centres. All were ≥60 years, on dialysis for ≥3 months and free from hospitalisation for 30 days. The HD eligible patients were matched to recruited aPD participants by age (±3 years), sex, diabetes status, time on dialysis (± 2 years), ethnicity and Index of Deprivation. Quality of life assessments were made using Hospital Anxiety and Depression Scale (HADS), SF-12, Palliative Outcome Symptom Scale and Illness Intrusiveness Rating Scale. Physical function was assessed by Barthel score (measure of aids to daily living) and Timed Up and Go. Results: 54 aPD and 52 matched HD patients were studied. Mean age was 74.1 ± 7.5 and 72.7 ± 7.8 years respectively; presence of frailty was similar between both modalities (57.4% on aPD and in 42.3% on HD). Multivariate analyses with p-values derived from a generalised linear model showed that frailty score was the most influential variable in relation to outcomes: SF 12 physical p=0.002; SF 12 mental p=0.03; Barthel p<0.0001; Timed Up and Go p<0.0001. Dialysis modality was the most Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 doi:10.1093/ndt/gfu158 | iii Abstracts Nephrology Dialysis Transplantation influential variable in determining the total HADS score (mean aPD 12.6, HD 9.5, p=0.0472) and symptom score (median aPD 17, HD 13.5, p=0.023). Using a propensity score derived from age, gender, frailty and comorbidity scores to compare pairs of participants on aPD and HD, showed that the significantly higher HADS score on aPD (P=0.03) remained but not the symptom score (P=0.37). Probable depression (HADS >8) was also more common in the aPD group ( p=0.0442). Conclusions: Degree of frailty is the major determinant of quality of life and physical function. Dialysis modality has a minor role with probably slightly more depression in the aPD group but this needs confirming in the larger longitudinal study. Both aPD and HD should therefore be discussed as potential modalities leaving choice to individual patients. SP610 DOES DIALYZER MEMBRANE MATERIAL AND PERFORMANCE HAVE ANY IMPACT ON THE SURVIVAL OF ELDER DIALYSIS PATIENTS? Ikuto Masakane1 and E-HOPED Study Group1 1 Yabuki Hospital, Yamagata, Japan Introduction and Aims: Several recent reports warned that high efficient hemodialysis with polysulfone (PS) membrane occasionally led to the deterioration of nutritional status in elder patients. Ethylene vinyl alcohol (EVAL) membrane has high biocompatibility and a broad solute removal property but efficacy of uremic solute is less than that of PS. In the prior studies, EVAL membrane improved the deteriolated nutritional status caused by PS membrane. The E-HOPOED-Study Group was established in 2010 to determine the best dialyzer choice for elder dialysis patients with early dialysis stage. Methods: The E-HOPED-Study is a open-label, dynamically allocated, central registrated, randomized control trial being performed in 325 dialysis facilities in Japan. The patients who accept the enrollment to the study will be randomly divided into the next two groups; Group A, treated by EVAL membrane; Group B, treated by several high flux membrane such as PS. The entry criteria of the patients are the age more than 70 years old, the dialysis vintage less than 180 days. The patient registration has just finished on Dec. 31st 2013. Finally 795 patients; 398 patients in Group A and 397 in Group B, were enrolled into the study. The 5 year-survival, changes in the nutritional status, occurrence of complications and others are the end points. Dimographic data of all 795 patients and an interim analysis for 536 patients whose clinical data could be followed longer than 12 months were included into this study. Results: The mean age of the all patients was 78.4 years old (294patients for 80 years of age or older, 501 patients for less than 80 years of age), 514 (65 %) were male, 380 (48 %) were diabetes, and 361 patients for serum albumin level 3.5 g/dL or more. Up to now, 28 patients have died (12 patients in Group A and 16 patients in Group B. 1-year-survival rate of the patients was 93.7% in Group A and 93.0% in Group B and there were no statistical significant differences between Group A and B. Conclusions: Based on this interim analysis the dialyzer material and performance didn’t have any impact on the survival of new elder dialysis patients. Further data collection and analyses were needed to figure out the best dialyzer choice for the elder patients. SP611 CONSIDER - CONSIDERATIONS OF NEPHROLOGISTS WHEN SUGGESTING DIALYSIS IN ELDERLY PATIENTS WITH RENAL FAILURE: A DISCRETE CHOICE EXPERIMENT Celine Foote1,2, Rachael L Morton3,4, Meg Jardine5,2, Martin Gallagher5,2, Mark Brown6, Kirsten Howard3 and Alan Cass7,5 1 The George Institute for Global Health, Sydney, Australia, 2Concord Repatriation General Hospital, Sydney, Australia, 3School of Public Health, University of Sydney, Sydney, Australia, 4Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom, 5The George Institute for Global Health, University of Sydney, Sydney, Australia, 6St George Hospital, Sydney, Australia, 7Menzies School of Health Research, Darwin, Australia Introduction and Aims: People aged ≥75 are the fastest growing dialysis age group. Nephrologists often face difficult treatment recommendations for elderly end stage kidney disease (ESKD) patients with respect to dialysis versus supportive (non-dialysis) care, given uncertainty around survival benefit and considerable treatment burden. We aimed to define nephrologists’ preferences for dialysis recommendation in elderly patients and to assess trade-offs between patient characteristics. Methods: We conducted a discrete choice experiment (DCE) of Australasian nephrologists. The DCE design was informed by a ranking exercise of characteristics derived from the literature and a pilot DCE of 30 nephrologists. We assessed the influence of patient characteristics (age, gender, cognition, comorbid burden, life expectancy, current quality of life (QOL), expected QOL change with dialysis, social support, patient and family inclination for dialysis) on nephrologists’ preferences for dialysis recommendation. The online DCE consisted of 12 scenarios, each with two elderly patients described in terms of the 10 characteristics. Nephrologists were asked which of the hypothetical patients, they would prefer to recommend dialysis to or whether they would recommend dialysis to neither patient. Respondent sociodemographic characteristics were also collected. Analysis used a random parameters logit model with results as the odds of recommending dialysis over no SP611 dialysis. Marginal rates of substitution (trade-offs) between QOL and survival were calculated. Results: 159 of 415 (38%) nephrologists participated in the DCE. Roughly one third (34%) were aged between 40-49years, 62% were male and 69% were Caucasian. Nephrologists chose “neither patient” for 57% of the scenarios. All patient characteristics other than gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis to patients with preserved cognition, lower comorbid burden, increased life expectancy and high current QOL. Patient and family inclination for dialysis also favoured dialysis recommendation. Nephrologists were less likely to recommend dialysis with each extra year of age and when dialysis was expected to decrease QOL. Nephrologists aged >65 were almost 12 times more likely to recommend dialysis compared with younger counterparts. Nephrologists were willing to forgo 12 months of patient dialysis survival in order to avoid a substantial decrease in patient QOL with dialysis initiation. Conclusions: Many patient characteristics were considered by nephrologists when recommending dialysis. Nephrologists were much more likely to recommend dialysis to those with normal cognition and those inclined for dialysis, and avoided recommending dialysis when initiation was expected to considerably reduce QOL. These findings highlight the need to systematically and longitudinally evaluate cognition and QOL when contemplating dialysis decisions in elderly patients. SP612 INFLUENCE OF INTERDIALYTIC WEIGHT GAIN AND ULTRAFILTRATION RATE ON BLOOD PRESSURE IN MAINENTANCE HEMODIALYSIS PATIENTS IN DIALYSIS CENTRES IN DALMATIA COUNTY IN SOUTHERN CROATIA J. Radic1, M. Sain1, D. Klaric2, M. Gulin3, M. Ilic4, Vedran Kovacic5, V. Vukman6, M. Sain4, V. Rozankovic7, N. Silic8, M. Primorac9 and J. Meter10 1 1Department of Nephrology and Dialysis, University Hospital Center Split, Split, Croatia, Split, Croatia, 22Department of Nephrology and Dialysis, General Hospital Zadar,Zadar,Croatia, Zadar, Croatia, 3Department of Nephrology and Dialysis, General Hospital Sibenik, Sibenik, Croatia, Sibenik, Croatia, 44Department of Nephrology and Dialysis, General Hospital Dubrovnik, Dubrovnik, Croatia, Dubrovnik, Croatia, 5University Hospital Center Split, Split, Croatia, 6Hemodialysis Department, Health Center Trogir, Trogir, Croatia, 7Department of Nephrology and Dialysis, General Hospital Sibenik, Sibenik, Sibenik, Croatia, 8Hemodialysis Department, Health Center Sinj, Sinj, Croatia, 9Department of Nephrology and Dialysis, Metkovic, Metkovic, Croatia, 10Hemodialysis Department, Health Center Imotski, Imotski, Croatia Introduction and Aims: Hypertension is very poorly controlled in patients on haemodialysis (HD) and hypertension is predictor of cardiovascular mortality in HD patients. Patients with thrice-weekly HD have higher predialysis weights (PWG) and ultrafiltration rates (UF) on the first compared with subsequent HD of the week. We hypothesized that these variations in PWG and UF are associated with a systematic difference in blood pressure. The aim of this study was to examine mean arterial pressure (MAP) and pulse pressure (PP) in HD patients and to assess the relationships between these parameters and PWG and UF. Methods: In this study 402 patients (aged 68.3±13.8 years) on maintained HD (4.73 ±5.17 years) were included (232 males, 170 females) in Dalmatian centres in Dalmatia county in Southern Croatia. Blood pressure measurement was undertaken at the first HD session on the beginning of the observed week. For every single observed HD mean arterial pressure (MAP) calculated as ((systolic + 2 diastolic blood pressure)/3) (mmHg) and pulse pressure (PP) computed as (systolic - diastolic blood pressure) (mmHg) predialysis and postdialysis were measured. Therefore, PWG and UF rate were calculated as average value during 4 weeks (12 HD treatments) prior tis study. iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation Results: These results showed influence of PWG and UF on blood pressure in HD patients. There were statistically significant correlation between average PWG and post HD MAP value (r = -0.131, p=0.004) indicating that higher PWG lead to hemodynamic instability and lower blood pressure in HD patients after HD treatment. Also, higher UF rate was significantly correlated with lower MAP and PP before and after HD treatment as shown in Table 1. Conclusions: Restriction in PWG and controling UF rate during HD session is important becouse these two parameters might influence blood pressure parameters in HD patients. It is well known that poor blood pressure control in HD patients leads to increased cardiovascular morbidity and mortality, so further reserch should evaluete improvement of blood pressure parameters and hemodianamic stability in these patients by PWG restriction and lower UF rate. SP612 Table 1. Correalation between blood pressure and average interdialytic weight gain and average ultra MAP pre HD (mmHg) PP pre HD (mmHg) MAP post HD (mmHg) PP post HD (mmHg) SP613 Average interdialytic weight gain (kg) Correlation Coefficient 0.052 0.075 -0.131 -0.077 P 0.150 0.067 0.004* 0.061 Average ultrafiltration rate per haemodialysis (L) Correlation Coefficient -0.005 -0.019 -0.131 -0.157 P 0.461 0.351 0.004* 0.001* OUTCOMES OF HOME HEMODIALYSIS IN ELDERLY ESRD PATIENTS: AN INTERNATIONAL FEASIBILITY ANALYSIS Tom Cornelis1, Karthik Tennankore2, Eric Goffin3, Virpi Rauta4, Eero Honkanen4, Akin Ozyilmaz5, Sandip Mitra6, Frank Van Der Sande1, Jeroen Kooman1 and Christopher Chan2 1 Maastricht University Medical Centre, Maastricht, The Netherlands, 2Toronto General Hospital, Toronto, ON, Canada, 3Cliniques Universitaires Saint-Luc, Brussels, Belgium, 4Helsinki University Hospital, Helsinki, Finland, 5University Medical Centre Groningen and Dialysis Centre Groningen, Groningen, The Netherlands, 6Manchester Royal Infirmary & University of Manchester, Manchester, United Kingdom Introduction and Aims: Home hemodialysis (HHD) is undergoing a significant revival. We postulated that intensive HHD may benefit the elderly dialysis population, which may help to preserve functionality and quality of life in this group of vulnerable patients. However, there is a lack of literature on the feasibility of HHD in elderly end-stage renal disease (ESRD) patients. Methods: Multi-centre multinational retrospective cohort study of HHD patients that were ≥65 years of age at the time of HHD initiation. Baseline demographic data of interest included age at start of dialysis, race and sex. Dialysis characteristics including total weekly treatment hours, need for assistance, training time, dialysis access, modality and dialysis vintage were captured, as well as cause of ESRD and medical co-morbidities. The primary outcome of this study was time to technique failure or death. Rates of hospitalization, cardiovascular events, non-infectious vascular access events and infections were also collected. Results: Seventy-nine patients were included. The median age at start was 68 (66-71) years. An arteriovenous fistula was the predominant access, and most patients were receiving < 16 hours of total weekly dialysis treatment. Family or nurse assistance for dialysis was required in 54% of patients. There were 17 deaths (22%) and 20 technique failures (26%). The cumulative time at risk was 188 years. Event-free survival at 1, 2 and 5 years was 85%, 77% and 24%, respectively, and technique survival was 92%, 83% and 56%, respectively. Advancing age (categorized into quartiles) was an unadjusted risk factor for death and technique failure. Conclusions: This analysis confirms the feasibility of HHD in patients older than 65 years. The potential benefits of (intensive) HHD in elderly ESRD patients require further investigation. SP614 RENAL PATIENT VIEW USERS ARE MORE LIKELY TO BEGIN RRT ON A HOME-BASED MODALITY: AN EFFECTIVE SOURCE OF PRE-DIALYSIS EDUCATION? Anirudh Rao1, David Pitcher1 and Richard Phelps2 1 UK Renal Registry, Bristol, United Kingdom, 2The Queen's Medical Research Institute, Edinburgh, United Kingdom Introduction and Aims: Renal Patient View (RPV) is an established Electronic Personal Health Records (EPR) designed to educate patients as well as enable them to participate in the monitoring and management of their renal disease in UK. It may therefore have a role in equipping patients to make an informed choice of dialysis modality when beginning RRT, one of the key standards proposed in The National Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Service Framework (NSF) for Renal Services. Most patients offered an informed choice choose a home-based modality, and pre-dialysis education has been reported to strengthen this trend. On this background we hypothesised that patients that utilised RPV are better informed about choice of modality and more likely to choose home-based modalities for first RRT provision. The aim was to investigate first dialysis modality in RPV users and non-users. Methods: The RPV user database extant on January 25th 2012 was linked by patient CHI / NHS number with the UK renal registry and anonymised data extracted for analysis. The extract was restricted to adult patients and included patient demography, deprivation indices, ethnicity, UKRR timeline data and referral time (time between first referral to nephrologist and date of starting RRT), date of beginning RRT, date of first logon to RPV, and measures of patient utilisation of RPV derived from log file analysis as reported elsewhere. Patients with a referral time of <90 days were excluded. RPV users were grouped by the interval between their first logon to RPV and their date of starting RRT, and comparison made between patients that had been users of RPV for at least 90 days before beginning RRT (longer term users) and users that began their use of RPV after starting RRT (late users). Logistic regression and Chi-squared tests were performed using SAS v 9.3. Results: Longer term RPV users were more likely than late users to begin RRT on a home based modalities (Home Haemodialysis or Peritoneal dialysis) than hospital haemodialysis (571/1345 and 543/1453 respectively, p = 0.006). The association was stronger for longer term users that logged into RPV more persistently suggesting the effect was related to the patients themselves rather than any selection by the centre of patients offered RPV (481/1068, p = 0.0001). By 90 days after starting RRT the difference in prevalence of home-based modality provision to longer term and late RPV users had waned but was still significant ( p = 0.037, 0.032 for persistent RPV users). The results were not just a proxy for a longer referral period (so more time to initiate RPV) as a similar pattern was found when patients with referral time <6 months of < 1 year were excluded. Controlling for age, sex, deprivation and ethnicity, longer term persistent RPV users were 31% (10-57%, 95% CI) more likely to begin RRT on a home- based modality than late users, and almost three times more likely than the overall RRT population. Longer term RPV users were more likely to begin RRT with a live transplant compared to late users (217/342 and 150/274 respectively, p = 0.029), even when controlling for age, sex and deprivation, and similarly, this association had weakened by 90 days after starting RRT ( p = 0.22). Conclusions: The results demonstrate an association between using RPV and beginning RRT on a home-based modality or with a live donor transplant. The greater strength of the association for users that make greater use of RPV is consistent with our hypothesis that RPV is contributing to patient’s discovery around RRT modality choice. SP615 A BUDGET IMPACT ANALYSIS OF INCREASING HOME-BASED DIALYSES IN THE UNITED KINGDOM Catrin Treharne1, Murat Arici2, Suzanne Laplante3, Usman Farooqui2, Bruce Culleton3 and Frank Xiaoqing Liu3 1 Abacus International, Oxfordshire, United Kingdom, 2Baxter Healthcare Ltd., Compton, United Kingdom, 3Baxter Healthcare Corporation, Deerfield, IL Introduction and Aims: Approximately 53,000 patients received renal replacement therapy (RRT) for end-stage renal disease (ESRD) in the UK in 2011, resulting in a substantial economic burden. Evidence suggests that high dose haemodialysis (more frequent and/or longer duration hemodialysis (HD)) may be associated with better health outcomes and can be cost savings in the UK (if conducted at home with the current tariff ) versus conventional in-centre HD (ICHD). However, the current weekly tariff for home dialysis in the UK is not reflecting the increased production costs associated with an increased number of dialysis sessions per week. We investigated the financial impact of increasing the proportion of ESRD patients on home-based dialysis modalities, especially high dose HD at home with increased tariff, from the UK payer perspective. Methods: A Markov model was constructed reflecting the natural history of dialysis patients; based on this, a budget impact analysis was performed over a 5-year time horizon from the perspective of the English National Health Service (NHS). Five scenarios were compared with the current UK dialysis modality distribution ( prevalent patients, 14.2% PD, 82.8% ICHD, 3.0% conventional home HD; incident patients, 22.2% PD, 77.8% ICHD) with all increases to home modalities coming from the ICHD population: Scenario 1, 10% of prevalent patients receive high dose HD at home; Scenario 2, 10% of prevalent patients receive high dose HD at home at an increased payment by results (PbR) weekly tariff (£575); Scenario 3, 10% and 20% of prevalent patients receive high dose HD at home (£575 PbR tariff ) and PD, respectively, and 31% of incident patients receive PD; Scenario 4, 10% and 25% of prevalent patients receive high dose HD at home (£575 PbR tariff ) and PD, respectively, and 39% of incident patients receive PD; Scenario 5, 100% of patients receive ICHD. Results: Performing high dose HD at home in 10% of the dialysis population resulted in a 0.6% savings (Scenario 1, £21 M) under the current home HD tariff of £456/week. With a hypothetical tariff of £575/week for high dose HD at home, the budget increase is minimal (Scenario 2, 0.44%, £15.7 M). Increasing the usage of PD to levels in the range of those seen in 2005-2008 in UK (i.e., 20-25%) totally offset the costs of high dose HD at home and generated savings of £37.8 M (Scenario 3, 1.1%) - £85.1 M (Scenario 4, 2.4%) over 5 years under the hypothetical tariff. On the other hand, having all patients treated in-center resulted in a 4.0% increase (Scenario 5, £142.6 M) in dialysis budget over 5 years. doi:10.1093/ndt/gfu158 | iii Abstracts Nephrology Dialysis Transplantation Conclusions: This analysis shows that increasing the uptake of home-based dialysis regimens could reduce the financial burden associated with the increasing demand for dialysis services in England, without compromising patient outcomes. SP616 LOW FT3 AMPLIFIES THE RISK BY HYPERFIBRINOGENEMIA FOR ALL CAUSE AND CARDIOVASCULAR MORTALITY IN ESKD PATIENTS ON DIALYSIS Claudia Torino1, Graziella D'Arrigo1, Maurizio Postorino1, Giovanni Tripepi1, Alessandra Testa1, Francesca Mallamaci1, Carmine Zoccali1 and - On Behalf Of The PROGREDIRE Working Group2 1 CNR-IFC, Reggio Calabria, Italy, 2Progredire Working Group, Reggio Calabria, Italy Introduction and Aims: Low free triiodothyronine (fT3), largely an epiphenomenon of inflammation and protein-energy wasting, is a strong predictor of mortality in end-stage kidney disease (ESKD). Fibrinogen is a marker of inflammation and a key molecule transducing the effect of inflammation on the coagulation cascade. We hypothesized that the risk associated with low fT3 in ESKD can be modified by fibrinogen levels in these patients. Methods: We tested this hypothesis in a cohort of 854 dialysis patients with a 2.7 years follow-up. Results: During follow-up, 261 patients died, 138 of whom of CV causes. The risk of low fT3 levels for all-cause and CV death was strongly modified by fibrinogen levels. In fully adjusted Cox models (including age, gender, smoking, diabetes, cholesterol, systolic BP, CV comorbidities, Hb, phosphate and dialysis vintage), the hazard ratios (HR) associated to low fT3 levels for the study outcomes were lowest in patients in the 1st fibrinogen quartile [all-cause death: HR: 2.3 (95% CI: 1.3-4.0, P=0.004); CV death: HR: 2.5 (1.2-5.2), P=0.014], intermediate in the 2nd and 3rd quartile [2nd quartile all-cause death: HR: 3.2 (1.4-7.3, P=0.006); CV death: HR: 3.7 (1.3-10.1, P=0.015); 3rd quartile - all-cause death: HR: 4.5 (1.5-13.4, P=0.007); CV death: HR: 5.5 (1.4-21.6, P=0.015)] and highest in the 4th quartile [all-cause death: HR: 6.3 (1.6-24.6), P=0.008; CV death: HR: 8.1 (CI: 1.5-44.5), P=0.016]. Conclusions: Low fT3 levels amplifies the risk by hyperfibrinogenemia for all-cause and CV death in dialysis patients. Such an interaction is fully compatible with biological and clinical data in patients with subclinical and overt hypothyroidism. Further studies are required to verify if correction of low fT3 may improve clinical outcomes in this very high risk population. SP617 SP617 TEMPORAL TREND FOR IMPROVEMENT OF CAROTID ATHEROSCLEROSIS IN INCIDENT DIALYSIS PATIENTS OVER THE PAST DECADE Takasuke Asakawa1, Toshihide Hayashi1, Yuri Tanaka1, Nobuhiko Joki1, Masaki Iwasaki1, Shun Kubo1, Ai Matsukane1, Yasunori Takahashi2, Yoshihiko Imamura2, Koichi Hirahata3, Ken Sakai4 and Hiroki Hase1 1 Toho University Ohashi Medical Center, Tokyo, Japan, 2Nissan Tamagawa Hospital, Tokyo, Japan, 3Hirahata Clinic, Tokyo, Japan, 4Toho University Omori Medical Center, Tokyo, Japan Introduction and Aims: The medical management for patients with chronic kidney disease (CKD) has changed in the past decade. We speculated that this change has led to improve in the prevalence of atherosclerotic cardiovascular disease in patients with CKD. The present study analyzes changes in carotid atherosclerosis in incident hemodialysis patients, as well as trends in clinical factors and medications over the past decade. Methods: This single-center cross-sectional study examines data from 134 consecutive patients starting hemodialysis (age, 69± 12 years; male, 75.4%; diabetic nephropathy, 61.9%) between January 2003 and December 2012. All patients were routinely screened for carotid atherosclerosis by using ultrasonography within three months of starting hemodialysis. The patients were categorized into five groups based on the date of the initial dialysis session to compare the historical data of carotid intima-media thickness (IMT) and plaque score with characteristics and medication therapy. Results: The mean carotid plaque score of 134 patients was 10.5±7.7, and mean IMT and max IMT were 0.9±0.3 mm and 2.2±0.8 mm respectively. In Spearman univariate regression analysis, LDL-C (r=0.335, p<0.001) and non-HDL-C (r=0.319, p=0.001) level significantly correlated with carotid plaque score. The carotid plaque score gradually declined from 12.6 to 8.5 over 10 years ( p=0.01 for trend). No significant temporal trend was observed in mean IMT and max IMT. LDL-C ( p=0.01 for trend) and non-HDL-C ( p=0.02 for trend) significantly decreased from 117±46 mg/dL to 91 ±42 mg/dL and from 145±53 mg/dL to 112±47 mg/dL respectively over time. No favorable changes were observed in blood pressure, serum albumin, and c-reactive protein. In parallel with this phenomenon, the proportion of statin users significantly increased from 6.2% to 48.7% ( p<0.001 for trend). Conclusions: Carotid atherosclerosis in patients with end-stage kidney disease has remarkably improved over the past decade. Changing in the medical management of patients with CKD over time may improve carotid atherosclerosis by favorably affecting dyslipidemia. SP617 SP617 iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation SP618 PATIENTS’ PERSPECTIVE ON DIALYSIS METHOD SELECTION: A NATION-WIDE SURVEY Evy Dehelean1, Dan Munteanu1, Marta Gemene2 and Gabriel Mircescu2,3,4 1 International Healthcare Systems, Bucharest, Romania, 2“Dr Carol Davila” Teaching Hospital of Nephrology, Bucharest, Romania, 3“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 4Romanian Renal Registry, Bucharest, Romania Introduction and Aims: The patients’ involvement in the selection of dialysis method allows them to choose the most fitted therapy to their psycho-socio-economic status and could influence short and even long-term outcome. However, this was not investigated in Romanian patients. Methods: Questionnaires were sent by the Romanian Renal Registry to patients who started dialysis in 2012 in 42 dialysis units from public hospitals, large private dialysis networks and independently run private dialysis units, all-around the country. The self-reported questionnaires addressed patients’ perception of overall satisfaction with the treatment modality (2 items), of the perceived personal involvement in the decision-making process of choosing dialysis method (5 items), and possible ways to improve the process from patients’ perspective (3 items). Results: Responses were received from 680 patients (average age 58 years, 56% males, 89% on hemodialysis, 7% of the dialysis patients in the country). A positive self-perception of health quality was significantly related to the psychological acceptance of dialysis therapy (which was dependent on information received), and to the emotional health. In 73% of cases the choice of the method was made collaboratively by patient and physician. Although only 17% of respondents integrally assumed the decision, those patients had a better overall satisfaction with the dialysis method(r=0.08; p=0.05), while in patients in whom the choice of the method was made exclusively by physician, a trend to a lower quality of health was reported (r=-0.05; p>0.05). The responders’ option for a certain treatment modality was guided by the perceived safety (55%), by their ability to manage the method (50%), and was influenced by the quality of information received about the method (37%). As the self-perceived quality of health was not related to either the initial or the actual method of dialysis, and the actual method was strongly correlated to the initial method (r=0.78; p=0.01), the probability to change the initial method seems to be low. In patients’ opinion, the choice of dialysis method could be improved by educational programs (62%) and psychological assistance (57%). Conclusions: The patients’ perception of health quality is related to the choice of the initial dialysis method. However, in a too low proportion the patients have enough information to make a conscientious choice and most of them feel that programs of medical education and psychological assistance are needed in the pre-dialysis period. SP619 INITIAL DIALYSIS MODALITY AND IMPACT ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY Waldum1,2, Leivestad3, Reisæter4 Os1 Torbjørn Anna V and Ingrid Bård E 1 University of Oslo, Oslo, Norway, 2Oslo University Hospital, Ullevål, Oslo, Norway, 3 4 Norwegian Renal Registry, Oslo, Norway, Oslo University Hospital, Rikshospitalet, Oslo, Norway Introduction and Aims: Patients with end stage renal disease (ESRD) treated with dialysis, experience a high risk of all-cause and cardiovascular mortality. Peritoneal dialysis (PD), and haemodialysis (HD) are considered equally effective as initial dialysis modalities. However,as patient preference, centre experience and comorbidities affect the choice of modality, the prognostic effect of choice of initial dialysis modality needs to be further explored. Our aims were to utilize propensity score to correct for confounding variables when comparing all-cause and cardiovascular mortality in patients treated with PD and HD as initial dialysis modality. Methods: ESRD patients entering the Norwegian Renal Registry for the first time by initiating dialysis in the period from January 2005 to December 2012 were included. Time dependent propensity scores for starting PD were calculated to correct for confounding variables at the time of dialysis initiation. Propensity score adjusted Cox regression models were used to investigate for independent differences in all-cause and cardiovascular mortality between HD and PD. Cases were censored for shift in dialysis modality, renal transplantation or loss to follow-up. Results: Incident ESRD patients entering dialysis in the period counted 3555; mean age 65 ± 15 years, 67.7 % men. PD was the initial dialysis modality in 754 patients (21.2 %). There were regional differences in the use of PD and HD as initial modality ( p<0.001). Clinically, patients treated with PD were older ( p=0.001), had lower body mass index ( p<0.001), higher eGFR ( p=0.003) and higher haemoglobin and albumin levels (both p<0.001). PD patients had less established heart disease ( p=0.008), peripheral vascular disease ( p=0.002) and malignant disease ( p=0.031) and were more likely to be treated with erythropoiesis stimulating agents ( p=0.020). Furthermore, patients initiating PD were more likely to start dialysis in a planned manner ( p<0.001) and were considered more likely to be suited for future transplantation ( p=0.008). Some aetiologies of renal failure were more likely to be treated with a particular dialysis modality ( p<0.001). Median follow-up before death or censoring was 13 months (range 0-92) in HD patients, and 10 months (0-73) in PD patients. PD as initial dialysis modality was not independently associated with altered risk of all-cause and cardiovascular mortality compared to HD (HR 1.04, 95 % CI 0.86-1.25 and HR 1.10, 95 % CI 0.83-1.44 respectively). Dialysis modality was also neutral concerning 1-year Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 all-cause and cardiovascular mortality (PD vs. HD: HR 0.94, 95% CI 0.71-1.25 and HR 0.84, 95% CI 0.54-1.29). Conclusions: Initial dialysis modality was not independently related to all-cause or cardiovascular mortality in Norwegian patients initiating renal replacement therapy from 2005 to 2012. SP620 NT-PROBNP AS A SIGNIFICANT PREDICTOR OF CEREBROVASCULAR, INFECTIOUS DISEASE, AND TUMOR DEATH IN HEMODIALYSIS PATIENTS Yuji Sato1, Shouichi Fujimoto2, Tatsunori Toida1 and Hideto Nakagawa1 University of Miyazaki Hospital, Miyazaki, Japan, 2University of Miyazaki, Miyazaki, Japan 1 Introduction and Aims: As NT-proBNP is a marker of volume overload and myocardial injury, it has been reported as a survival predictor for dialysis patients in terms of all-cause death and cerebrovascular death (CVD) in a relatively small number of patients. Methods: We conducted a prospective cohort study of 1310 patients (41.5% women, 58.5% men) on chronic hemodialysis (UMIN000005160). Mean age was 67.9 years, mean dialysis vintage was 112 months, and 23.7% of diabetes as a basal kidney disease. A 24-month follow-up was performed. Results: A total of 144 deaths occurred during the observational period: 53 patients by CVD, 33 by infectious disease death, 19 by tumor death, and 39 by other causes, including those of unknown origin. ROC curve represented 0.761 of AUC and 7400 pg/ml of NT-proBNP as a cut-off point for predicting all-cause death. Other AUC for CVD, infectious disease death, and tumor death were 0.750, 0.729, and 0.647, respectively. Two groups divided at 7400 pg/ml of NT-proBNP showed clearly distinct survival curve analyzed by Kaplan-Meier methods for all-cause death, CVD, infectious disease death, and tumor death. Cox regression analysis showed NT-proBNP was a significant survival predictor for every endpoint. Hazard ratio (95% CI) was 4.360 (2.892-6.574) for all-cause death, 4.116 (2.054-8.251) for CVD, 2.961 (1.215-7.217) for infectious disease death, and 3.662 (1.230-10.904) for tumor death, adjusted by age, gender, dialysis vintage, cardiothoracic ratio on X-ray, pre-dialysis systolic blood pressure, mean body weight gain from dry weight, and basal kidney disease. Conclusions: NT-proBNP is a strong survival predictor for all-cause death and CVD, and a modest but significant predictor for infectious disease death and tumor death. SP621 VALIDATION AND EVALUATION OF MEMORIAL SYMPTOM ASSESSMENT SCALE SHORT-FORM (MSAS-SF)IN A ROMANIAN COHORT OF HEMODIALYSIS PATIENTS Alexandra Tasmoc1,2, Ionut Nistor2, Mihaela Donciu1,2, Luminita Voroneanu1,2, Carmen Volovat1 and Adrian Covic2,1 1 University Hospital “Dr. C.I. Parhon”, Iasi, Romania, 2Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania Introduction and Aims: Pain and symptoms evaluation are increasingly perceived as important in patients` management in dialysis units and palliative care institutes. There is little experience on using the Memorial Symptom Assessment Scale Short-Form (MSAS-SF) in end-stage renal disease population. MSAS-SF is a useful tool that assesses not only the prevalence of symptoms, but also assesses the severity of symptoms experienced by patients. The objectives of this study were: i. to validate the MSAS-SF in a Romanian hemodialysis (HD) population, ii. to assess the prevalence and severity of physical and psychological symptoms of hemodialysis patients using the MSAS-SF, iii. to determine the quality of life of HD patients, including two summary scores: physical component (PCS) and psychological component (MCS). Methods: Seventy hemodialysis patients were recruted for assessing the internal reliability of MSAS-SF. A different group of 102 stable patients (41 males, 61 females, mean age 52.51 ± 12.02), who were treated with hemodialysis three times weekly completed questionnaires on prevalence and severity of symptoms and quality of life. To determine symptoms prevalence and severity for HD patients MSAS-SF was used, while for determing the quality of life, patients completed the Short Form Health Survey Questionnaire (SF-36). Cronbach`s alpha reliability test was performed to assess internal consistency of the MSAS-SF. Results: The Cronbach`s alpha reability score for the total number of items of the MSAS-SF was 0.838, while for the subscales of MSAS-SF the reability scores ranged from 0.648 to 0.749. This means that subscales ranged from acceptable to very good. The top three memorial symptoms experienced by hemodialysis patients were lack of energy, followed by pain, and worrying. The most frequently reported physical symptoms included lack of energy (69.6%), pain (68.6%), numbness/tingling in hands/ feet (64.7%), difficulty sleeping (63.7%), dry mouth (61.8%), dizziness (58.8%), problems with sexual interest or activity (52%). The most frequent psychological symptoms included worrying (65.7%), feeling sad (59.8%), feeling nervous (50%), feeling irritable (40.2%). The mean physical component summary (PCS - Quality of Life) score was 51.78 ± 19.21, and the mean mental component summary (MCS Quality of Life) score was 61.38 ± 16.71. No statistical relationship between biochemical parameters and MSAS-SF and QoL scores was found. Conclusions: These results support the validity of the MSAS-SF in the assessment of patients undergoing hemodialysis. The major concerns in HD doi:10.1093/ndt/gfu158 | iii Abstracts patients were the lack of energy, pain caused by symptoms and keep worrying about everything in their life. SP622 GENDER DIFFERENCE IN THE ASSOCIATION BETWEEN THE FRAX® AND MORTALITY IN JAPANESE HEMODIALYSIS PATIENTS Toshihide Hayashi1, Nobuhiko Joki1, Yuri Tanaka1, Ai Matsukane1, Takasuke Asakawa1, Shun Kubo1, Masaki Iwasaki1, Yasunori Takahashi2, Yoshihiko Imamura2, Koichi Hirahata3, Ken Sakai4 and Hiroki Hase1 1 Toho University Ohashi Medical Center, Tokyo, Japan, 2Nissan Tamagawa Hospital, Tokyo, Japan, 3Hirahata Clinic, Tokyo, Japan, 4Toho University Ohmori Medical Center, Tokyo, Japan Introduction and Aims: Recently, The WHO Fracture Risk Assessment Tool (FRAX®) has been developed to estimate a 10-year absolute risk of major osteoporotic fracture among general population; however the evidence in CKD patients has been lacking and the association between the FRAX® and mortality is unknown. We, therefore, conducted a hospital-based prospective cohort study to evaluate the predictive ability of the FRAX® for mortality in hemodialysis patients. Methods: Two hundred and fifty-two patients who had been started initiate maintenance hemodialysis from April 2004 to December 2013, 171 men and 81 women, with a mean (± SD) age of 67 ± 14 years were studied. The endpoint was defined as all-cause death. The Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% CI. Results: During the mean (± SD) follow-up period of 3.4 ± 2.7 years, total 61 death were observed. The median (interquartile range) of the FRAX® for major osteoporotic fracture were 6.9 (4.6 - 12.0) % in men and 19.0 (7.6 - 33.0) % in women. A significant interaction between the FRAX® and gender was detected ( pinteraction < 0.001); therefore, separate analyses were conducted for men and women. Cumulative survival at the point of 5 years after starting dialysis, in men with the FRAX® levels above and below the median was 51.9 and 87.9 % and in women was 67.4 and 83.7 %, respectively (Figure). Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX® remained as an independent predictor for death after adjusting by confounding variables (Model 2: HR 3.03, 95% CI 1.37 to 6.70). In women, the FRAX® was not associated with the endpoint (Table). Conclusions: Among Japanese hemodialysis patients, the FRAX® levels seem to be a useful procedure to predict for death in men but not in women. Nephrology Dialysis Transplantation SP623 METABOLIC SYNDROME (MS) PREDICTS HOSPITALIZATION RATE BUT NOT MORTALITY IN HEMODIALYSED (HD) PATIENTS Michal Vostrý1, J Racek1, D. Rajdl1, J. Eiselt1 and L Malánová2 1 Faculty Hospital and Charles University - Faculty of Medicine In Pilsen, Pilsen, Czech Republic, 2Hemodialysis Centre B.Braun Avitum, Pilsen, Czech Republic Introduction and Aims: MS is associated with increased cardiovascular risk in general population and is also highly prevalent among HD patients. Renal failure and MS show several biochemical parallels, but the effect and the clinical importance of their co-occurrence are poorly understood in the complex epidemiologic milieu of uraemia. We aimed to investigate the relationship of MS to the prognosis of HD patients. All cause mortality, time to first hospitalization and overal hospitalization rate were the outcomes of our interest. Methods: The cohort of 117 HD patients (62 males, median [IQR] of age = 67 [63-73] years, HD duration = 24 [10-55] months and BMI 24.9 [23.4-32.9] kg/m2) was divided into two groups according to presence of MS (NCEP definition, 60 patients with MS) and it was prospectively monitored for the period of 32 [14-57] months. Besides the MS impact, the role of several classic or emerging laboratory risk factors (CRP, albumin; adiponectin, asymmetric dimethylarginine) was evaluated. Results: 66 patients died during the follow-up period (56%, 34 with MS). No relationship was found between MS and all-cause mortality (log-rank p = 0.6). However, distinction emerged in the analysis of hospitalizations. Patients with MS were hospitalized more frequently and for a longer time period (1.24 vs 0.91 events per person-year ( py); 17.66 vs 14.05 days per py; both p < 0.05). The hospitalization rate ratio was 1.35 (95% CI 1.1-1.7). The impact of MS was also confirmed in the analysis of the time to first hospitalization (log-rank p < 0.05). Among the laboratory parameters, only albumin proved as significant predictor of mortality (adjusted Cox model, HR = 0.94, p < 0.05). Conclusions: Our results suggest that the influence of MS on all-cause mortality is insignificant. However, the MS concept may be useful in predicting the risk of complications in haemodialysis patients. SP623 SP622 SP624 “THE CHILDREN OF DIALYSIS, THE COMEBACK OF LIFE”. LIVE BORN BABIES FROM DIALYSIS MOTHERS IN ITALY: AN EPIDEMIOLOGICAL PERSPECTIVE Giorgina Piccoli1, Gianfranca Cabiddu2, Gabriella Guzzo1, Giuseppe Daidone3, Stefania Maxia2, Sara Ghiotto4, Ida Ciniglio1, Valentina Postorino5, Valentina Loi2, Michele Nichelatti6, Rossella Attini1, Alessandra Coscia1, Maurizio Postorino7 and Antonello Pani2 1 Italian Working Group On the Kidney and Pregnancy, Torino, Italy, 2Italian Working Group On the Kidney and Pregnancy, Cagliari, Italy, 3Italian Working Group On the Kidney and Pregnancy, Siracusa, Italy, 4Italian Working Group On Kidney and Pregnancy, Torino, Italy, 5Italian Working Group On the Kidney and Pregnancy, Roma, Italy, 6Italian Working Group On the Kidney and Pregnancy, Milano, Italy, 7 Italian Working Group On the Kidney and Pregnancy, Reggio Calabria, Italy SP622 Introduction and Aims: The advances in intensive dialysis contributed to re-discuss the issue of pregnancy in dialysis patients. In spite of the renewed interest, and of the improved results, pregnancy is still exceptional on dialysis. Few data are available comparing pregnancy rates on dialysis and after kidney transplantation also with respect to the overall population. Aim of the study was to assess the incidence of live-born babies from mothers on chronic dialysis in Italy, in the new millennium, comparing the results with the overall population and with kidney transplant patients. Methods: Setting of study: Italy 2000-2012. Sources of data: Dialysis: a phone inquiry was performed in June-September 2013, involving all the public dialysis Centers and all iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation the major private dialysis Centers in Italy; response rate was 100%. Transplantation: inquiry by phone and mail by the Italian study group on kidney and pregnancy: response rate 60%. The following data were gathered: ESRD, type of dialysis, GFR, changes of dialysis, hospitalizations, living versus cadaveric donor; therapies and complications, creatinine, hypertension, proteinuria, CKD stage; week of birth, birth weight, birth weight percentile; outcome of mother and child. Prevalence of women in childbearing age (20-45) was obtained from the Italian Dialysis and Transplant Registries (2010-2011 updating; inference from test Regions). Overall population: Ministry site. Results: In the period of study 23 women on dialysis (3 on peritoneal dialysis) delivered live-born babies; one woman delivered two twins (overall: 24 babies). Interestingly, about half of the mothers had no residual diuresis (and a long dialysis vintage) and one third had immunologic diseases, including SLE and vasculitis, thus suggesting that pregnancy is possible also after a long dialysis follow-up or with "difficult" diseases. Preterm delivery was the rule: 19/21 singletons with available data were preterm (33.3% were "early preterm", ie <34 gestational weeks). The prevalence of children below the 10th weight percentile (gestational age-adjusted) was high: 33.3%. Three babies died in the first months of life (including one twin). The surviving children had no clinical or developmental problem. The most common therapeutic adjustment was the switch to daily dialysis (and an increase in exchanges in peritoneal dialysis). As expected, comparing the data with 110 pregnancies recorded after kidney graft (about 60% of the Italian grafted population), birth weight was lower on dialysis (1200 vs 2500 g; p<0.01), and gestational age was also lower (30 vs 36 weeks, p<0.01). Incidence of live-born babies was inferred as 0.7-1.1 per 1000 female dialysis patients in childbearing age (age 20-45 years) and 5.5-8.3 per 1000 grafted patients of the same age groups. This figure corresponds to a live-birth rate in the Italian population of 72.5 per 1000 women aged 20-45 years. Conclusions: Having a baby on dialysis is rare but not impossible; early mortality remains high. There is a “scale of probability” with an about 10 folds decrease of probability of a live-born baby from the overall population to transplantation and from transplantation to dialysis. SP625 VISCERAL ADIPOSITY INDEX AND RISKS OF CARDIOVASCULAR EVENTS AND MORTALITY IN PREVALENT HEMODIALYSIS PATIENTS Hung-Yuan Chen1,2, Yen-Ling Chiu3, Shih-Ping Hsu3, Mei-Fen Pai1, Ju-Yeh Yang3, Hon-Yen Wu3 and Yu-Sen Peng3 1 Far Eastern Memorial Hospital, New Taipei, Taiwan, 2National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 3Far Eastern Memorial Hospital, New Taipei City, Taiwan Introduction and Aims: Visceral adiposity index (VAI) is a newly-derived measure of visceral adiposity with well-validated predictive power of cardiovascular (CV) outcomes in general population. However, this predictability has not been investigated in hemodialysis (HD) patients and whether VAI is superior to waist circumference (WC) and waist-to-height ratio (WHtR) in prediction of CV outcomes and survival in HD patients remains unknown. Methods: We performed a prospective study and 464 prevalent hemodialysis patients were enrolled. The composite outcome was the occurrence of death and CV event during follow-up. Using multivariable Cox regression model, VAI, WC and WHtR were tested for the predictive power of composite outcome and all-cause mortality. Results: VAI, WC and WHtR positively correlated with each other. Patients with higher VAIs (tertile 3 v.s tertile 1, adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.12 to 2.42; tertile 2 v.s tertile 1, adjusted HR, 1.52; 95%CI, 1.1 to2.18) had more composite outcomes. VAI had similar predictive power of composite and CV outcomes to WC and WHtR, but had superior predictive power of all-cause mortality to WC and WHtR analyzed by receiver operating characteristic curve. Conclusions: VAI is an optimal method to measure visceral adiposity for assessing long-term CV outcome and all-cause mortality in prevalent HD patients. VAI may provide superior predictive power of all-cause mortality to WC and WHtR. SP626 NOT TOO LATE INITIATION OF DIALYSIS COULD IMPROVE SURVIVAL IN HEMODIALYSIS PATIENTS FROM BEIJING: EXPERIENCE OF 6 YEARS’ FOLLOW-UP Li Liu1, Li Zuo2 and Yang Luo3 1 Peking University First Hospital, Beijing, China, 2Peking University People's Hospital, Beijing, China, 3Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing,China, Beijing, China Introduction and Aims: Optimal time to initiate dialysis for end stage renal disease patients is still a controversial question. Studies done recently challenged early initiation trend of dialysis. We conducted the study to evaluate the relationship between GFR and mortality in hemodialysis (HD) patients in Beijing. Methods: A total of 5612 incident HD patients enrolled in the database from January 2007 to December 2012. eGFR was estimated by the CKD-EPI equation according to the creatinine at the start of dialysis. Patients were classified into five groups based on eGFR (Group 1: 0-2.5, Group 2: 2.5-5.0, Group 3: 5.0-7.5, Group 4: 7.5-10.0 and Group 5: above 10.0 ml/min/1.73m(2)). Kaplan-Meier and Cox regression analyses were Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 performed to assess the association between eGFR and all-cause mortality. The Cox regression model included pre-dialysis eGFR, age, gender and primary renal disease. Results: The eGFR at dialysis initiation was 8.88±13.69 ml/min/1.73m(2). During the six years’ follow-up, 17.18% patients died. The Cox regression model revealed increasing mortality risks was not only in the higher eGFR groups (Group 3 (HR=1.28, 95%CI=1.08-1.53), 4 (HR=1.39, 95%CI=1.13-1.71) and 5 (HR=2.29, 95% CI=1.90-2.76)), but also in Group 1 (HR=1.68, 95%CI=1.15-2.45), compared to Group 2 after adjusted for age, gender and primary renal disease (chronic glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, chronic tubulointerstitial nephritis, polycystic kidney disease and others). Conclusions: Initiation of dialysis at higher levels of eGFR was associated with increased mortality in HD patients in the long follow-up period. Meanwhile, too low eGFR (<2.5 ml/min/1.73m(2)) might also induce to higher mortality. The factors related need further studies. SP626 SP627 KIDNEY HEALTH IN VOLUNTEERS RECRUITED AS STUDY CONTROLS Samer Abbas1, Cassandra Cartagena1, Cesar Flores-Gama1, Caroline Williams1, Mary Carter1, Fansan Zhu1, Nathan W Levin1, Stephan Thijssen1 and Peter Kotanko1 1 Renal Research Institute, New York, NY Introduction and Aims: Little is known about kidney function in volunteers recruited as healthy controls. Here we report kidney function in such individuals. Methods: We solicited the participation of healthy volunteers using posters and newspapers. Telephone callers underwent a structured 22 questions to explore their eligibility. Volunteers who passed the telephone interview underwent clinical assessment (height, weight, blood pressure) and measurement of serum creatinine, BUN, urinalysis) 1-4 weeks later. Estimated glomerular filtration rate (eGFR) was computed with the CKD-EPI equation. Albumin-creatinine ratio (ACR) was calculated as urine albumin/urine creatinine (mg/g). Systolic blood pressure (SBP) was recorded three consecutive times in a sitting position; subjects with average SBP > 140 mmHg were considered hypertensive. Results: Based on the phone interview, almost 50% of 180 volunteers were excluded because of kidney, cardiac, or malignancy-related conditions. Ninety-one participants (age 57±10 years; 49 female) were eligible. Of these 18 participants were excluded, mostly because of absent blood and urine samples. Results obtained in the remaining 73 participants are shown in Table 1. Age was significantly different between eGFR groups ( p = 0.001, 1-way ANOVA). Conclusions: Our results indicate the presence of unrecognized kidney impairment in a notable fraction of normal healthy volunteers who identify themselves as healthy and who pass a telephone interview screening aimed at identifying and excluding non-healthy volunteers. Since decreased function of unknown cause is frequent in older people this should be considered in recruiting apparently healthy volunteers. Laboratory tests are indispensable to define healthy controls. SP627 eGFR in mL/min/1.73 m2 Black [N] White [N] Male [N] Female [N] Age [years] eGFR>90 (N=20) eGFR 60-89 (N=43) eGFR < 60 (N=10) ACR > 30 (N=5) Hypertensive (N=9) 10 10 10 10 50±7 17 2 21 22 60±9 2 8 4 6 69±9 1 4 1 4 62±9 6 3 5 4 63±12 doi:10.1093/ndt/gfu158 | iii Abstracts SP628 HEALTH-RELATED QUALITY OF LIFE IN HIGH CONVECTIVE VOLUME ONLINE HEMODIAFILTRATION Julia Tsobaneli1,2, Theoharis Tsobanelis3, Peter Kurz3, Norbert Hensel3, Konrad Obermann2 and Vedat Schwenger1 1 University of Heidelberg, Heidelberg, Germany, 2University of Heidelberg, Mannheim, Germany, 3Centre for Renal Diseases and Hypertension, Frankfurt/ Main, Germany Introduction and Aims: The purpose of this study is to evaluate health-related quality of life of patients undergoing high convective volume online hemodiafiltration, and contribute to current controversial discussions regarding online hemodiafiltration. Methods: In this study, end stage renal disease patients treated in an ambulatory healthcare centre, in which for 10 years all hemodialysis patients are treated by online hemodiafiltration, were offered to participate in an optional assessment of their health-related quality of life (no selection bias within the centre, total 200 patients). Assessment was performed with the Kidney Disease Quality of Life - Short Form. Based on publications of the Dialysis Outcomes and Practice Patterns Study, socioeconomic and clinical data of each patient were used to estimate expected health-related quality of life scores. These expected scores were subsequently compared to the actual scores as indicated by the patients ( paired t-test). Results: 111 questionnaires returned (response rate 55%). The mean age of analyzed patients was 68 ± 13.8 years, 55.6% were male. Mean convective volume was 25.2 l ± 5.1 l (median 26.0 l). In several domains concerning health-related quality of life, patients undergoing online hemodiafiltration reported significantly higher scores than predicted by the model. These domains include physical component summary (P<0.001), physical functioning (P<0.001), pain (P=0.002), general health (P<0.001), social functioning (P=0.011), mental health (P=0.002), symptoms and problems (P=0.047), and cognitive functioning (P<0.001). Conclusions: In contrast to other studies, these data suggest that health-related quality of life of end-stage renal disease patients benefits from online hemodiafiltration. Though not a randomised controlled trial, this study might contribute to current discussions regarding online hemodiafiltration: The high convective volume in this patient group should be noted. It might explain discrepancies to results of other studies. However, these data result from only one centre, to exclude selection bias further research is needed. Nephrology Dialysis Transplantation SP630 Kenji Tsuchida1, Jun Minakuchi1, Tadashi Tomo2 and Shu Kawashima1 1 Kawashima Hospital, Tokushima City, Japan, 2Oita University, Oita City, Japan Introduction and Aims: β2-microglobulin (β2M) is recognized as a surrogate marker of middle-molecule uraemic toxins. Several studies have evaluated the association of pre-dialysis serum β2M levels with clinical mortality in dialysis patients. Japanese Society for Dialysis Therapy (JSDT) reported the guidelines for maintenance hemodialysis: hemodialysis prescription, and in Section 2, dialysis dose and effect: (β2M) in Japanese. The aim of this study is to investigate the guidelines are appropriate or not. Methods: A retrospective study was designed. Clinical recordings from 748 patients (62.7±12.7 years, haemodialysis duration of 103.0±88.5 months, 475 male and 273 female, 21.4% diabetes) initiated on HD at April 2006. The patients were divided into two groups according to their pre-dialysis serum β2M levels; 30mg/L< group (N=537, 62.0±12.6 year, haemodialysis duration of 99.3±90.7 months, pre-dialysis serum β2M level of 24.6±4.0 mg/L) and 30mg/L≤ group (N=211, 64.2±12.7 year, haemodialysis duration of 112.5±82.0 months, pre-dialysis serum β2M level of 35.1±5.0 mg/L). Survival probability was generated using the Kaplan-Meier analysis. Results: During the follow up period of 61.9±13.5 month, these were 174 deaths. Kaplan-Meier analysis showed that mortality in the pre-dialysis serum β2M levels; the 30mg/L< group was significantly lower than that in the 30mg/L≤ group ( p<0.0001). Multivariate Cox proportional Hazards model showed that pre-dialysis serum β2M was a significant predictor for mortality (hazard ratio, 1.036; 95%CI 1.015-1.057; p<0.0009), after adjustment for age, haemodialysis duration, the presence of diabetes, pre-dialysis serum albumin, and blood urea nitrogen. Conclusions: JSDT recommended that the dialysis conditions should be determined to achieve a pre-dialysis serum β2M level at the maximum intervals < 30 mg/L. In this study, less than 30mg/L of pre-dialysis serum β2M levels is lower mortality in dialysis patients independent of age, haemodialysis duration, the presence of diabetes, pre-dialysis serum, albumin, and blood urea nitrogen, from the point of view, the guidelines are appropriate. Therefore, we may have to design the dialysis conditions to achieve effective removal of β2M. SP631 SP629 CANDIDA SP. CARRIAGE IN HAEMODIALYSIS PATIENTS: PREVALENCE AND MEDIUM TERM OUTCOMES Iryna Shifris1, Iryna Dudar1, Adele Rudenko1 and Viktor Krot1 1 Institute of Nephrology Nams of Ukraine, Kyiv, Ukraine Introduction and Aims: Candidiasis is a common opportunistic infection in immunocompromised patients. Infection is a major cause of morbidity and mortality in patients with end stage renal failure (ESRF). ESRF patients on haemodialysis (HD) have a high frequency of nutritional, immunological, and psychological disorders as well disorders from invasive procedures and antimicrobial treatments, which are known to contribute to the presence of a higher number of yeast colonies. The aim was to study the localization and prevalence of fungal colonization with subsequent evaluation of medium term outcomes in HD patients. Methods: This study was an observational, prospective, epidemiological tracking, performed in 24 months by microbiological and clinical examination. The study included 79 patients with the end stage renal failure on HD from dialysis single center of Ukraine. 45 (57%) patients were men, median age was 48.4 (range 23 - 77 years) and the most common cause of ESRF was glomerulonephritis (47 patients, 59.5%); diabetes mellitus have 7 (8.9 %) persons. Аrteriovenous fistulas (AVF) were used as vascular access in 100% of the patients. The microorganisms (fungi) isolation was carried by seeding swabs from the nose and pharynx out in conventional culture media. During follow-up, all bacterial infections, hospital admissions and all cause mortality were documented and analyzed. Results: 33 patients had positive swab results. The prevalence of colonisation with Candida species was 41.8%. Pharyngeal colonization of Candida was found in 29 (87.9%) and nasal in 4 (12.1%) patients. Of the swab positive patients, 63.64% having glomerulonephritis and 12.12% - diabetes ( p=0.537). 75.8% of this group had at least one hospital admission during the follow up period (32 episodes). Over a third (40.6%) of admissions were related to infections (53.8% respiratory infection, 23.1% vascular access, 15.4% wet gangrene, 7.7% osteomyelitis ). During the observation 19 bacterial infections episodes among all patients were detected. Patients with a history of Candida colonization (n = 33) showed a higher rate cases (13/39.4% vs. 6/13.0%, p = 0.006879) of infection complication than without it (n = 46).18.2% patients of Candida carriage died within 24 months of follow up. Conclusions: The results confirm the available data on the higher rate of Candida carriage among HD patients. There is an association between Candida colonisation and poor clinical prognosis in HD population. Diabetes mellitus in this study was ruled out as risk factor for Candida colonisation. THE EFFECT OF SERUM BETA2-MICROGLOBULIN LEVEL ON MORTALITY IN HAEMODIALYSIS PATIENTS SODIUM GRADIENT AND ITS CONSEQUENCES Pedro Vieira1, A Miguel Gonçalves2, Nuno Guimarães Rosa1, Luís Resende1, José M Durães1, Alves Teixeira1, Gil G Silva1 and José A Araújo1 1 Hospital Central do Funchal, Funchal, Portugal, 2Hospital Central do Funhal, Funchal, Portugal Introduction and Aims: Hemodialysis patients lack normal homeostatic mechanisms to regulate body water volume and osmolality. However they too seem to have its own individual‘s osmolar set point, and being dialysed against a positive sodium gradient might be associated with increased interdialytic weight gain and blood pressure and therefore an individually sodium prescription approach may be beneficial. Methods: We conducted a cross-sectional study at a hospital based hemodialysis unit, SP631 iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation during a period of 3 months, comprising 40 clinically stable patients on hemodialysis. A descriptive analysis of each patient sodium dialysis prescription and analytical/ clinical data was assessed for statistical analysis. Results: From the analysis of both the prescription and clinical data of the patients comprised in the study we found that the dialysate sodium prescription ranged from 138-140mEq/L (median of 140 mEq/L) while the mean pre-HD serum sodium was 134,6 ±2,27mEq/L. This resulted in a mean sodium gradient of 5,0 ±2,3mEq/L with the majority of patients (n=39, 97,5%) being dialysed against a positive sodium gradient. We found a direct correlation between sodium gradient and IDWG (ρ=0,317, p<.05), sodium gradient and percent IDWG (%IDWG) (ρ=0,398, p<.05) and sodium gradient and number of intradialytic hypotensive episodes (ρ=0,540, p<.01). After adjustment for confounders (age, dialysis vintage, dry weight), the sodium gradient was independently associated with %IDWG ( p<.05). We found no significant associations either between sodium gradient and blood pressure control, number of antihypertensive agents, hospitalizations, medical complications or death. Conclusions: Despite the small sample, it was possible to find statistical significance between the sodium gradient and IDWG, %IDWG and intradialytic hypotensive episodes suggesting the importance of individual hemodialysis sodium prescription in order to look for alignment between the dialysate sodium with the serum sodium concentration. SP632 COGNITIVE CHANGES IN A HAEMODIALYSIS SESSION IN STABLE HAEMODIALYSIS PATIENTS OVER THE AGE OF 60 YEARS - A PROSPECTIVE PILOT STUDY Hannah Currie1 and J Baharani1 1 Heart of England NHS Foundation Trust, Birmingham, United Kingdom Introduction and Aims: End-stage renal disease (ESRD) is associated with cognitive impairment (CI) and it is estimated that as many as 70% of haemodialysis(HD) patients aged 75 years or over have moderate to severe CI. The pathophysiology remains unclear but its effects undeniable with the paradigm shift in more elderly patients than ever needing HD. A single study conducted amongst 28 haemodialysis patients aged 55 years or older found that cognitive function was significantly lower during a dialysis session compared to shortly before or the following day after dialysis. The aim of this pilot study was to further assess the effect of a single haemodialysis session on the cognitive function of established and stable haemodialysis patients. Methods: Patients aged 60 or above established on HD for 3 months with no prior documentation of memory impairment were included. 30 patients were randomly selected from our local haemodialysis cohort and were invited to participate. Prior to a dialysis session they completed a MMSE and if scored >24 were assessed further using the Montreal Cognitive Assessment tool (MoCA). The MoCA is a one-page 30-point test administered in approximately 10 minutes and has 3 versions enabling its re-use in a short space of time. Patients completed the MoCA-1 at baseline prior to commencing HD, MoCA-2 at 1 hour into dialysis and MoCA-3 within 1 hour of completing the session. Results: All 30 patients agreed to participate. 1 was excluded for scoring ≤24 on their MMSE. 29 patients with an M: F ratio of 3:1 and a mean age of 73 years (range 64 84) completed the cognitive tests. 97% were Caucasian. Mean duration on dialysis was 37.2 months (6 - 88 months). 13.8% were diabetic and 97% were dialysed via a fistula. Mean Karnofsky score was 70% and only 15% were in the low co-morbidity group. The mean baseline MMSE was 27.6 (25 - 30) and MOCA-1 was 20.9 (14 27). Mean 1 hour MOCA-2 was 20.1 (13 - 25) and mean recovery MOCA-3 was 19.6 (12 - 25). Baseline MoCA scoring in this cohort revealed that 75% had mild to moderate CI not evident on MMSE. There was evidence that CI worsened during dialysis in 55% and did not fully reverse or fell further in 65% of the cohort following completion of dialysis. Conclusions: Our pilot shows that CI is present in three quarters of our patients over the age of 60 years who are receiving long term HD. Despite the presence of CI these patients had reasonable functional scoring despite moderate to high co-morbidity. CI worsened during HD in half the group and did not fully recover or worsened further at the end of the session. This raises implications in the short term for those travelling home alone or to an empty home after HD. In the long term, there are wider implications with sharing the diagnosis of CI with patients which goes hand in hand with future planning of care, prognosis and outlook. SP633 military medical city (PSMCC), nephrology ward and their outcomes are reported in this study. Methods: Four consecutive patients were included in this reporting. All these patients were isolated and diagnosis was made by PCR. Their Clinical presentation, total hospital stay, ventilation requirement and mortality rate was studied. Three serial blood, sputum and urine cultures were done to exclude any possibility of bacterial or fungal sepsis. Results: Three patients were male, the median age being 51.5 years. All of them were diabetic and hypertensive. Out of 4 infected patients 3 were recently started on HD through permanent catheter with a mean average premorbid duration on dialysis for 64 days. The fourth patient was on dialysis through fistula for 993 days before infection. The average hospital stay was 43 days. 75 % presented with pneumonia by clinical and radiological criteria. 100% of them presented with lymphopenia and fever. None of them had associated permanent catheter infection. One of them received intravenous immunoglobulin and was discharged home after 6 weeks and did not require ventilator support during hospital stay. 50% of them needed mechanical ventilator and eventually died due to multiple organ failure. One patient, who had flue like symptoms recovered fully without any intervention but was kept in hospital for 6 weeks until PCR became negative for MERS-CoV. Conclusions: MERS-CoV infection in HD patients has prolonged hospital stay and is associated with higher mortality, thus contrasting with the non HD population. The patients with milder symptoms have good overall outcome similar to non HD patients. Immunoglobulin may improve outcome and should be considered in selected patients till new antivirals are made available. SP634 A LONGITUDINAL STUDY OF BURDEN, QUALITY OF LIFE AND EMOTIONAL DISTRESS IN CAREGIVERS OF PERITONEAL DIALYSIS PATIENTS Augustine Wee Cheng Kang1, Zhenli Yu1, Marjorie Wai Yin Foo2 and Konstadina Griva1 1 National University of Singapore, Singapore, Singapore, 2Singapore General Hospital, Singapore, Singapore Introduction and Aims: Caregivers of Peritoneal Dialysis (PD) patients may face a high degree of burden and distress as factors such as a strict adherence to treatment for patients and the medicalization of the home environment may affect the entire family unit. This is the first longitudinal study examining levels and factors affecting Caregiver Burden, Quality of Life (QOL) and Emotional Distress in caregivers of Singaporean PD patients. Methods: A cross sectional sample of N = 86 were recruited through outpatient PD clinics in Singapore between 2009-2011. Of the original sample, N = 44 caregivers who were still in care of their PD patients were reassessed 12 months later. Participants completed the World Health Organization Quality of Life Brief (WHOQOL-BREF), Zarit Burden Interview (ZBI) and the Lay Care-giving for Adults Receiving Dialysis (LC-GAD). The Hospital Anxiety and Depression scale (HADS) was administered only at follow-up. Results: Participants reported moderate burden severity according to ZBI classifications at both baseline and followup assessments, although ANOVA comparisons indicated a statistically significant increase in caregiver burden ( p = 0+) at followup. Participants also reported poorer QOL outcomes in terms of psychological health ( p = 0.011) at followup. Additionally, overall QOL levels were found to be worse relative to general population norms in all domains at both baseline and followup assessments. Symptoms of anxiety and depression measured higher in caregivers reaching threshold scores for moderate to severe burden as per ZBI classifications. High burden caregivers are also found to be providing care for older patients (p = 0.04). Conclusions: Overall, the results suggest that caregivers of PD patients experience increased burden over time and are at risk for anxiety, depression and poor psychological health. PD regimes offer flexibility and autonomy for patients, but may result in increasing caregiver burden over time due to factors such as the requirement to assist in managing multiple, technical aspects of PD exchange. Additionally, an inverse relationship between patient age and caregiver QOL is documented, suggesting the need to further understand the various clinical needs of different age groups in PD patients that may translate into different burdens on caregivers. The study results raises questions on ways to promote wellness in the context of the PD family unit and to address psychosocial needs in the PD caregiver population. Supporting carers and patients alike may promote technique survival and adjustment. FATE OF MIDDLE EAST RESPIRATORY SYNDROME CORONA VIRUS INFECTION IN FOUR HEMODIALYSIS PATIENTS IN PRINCE SULTAN MILITARY MEDICAL CITY Ebadur Rahman1, Mohammed Sulaiman2, Modassar Mahboob2, Fahad Hawas3, Naveed Aslam2 and Ghada Shoel2 1 Prince Sultan Military Medical City(PSMMC), Riyadh, Saudi Arabia, 2PSMMC, Riyadh, Saudi Arabia, 3Prince Sultan Military Medical City, Riyadh, Saudi Arabia Introduction and Aims: Middle East respiratory syndrome corona virus (MERS-CoV) has created global havoc because of its high case fatality rate. The natural history of this infection in hemodialysis (HD) patient has not been studied well. To the best of our knowledge this is the largest single center case series reporting of MERS-CoV infected hemodialysis patient population. These patients were admitted in prince sultan Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 SP634 Caregiving-Related Outcomes Variable Total ZBI Score WHOQOL - Psychological Health HADS Anxiety HADS Depression Baseline 36±5.55 17.05±3.86 NIL NIL Follow-up 41.39±5.44 15.18±2.88 5.13±1.53 6.55±2.55 p-value 0+ 0.011 NIL NIL doi:10.1093/ndt/gfu158 | iii Abstracts Nephrology Dialysis Transplantation SP634 Burden Severity with respect to QOL and HADS Measure WHOQOL - Psychological Health Anxiety (HADS) Depression (HADS) SP635 Low-Burden Caregivers, defined as scores lower than mean (n = 32 M ± SD 12.01±2.78 4.46±1.83 6.01±2.15 COMPARISSON BETWEEN ANESTHESIA TYPES OUTCOME IN DIALYZED PATIENTS UNDERGOING SURGERY−A 5 YEARS STUDY Cristiana David1, Ileana Peride1, Daniela Radulescu1, Andrei Niculae1, Ionel Alexandru Checherita1 and Alexandru Ciocalteu1 1 "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest, Romania Introduction and Aims: Chronic dialyzed patients, because of a wide range of pathophysiological problems and associated comorbidities, should be carefully preand postoperative assessed when surgery is considered. Aim of the study. Between September 2008 and October 2013, we conducted a prospective, randomized research, evaluating postoperative complications and outcome of different anesthesia types (e.g.: spinal or general) in chronic dialyzed patients undergoing various surgical procedures. Methods: 312 individuals were included in the study and the following pre- and postoperative data were analyzed - demography, cardiovascular and respiratory comorbidities, dialysis time, diuresis, BP variations, APACHE II score, preoperative EMG to assess the degree of autonomic neuropathy, complexity of surgical procedure, type of anesthesia, levels of CRP, hemoglobin, albumin, and clinical status at discharge. Patients with no surgical related-infections, improved clinical status and values of albumin > 4g/dL, hemoglobin > 8g/dL, and CRP < 1mg/dL represented group A; the rest of subjects formed group B. We analyzed the data using Chi-Square test and compared the findings of the 2 groups calculating the relative risk and confidence intervals ( p = 0.05). Results: The percentage of patients receiving spinal anesthesia was significantly higher (48.75%) in group B versus group A (25%), with increased poor outcome and prevalence of postoperative hypotension events comparing to general anesthesia (69.23%, p = 0.0479). Additionally, elevated preoperative degrees of autonomic neuropathy strongly correlated with hypotensive episodes after spinal anesthesia (Chi-Square = 35.412, df = 2; p < 0.001). Conclusions: Chronic dialyzed patients receiving spinal anesthesia presented more often unfavorable prognosis, hypotensive events and risk of sympathetic blockade. Our study highlighted that general anesthesia offered a better global control of different bioumoral variables (e.g.: hemoglobin, albumin), especially since the use of new volatile agents. Furthermore, preoperative EMG findings may be useful in predicting the risk of hypotension episodes after spinal anesthesia in chronic dialyzed individuals. Further extensive clinical trials are needed to support our results for choosing the right anesthesia type and performing preoperative EMG by routine in this group of population. SP636 CLINICAL AND PSYCHOSOCIAL FACTORS PREDICTING QUALITY OF LIFE IN HEMODIALYSIS PATIENTS Ki Sung Ahn1, Gun Woo Kang1, In Hee Lee1, Jong Hun Lee1, Yun Mi Ji1 and Jung Min Woo1 1 Catholic University of Daegu School of Medicine, Daegu, Republic of Korea Introduction and Aims: A number of patients with End-Stage Renal Disease (ESRD) have significant impairment in quality of life. Most of previous studies focused on clinical factors, although this could be derived from psychosocial factor as well. The aim of the current study was to identify the possible predictors of quality of life in clinical and psychosocial factors in hemodialysis (HD) patients. Methods: The 107 participants on HD from the Daegu Catholic University Medical Center were assessed from September to October in 2013. Patients on HD for acute kidney injury were excluded from this study. Subjects were evaluated using the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social support, Montreal Cognitive Assessment, Pittsburgh Sleep Quality Index for psychosocial factor. Laboratory and clinical information including hemoglobin, vitamin D (25(OH)D, 1,25(OH)2D3), albumin, Kt/V (a marker of dialysis adequacy), normalized protein catabolic rate (nPCR), ferritin, bone mass index (BMI), duration of HD were assessed. Euro Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D) was used for evaluating patients’ quality of life. Stepwise multivariate logistic regression with backward selection was performed. Results: The mean of EQ-5D index score was 0.702 (SD=0.199). The variables showed significant association with EQ-5D were depression (r=-0.381, p<0.001), anxiety (r=-0.346, p<0.001), support from friends (r=0.370, p<0.001), cognitive function (r=0.227, p=0.015), insomnia (r=-0.181, p=0.043), duration of HD (r=-0.207, p=0.025), High-Burden Caregivers, defined as scores greater than or equal to the mean (n = 12) M ± SD 16.00±2.89 7.52±1.23 7.99±2.44 Statistical Significance p-value 0+ 0+ 0.012 albumin (r=0.175, p=0.048) and BMI (r=0.188, p=0.037). Multiple regression showed that anxiety ( p<0.001), cognitive function ( p=0.049) and BMI ( p=0.026) were independent predictors of impaired quality of life. Conclusions: This study explored the determinants of high susceptibility to the impaired quality of life in HD patients. We found that the impaired quality of life is associated with the anxiety, cognitive function and BMI. We should consider psychosocial factors as well as clinical ones for improving the quality of life in HD patients. SP637 MODERN MANAGEMENT OF DIALYSIS CENTER IMPROVES THE PATIENTS’ HEALTH STATUS Leszek Domanski1, Karolina Kłoda1, Tomasz Prystacki1, Krzysztof Safranow1, Violetta Dziedziejko1 and Kazimierz Ciechanowski1 1 Pomeranian Medical University In Szczecin, Szczecin, Poland Introduction and Aims: Hemodialysis (HD) remains the main method of end stage renal disease (ESRD) therapy in Poland. Well-being of patients undergoing dialysis can be measured through assessment of the dialysis effectiveness and biochemical blood parameters evaluation. Dialysis index estimated with use of single pool Kt/V or urea reduction ratio (URR), are standard measures used to quantify HD treatment adequacy. The aim of this study was the analysis of 9 dialysis centers (DCs) modern management association with patients’ health status evaluated through HD effectiveness, anemia severity, iron metabolism, blood pressure control, Ca and P concentrations. Methods: A retrospective review (2000-2012) of 16439 HD patients medical records was performed. All these individuals originated from 9 DCs, which began to be managed efficiently at different time points. We analyzed the HD adequacy expressed with spKt/V and URR. Moreover, the current duration of HD (hours per week) and total time of HD treatment (months) was also recorded. Patients’ anemia severity and iron (Fe) metabolism parameters were assessed. The serum concentration of Ca, P, and Ca x P product were evaluated. Finally, subjects’ systolic (SBP) and diastolic blood pressure (DBP) were noted down and mean arterial pressure (MAP) was estimated. Results: The average HD duration per week and total time of HD treatment were significantly longer in managed time period ( p<0.00001 and p<0.00001 respectively). The effectiveness of dialysis measured with URR and spKt/V was significantly higher in managed DCs ( p<0.00001 and p<0.00001 respectively). The anemia severity and iron metabolism parameters - Hb, ferritin, administration of ESA per week and per kg body weight, and administration of Fe per week differed significantly between unmanaged and managed time period ( p<0.00001, p=0.0009, p<0.00001, p<0.00001and p<0.00001 respectively). The P concentrations and Ca x P product were significantly lower in managed time period ( p<0.00001 and p<0.00001 respectively). DBP and MAP were significantly lower in managed time period ( p=0.02 and p=0.009 respectively). Conclusions: Results from our study confirm that modern management of dialysis center improves patients’ health status evaluated through HD effectiveness, anemia severity, iron metabolism, blood pressure control, Ca and P concentrations. SP638 CAN COMBINED ASSESSMENT OF SMALL MOLECULE UREMIC MARKERS IMPROVE PREDICTION OF DIALYSIS PATIENTS’ SURVIVAL? Jana Holmar1, Ivo Fridolin1, Fredrik Uhlin2, Merike Luman3 and Anders Fernström2 1 Tallinn University of Technology, Tallinn, Estonia, 2Linköping University, Linköping, Sweden, 3North Estonian Medical Centre, Tallinn, Estonia Introduction and Aims: It has been reported that the mean life expectancy of hemodialysis patient is less than 3 years [1]. Therefore, markers and methods for patient outcome estimation are highly longed for. Widely used small molecular weight markers for estimating kidney function and dialysis adequacy are creatinine and urea [2]. Using urea nitrogen appearance in serum/urine/dialysate allows to calculate of PNA ( protein nitrogen appearance) and/or nPNA (normalized PNA) for estimation of nutritional status in dialysis patients [3]. Several studies suggest that a high level of uric acid (UA) may play an important role in the development of hypertension, renal disease and cardiovascular events [4-8]. In some regions, UA is considered as an essential molecule to monitor in dialysis patients [9]. The purpose of this study was to examine if simultaneous monitoring of two small molecule uremic markers, urea and UA, could be related to 3-year survival of dialysis patients. iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014 Abstracts Nephrology Dialysis Transplantation Methods: The study was performed after approval of the protocol by the Regional Ethical Review Board, Linköping, Sweden. 30 dialysis patients (26 male and 4 female, mean age 73±11 years) were followed. Logistic (logit) regression analysis was used for creating models for 3 years survival probability estimation. Since patient’s baseline creatinine level turned out to be an insignificant parameter for the model ( p>0.05), baseline serum urea and UA levels were selected for independent parameters. Three models were created: two single molecules based and one combined model. The performance of the models was evaluated by Receiver Operating Characteristic (ROC) curve. Results: During the follow-up 21 patients died and 9 survived. Figure 1 shows that using combined logistic regression models could lead to more accurate results, compared to a single molecule model. It suggests that survival probability may be determined by a set of causal factors. Figure 1. ROC curves of the created models for estimating dialysis patient’s 3 year survival. Models used baseline urea, UA or combination of both for prediction. Conclusions: The main limitation of this study was a small study group. However, by our knowledge this kind of parameter combining approach is unique and has a potential to improve the quality of dialysis, and hopefully also life expectancy of dialysis patients. The future goal is to test created models in a larger independent validation cohort and make adjustments if needed. References: 1. Stokes, J.B., Trans Am Clin Climatol Assoc, 2011.2. Yavuz, A., et al., Semin Dialysis, 2005.3. Fouque, D., et al., Nephrol Dial Transplant, 2007.4. Feig, D.I., et al., N Engl J Med, 2008.5. Høieggen, A., et al., Kidney Int, 2004.6. Viazzi, F., et al., J Clin Hypertens, 2006.7. Kanbay, M., et al., Blood Purif 2010.8. Gustafsson, D., et al., BMC Nephrol., 2013.9. Nakai, S., et al., Ther Apher Dial, 2013. Patient Health Questionnaire (PHQ) with only 2 questions (PHQ-2). A score of 3 or greater prompted the administration of the brief version of the Geriatric Depression Scale (GDS) with 5 instead of 15 questions (GDS-5) as a confirmation of depression symptoms, and of the full PHQ-9 (9 questions), used as a grading instrument. A GDS-5 score of 2 or greater was considered as positive for depression screening. PHQ-9 scores of 5, 10, 15 and 20 represented cutpoints for mild, moderate, moderately severe and severe depression. Demographic and clinical variables were also analyzed and related to the questionnaires scores. Results: The study sample consisted of 22 males and 19 females. Mean age was 78 ± 6.6 years and dialysis vintage was 48.3 ± 56.5 months. Kt/V was 1.52 ± 0.38. In the 8 patients with positive history of thyroid pathology, euthyroidism condition was showed by normal values of TSH. PHQ-2 score was 3 or greater in 43.9% of patients (n= 18), with higher scores in women ( p 0.0118). Gender-related differences of PHQ-9 and GDS-5 scores were not statistically significant. Considering the sub-sample of 18 patients, GDS-5 resulted as positive in 100%. PHQ-9 scores stratified depression as follows: mild 22.2%, moderate 16.6%, moderately severe 39% and severe 22.2%. Simple regression analysis showed that PHQ-2 score was directly related to dialysis vintage (r 0.347, p 0.0226), and inversely related to haemoglobin concentration (r -0.32, p 0.0364), albumin concentration (r -0.433, p 0.0037) and level of education reached (r -0.375, p 0.0132). Also PHQ-9 score was inversely related to albumin concentration (r -0.548, p 0.0124). Conclusions: In our hemodialysis population depressive symptoms were highly prevalent, consistently to previous literature data, which show prevalence of 24-58% in dialysis patients, higher than general population and comparable to cancer patients. Further, depressive symptoms were relevant (moderate or worse) in almost 80% of patients, likely influencing health and quality of life of patients and of their care givers. SP640 RELATIONSHIP BETWEEN RESTLESS LEGS SYNDROME AND MORTALITY IN HEMODIALYSIS PATIENTS Shigeru Otsubo1, Ken Tsuchiya2, Takashi Akiba2 and Kosaku Nitta2 Sangenjaya Hospital, Tokyo, Japan, 2Tokyo Women’s Medical University, Tokyo, Japan 1 Introduction and Aims: Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by paraesthesia, dysaesthesia and the irresistible urge to move the legs especially at night. Its prevalence is much higher among dialysis patients compared to the general population. RLS is known to associate with depression and quality of life. Recently, the association between the severity of RLS and the risk of new cardiovascular events in hemodialysis patients was also reported. In this study, we examined the relationship between RLS and mortality in hemodialysis patients. Methods: A total of 67 patients receiving maintenance hemodialysis at Sangenjaya Hospital were enrolled in this study. Clinical data, including age, gender, duration of hemodialysis therapy and cause of end-stage kidney disease, were collected. The clinical follow-up data were obtained from the hospital records. A peripheral blood sample was obtained before hemodialysis on a Monday or a Tuesday, and standard biological data were measured. RLS was diagnosed according to the four diagnostic criteria established by the International RLS Study Group. The clinical endpoints were defined as death from any cause. Cox proportional hazards model for the predictor of survival was examined. We divided patients according to the presence or absent of RLS and compared the survival rate between the groups. The survival curves were estimated using the Kaplan-Meier method followed by a log-rank test. Results: RLS affected 14.9 % of the study population. The mean observation period was 2.8 ± 0.8 years. During the follow-up period, 15 deaths were recorded. In the univariate regression analysis, the hazard ratio (HR) of patients with RLS was 2.16 (95% CI, 1.25 3.61, P=0.008). A multivariate Cox analysis which include age, albumin, creatinine and presence of diabetic nephropathy identified RLS as an independent predictor of mortality (HR 2.19 (95% CI 1.21 - 3.93), P=0.011). The survival curves showed a statistically significant difference between patients with and without RLS (P=0.010). Patient survival rate at 2 years was 70.0 % in the patients with RLS group and 91.0 % in the patients without RLS. Conclusions: RLS was a risk factor for mortality and acted independently of other risk factors, including age, albumin, creatinine and presence of diabetic nephropathy. SP638 SP639 SP641 PREVALENCE OF DEPRESSION SYMPTOMS, ESTIMATED BY ULTRA-BRIEF SCREENING SELF-ADMINISTERED QUESTIONNAIRES, IN ELDELRY HEMODIALYSIS PATIENTS Alessandro Palermo1, Paola Cusimano1 and Grazia Locascio1 1 Centro Emodialitico Meridionale, Palermo, Italy Introduction and Aims: Depression is common among elderly people, and some studies showed that its prevalence is higher in hemodialysis patients and is associated with worse quality of life and increased mortality. Screening of depression symptoms can be performed using some validated self-administered questionnaires, which can be used as both a diagnostic module as well as a depression severity score. We aimed to perform a screening for depression among elderly hemodialysis patients using 3 different self-administered questionnaires. Methods: Among the patients followed in our Dialysis Centre, 41 elderly (over 65 years) patients received the questionnaires. First, patients had to fill in the ultra-brief Volume 29 | Supplement 3 | May 2014 Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 DOES DIABETIC NEPHROPATHY INCREASES CHRONIC COMPLICATIONS? A MULTICENTER CLINICAL STUDY OF DIABETIC NEPHROPATHY ON HEMODIALYSIS COMPARED WITH A COSMOPOLITAN RENAL REGISTRY REPORT Yishen Wang1 and Niansong Wang1 Shanghai No.6 People's Hospital, Shanghai, China 1 Introduction and Aims: Diabetic nephropathy (DN) is second leading cause of end stage renal disease (ESRD) and hemodialysis (HD) following chronic glomerulonephritis in China. Chronic complications of HD patients (e.g., anemia) are very common in ESRD patients caused by DN, as it is suggested to increase the risk of complications in HD patients. We done the first large scale multicenter clinical study about those patients in China. This article is to compare the chronic complications and treatment of DN patients on HD with all HD patients on Shanghai renal registry annual report (the biggest cosmopolitan city in China with a population of over 23 doi:10.1093/ndt/gfu158 | iii Abstracts million), in order to find the difference between these 2 groups of patients and provide evidence for treatment guidelines. Methods: During 2011.3∼2012.3 558 DN patients on HD in 39 hemodialysis centers in Shanghai were enrolled and compared with 8473 HD patients on 2012 Shanghai renal registry annual report. Results: There were similar proportion of male patients in HD and DN (57.8% versus 61.1%) groups (P>0.05). More patients in DN group (41.2%) were in elderly age group (≥65 years old) than HD group (34.8%) (P<0.01). There was significant difference between HD (65.6% within 1-5 years and 3.4% over 15 years) and DN groups (73.5% within 1-5 years and no patients over 15 years) in dialysis vintage (P<0.001). In terms of hemoglobin (Hb) and hematocrit (Hct) level, there was no significant difference of Hb between HD and DN (P>0.05) groups, but significant difference of Hct (30.5% versus 31.5%, P<0.01). The average erythropoietin (EPO) dosages were similar in HD and DN groups (8185 versus 8263 IU per week, P>0.05). There was no significant difference of URR, KT/V, BMI, iPTH, serum total calcium, total protein, albumin (P>0.05), but significant difference of serum phosphate Nephrology Dialysis Transplantation (2.0 versus 1.7 mmol/L, P<0.001) in DN and HD groups. There was significant difference in vascular access between DN and HD groups (P<0.001). Although over 80% patients in both groups use arteriovenous fistulas (AV fistulas), more patients in HD group were using temporary venous catheter than permanent venous catheter (12.5% versus 5.8%) while more patients in DN group were using permanent venous catheter than temporary venous catheter (10.8% versus 6.8%). Both HD and DN groups had similar proportion of HBV (7.2% versus 15.2%) and HCV infection rate (5.9% versus 10.3%)(P>0.05). Conclusions: Compared with all HD patients, DN patients on HD were older, had shorter vintage of dialysis, higher phosphate and more permanent venous catheter use. This may be because the progression to DN usually takes 10-20 years after diabetes, patients are usually older and more fragile, with more complications and less life expectancy. Also, since maintenance HD is necessary for most DN patients on HD, permanent venous catheter is preferred than temporary venous catheter. Both DN on HD patients and all HD patients had anemia, similar Hb, EPO dosage, serum protein, iPTH, dialysis adequacy and similar rate of virus infection. iii | Abstracts Downloaded from https://academic.oup.com/ndt/article-abstract/29/suppl_3/iii272/1882257 by guest on 27 July 2018 Volume 29 | Supplement 3 | May 2014