- Email: [email protected]
155
NKF 2007 Spring Clinical Meetings Abstracts
153
DOSING INTERVALS AND HEMOGLOBIN CONTROL IN PATIENTS WITH ANEMIA OF CHRONIC KIDNEY DISEASE TREATED WITH ERYTHROPOIESIS STIMULATING AGENTS Saul Nurko1, Rita Spirko1, Amy Law2, Vincent W. Dennis1 1 Cleveland Clinic Foundation, Cleveland, OH, USA; 2Roche Laboratories, Nutley, NJ, USA Many clinicians see a need to extend dosing intervals of current erythropoiesis stimulating agents (ESAs) beyond the approved intervals. Thus, the effects of extended intervals on hemoglobin (Hb) control in real-world practice merit further study. This retrospective chart review study examined anemia management patterns and Hb outcomes in adult outpatients treated for anemia of CKD not on dialysis at a tertiary CKD clinic. Patients receiving ESAs between Jan. 1, 2000 and Mar. 1, 2005 were eligible for the study. Those who underwent dialysis or transplantation were censored as well as those who died. Twenty-one patients received only epoetin (EPO), and seventyfour patients received only darbepoetin (DA). Sixteen patients switched from one agent to the other and were excluded from further analysis. Initial, dominant, and final dosing intervals were determined from chart review. Control of Hb was assessed by the magnitude and total duration of deviations from target range (11-12 g/dL) and the percentage of Hb measurements below, within, and above target range. Most EPO patients began therapy weekly and most DA patients began at Q2W. Many attempted extended dominant intervals (Q2W in 62% of EPO patients and Q3W in 53% of DA patients). However, 80% of EPO patients with Q2W dominant intervals returned to Q1W. Similarly, 63% of DA patients with Q3W dominant intervals had final intervals of Q2W. Patients receiving EPO at Q2W or DA at Q3W had, respectively, 44% and 25% of Hb measurements above 12 g/dL, and 31% and 43% of Hb measurements below 11 g/dL. Many patients at this center were tried on extended intervals with current agents but were returned to more frequent intervals, possibly due to unsustainable Hb control at extended intervals.
154
HYPERHOMOCYSTEINAEMIA AND TYPE IV HYPERTRIGLYCERIDAEMIA ARE COMMON CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVES Enyioma N. Obineche1, Nico Nagelkerke2, Javed Y. Pathan1, M. Gary Nicholls3, Abdishakur M. Abdulle1 1 Department of Internal Medicine; 2Community Medicine; Faculty of Medicine and Health Sciences, UAE University; Al-Ain; 3Department of Medicine, Christchurch School of Medicine, Christchurch, New Zealand. This study was initiated to quantify various risk factors for hypertension in a heterogeneous population. A random sample of 170 hypertensive subjects (mean age SEM; 46.7 0.6 yrs) and 170 healthy non-obese normotensive subjects (46.1 0.6 yrs) were closely matched for age, gender and ethnicity. Fasting plasma samples were used to measure endothelin-1 (ET-1), nitric oxide (NO), homocysteine (Hcy), and insulin by ELISA methods. Lipids, lipoproteins, blood urea nitrogen (BUN), creatinine, and glucose were measured by colorimetric methods. Hypertensives had significantly (p<0.01) higher levels of Hcy, NO, ET-1, insulin very low-density lipoprotein (VLDL) and triglycerides (TG) and lower levels of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL–C) as compared to normotensives. Moreover, Hcy correlated postively with Age, SBP, DBP, NO, BUN, creatinine, TG, VLDL, and inversely with High Density Lipoprotein Cholesterol (HDL-C) and Body Mass Index (BMI). Also, NO positively correlated with SBP, BUN, creatinine, and inversely with TC, HDL-C, and LDL, no significant correlations were observed for ET-1. In this study, hyperhomocysteinaemia is associated with hypertension, increased age, SBP, pulse, BUN and creatinine and may thus be a valuable marker in the etiology of hypertension particularly among the older population. The abnormally elevated levels of TG and VLDL in association with normal TC levels seem to indicate typical characteristics of Type IV hyper-triglyceridaemia among hypertensives and may constitute a significant risk factor for vascular complications.
A63
155
156
THE RELATIONSHIP BETWEEN BLOOD PRESSURE, OBESITY, ENDOTHELIN-1 AND PLASMA LIPIDS IN A GULF ARAB POPULATION Enyioma N Obineche, Abdishakur M Abdulle, Javed Y Pathan, Elhadi E Abbas, Mustafa N Suleiman, C M Mathews Department of Internal Medicine, Faculty of Medicine, United Arab Emirates University, Al Ain, U.A.E. This study sought to evaluate the relationship between blood pressure, obesity, dyslipidemia, fasting plasma levels of glucose (Glu), insulin (Ins) and endothelin-1 (ET-1) in United Arab Emirates (UAE) nationals. The study was conducted between the period of April 2002 to October 2005 in Al-Ain, United Arab Emirates. Plasma levels of lipids, lipoproteins, glucose, insulin and endothelin-1 (ET-1) were measured after overnight fasting in 215 UAE nationals, including 93 with untreated hypertension. In hypertensives, the levels of ET-1, non-esterified fatty acids (NEFA), triacylglycerols (TG), glucose (Glu) and insulin (Ins) were increased, but only significantly (p<0.001) for the first two parameters. High-density lipoprotein- (HDL) total cholesterol was significantly (p<0.001) decreased in hypertensives, but total and low-density lipoprotein- (LDL) cholesterol levels were unchanged. Taken as a single group, both systolic and diastolic blood pressures were significantly (p<0.01) correlated with plasma levels of NEFA, ET-1, and less significantly (p<0.05) with Ins and correlated inversely (p<0.01) with HDL- cholesterol. Plasma levels of NEFA and HDL-cholesterol were significantly (r=0.33; p<0.01) correlated directly and inversely (r=-0.25; p<0.01) respectively with ET-1 levels and inversely (r=-0.16; p<0.05) with each other. Partial correlation analysis showed that the correlations between blood pressure and ET-1 levels and HDL, but not NEFA, were independent of a range of other variables. Similarly, the correlations between ET-1 levels and HDL and NEFA were independent of the other variables, but not so the inverse correlation between HDL and NEFA. In conclusion, the results point to the importance of both raised ET-1 and dyslipidaemia in hypertension in the UAE national population and suggest an association between ET-1 and lipoprotein metabolism in the vascular endothelium.
COMPARISON OF DIABETICS AND NON-DIABETICS IN A MODERATE TO SEVERE CHRONIC KIDNEY DISEASE COHORT Aide Onime, Robert White, Karen Servilla, Antonios Tzamaloukas, Clifford Qualls, New Mexico VA Health Care System and University of New Mexico, Albuquerque, NM, USA. Diabetes accounted for 45% of incident end stage renal disease (ESRD) patients from 2000-2004. As a result of the increasing prevalence of diabetes, the incidence and prevalence of chronic kidney disease (CKD) and ESRD are expected to increase further in the next few decades. We compared diabetics and non-diabetics in a retrospective cohort (n=1325) derived from October 2005 to April 2006, with at least two eGFR values, maximum of < 60 ml/min/1.73m² within a period of 12 months (moderate to severe CKD i.e. National Kidney Foundation stages 3-5). Patients on dialysis or with a renal transplant were excluded. In the cohort 490 (37%) patients were diabetic with 97% of these male and 3% female. Diabetics when compared to non diabetics were younger (74 ± 8.9 vs. 76 ± 9.4 years), had lower eGFR (43.3 ± 10.7 vs. 46.4 ± 9.8 ml/min/1.73m²) and higher serum Cr (2 ± 1 vs. 1.8 ± 0.8 mg/dL), all at p<.001. Diabetics were at a more advanced stage of CKD than non diabetics (88% stage 3, 11% stage 4, 1% stage 5 vs. 93%, 6% and 1%, p<.05). When eGFR values were compared to values obtained in the prior 12 months it had declined more in diabetics than non-diabetics (2.3 ± 6.2 vs. 1.5 ± 5.8, ml/min/1.73m², p<.05). More diabetics had renal clinic visits (23% of the diabetic patients vs. 12% of non-diabetics, p<.001). Compared to non-diabetics, diabetics had more coronary artery disease (43% vs. 32%, p<.001), hypertension (89% vs. 79%, p<.001) and congestive heart failure (16% vs. 10%, p<.01) but not peripheral vascular disease or chronic obstructive pulmonary disease. In diabetics vs. non-diabetics, there was more use of angiotensin converting enzyme inhibitors (54% vs. 32%), angiotensin receptor blockers (17% vs. 9%) and statins (69% vs. 49%), all at p<.001. In comparison to non-diabetic chronic kidney disease (CKD), diabetic CKD is associated with more rapid decline in renal function and more cardiovascular disease, but more use of renal protective medications and more nephrology referrals, in our elderly cohort.
153
DOSING INTERVALS AND HEMOGLOBIN CONTROL IN PATIENTS WITH ANEMIA OF CHRONIC KIDNEY DISEASE TREATED WITH ERYTHROPOIESIS STIMULATING AGENTS Saul Nurko1, Rita Spirko1, Amy Law2, Vincent W. Dennis1 1 Cleveland Clinic Foundation, Cleveland, OH, USA; 2Roche Laboratories, Nutley, NJ, USA Many clinicians see a need to extend dosing intervals of current erythropoiesis stimulating agents (ESAs) beyond the approved intervals. Thus, the effects of extended intervals on hemoglobin (Hb) control in real-world practice merit further study. This retrospective chart review study examined anemia management patterns and Hb outcomes in adult outpatients treated for anemia of CKD not on dialysis at a tertiary CKD clinic. Patients receiving ESAs between Jan. 1, 2000 and Mar. 1, 2005 were eligible for the study. Those who underwent dialysis or transplantation were censored as well as those who died. Twenty-one patients received only epoetin (EPO), and seventyfour patients received only darbepoetin (DA). Sixteen patients switched from one agent to the other and were excluded from further analysis. Initial, dominant, and final dosing intervals were determined from chart review. Control of Hb was assessed by the magnitude and total duration of deviations from target range (11-12 g/dL) and the percentage of Hb measurements below, within, and above target range. Most EPO patients began therapy weekly and most DA patients began at Q2W. Many attempted extended dominant intervals (Q2W in 62% of EPO patients and Q3W in 53% of DA patients). However, 80% of EPO patients with Q2W dominant intervals returned to Q1W. Similarly, 63% of DA patients with Q3W dominant intervals had final intervals of Q2W. Patients receiving EPO at Q2W or DA at Q3W had, respectively, 44% and 25% of Hb measurements above 12 g/dL, and 31% and 43% of Hb measurements below 11 g/dL. Many patients at this center were tried on extended intervals with current agents but were returned to more frequent intervals, possibly due to unsustainable Hb control at extended intervals.
154
HYPERHOMOCYSTEINAEMIA AND TYPE IV HYPERTRIGLYCERIDAEMIA ARE COMMON CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVES Enyioma N. Obineche1, Nico Nagelkerke2, Javed Y. Pathan1, M. Gary Nicholls3, Abdishakur M. Abdulle1 1 Department of Internal Medicine; 2Community Medicine; Faculty of Medicine and Health Sciences, UAE University; Al-Ain; 3Department of Medicine, Christchurch School of Medicine, Christchurch, New Zealand. This study was initiated to quantify various risk factors for hypertension in a heterogeneous population. A random sample of 170 hypertensive subjects (mean age SEM; 46.7 0.6 yrs) and 170 healthy non-obese normotensive subjects (46.1 0.6 yrs) were closely matched for age, gender and ethnicity. Fasting plasma samples were used to measure endothelin-1 (ET-1), nitric oxide (NO), homocysteine (Hcy), and insulin by ELISA methods. Lipids, lipoproteins, blood urea nitrogen (BUN), creatinine, and glucose were measured by colorimetric methods. Hypertensives had significantly (p<0.01) higher levels of Hcy, NO, ET-1, insulin very low-density lipoprotein (VLDL) and triglycerides (TG) and lower levels of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL–C) as compared to normotensives. Moreover, Hcy correlated postively with Age, SBP, DBP, NO, BUN, creatinine, TG, VLDL, and inversely with High Density Lipoprotein Cholesterol (HDL-C) and Body Mass Index (BMI). Also, NO positively correlated with SBP, BUN, creatinine, and inversely with TC, HDL-C, and LDL, no significant correlations were observed for ET-1. In this study, hyperhomocysteinaemia is associated with hypertension, increased age, SBP, pulse, BUN and creatinine and may thus be a valuable marker in the etiology of hypertension particularly among the older population. The abnormally elevated levels of TG and VLDL in association with normal TC levels seem to indicate typical characteristics of Type IV hyper-triglyceridaemia among hypertensives and may constitute a significant risk factor for vascular complications.
A63
155
156
THE RELATIONSHIP BETWEEN BLOOD PRESSURE, OBESITY, ENDOTHELIN-1 AND PLASMA LIPIDS IN A GULF ARAB POPULATION Enyioma N Obineche, Abdishakur M Abdulle, Javed Y Pathan, Elhadi E Abbas, Mustafa N Suleiman, C M Mathews Department of Internal Medicine, Faculty of Medicine, United Arab Emirates University, Al Ain, U.A.E. This study sought to evaluate the relationship between blood pressure, obesity, dyslipidemia, fasting plasma levels of glucose (Glu), insulin (Ins) and endothelin-1 (ET-1) in United Arab Emirates (UAE) nationals. The study was conducted between the period of April 2002 to October 2005 in Al-Ain, United Arab Emirates. Plasma levels of lipids, lipoproteins, glucose, insulin and endothelin-1 (ET-1) were measured after overnight fasting in 215 UAE nationals, including 93 with untreated hypertension. In hypertensives, the levels of ET-1, non-esterified fatty acids (NEFA), triacylglycerols (TG), glucose (Glu) and insulin (Ins) were increased, but only significantly (p<0.001) for the first two parameters. High-density lipoprotein- (HDL) total cholesterol was significantly (p<0.001) decreased in hypertensives, but total and low-density lipoprotein- (LDL) cholesterol levels were unchanged. Taken as a single group, both systolic and diastolic blood pressures were significantly (p<0.01) correlated with plasma levels of NEFA, ET-1, and less significantly (p<0.05) with Ins and correlated inversely (p<0.01) with HDL- cholesterol. Plasma levels of NEFA and HDL-cholesterol were significantly (r=0.33; p<0.01) correlated directly and inversely (r=-0.25; p<0.01) respectively with ET-1 levels and inversely (r=-0.16; p<0.05) with each other. Partial correlation analysis showed that the correlations between blood pressure and ET-1 levels and HDL, but not NEFA, were independent of a range of other variables. Similarly, the correlations between ET-1 levels and HDL and NEFA were independent of the other variables, but not so the inverse correlation between HDL and NEFA. In conclusion, the results point to the importance of both raised ET-1 and dyslipidaemia in hypertension in the UAE national population and suggest an association between ET-1 and lipoprotein metabolism in the vascular endothelium.
COMPARISON OF DIABETICS AND NON-DIABETICS IN A MODERATE TO SEVERE CHRONIC KIDNEY DISEASE COHORT Aide Onime, Robert White, Karen Servilla, Antonios Tzamaloukas, Clifford Qualls, New Mexico VA Health Care System and University of New Mexico, Albuquerque, NM, USA. Diabetes accounted for 45% of incident end stage renal disease (ESRD) patients from 2000-2004. As a result of the increasing prevalence of diabetes, the incidence and prevalence of chronic kidney disease (CKD) and ESRD are expected to increase further in the next few decades. We compared diabetics and non-diabetics in a retrospective cohort (n=1325) derived from October 2005 to April 2006, with at least two eGFR values, maximum of < 60 ml/min/1.73m² within a period of 12 months (moderate to severe CKD i.e. National Kidney Foundation stages 3-5). Patients on dialysis or with a renal transplant were excluded. In the cohort 490 (37%) patients were diabetic with 97% of these male and 3% female. Diabetics when compared to non diabetics were younger (74 ± 8.9 vs. 76 ± 9.4 years), had lower eGFR (43.3 ± 10.7 vs. 46.4 ± 9.8 ml/min/1.73m²) and higher serum Cr (2 ± 1 vs. 1.8 ± 0.8 mg/dL), all at p<.001. Diabetics were at a more advanced stage of CKD than non diabetics (88% stage 3, 11% stage 4, 1% stage 5 vs. 93%, 6% and 1%, p<.05). When eGFR values were compared to values obtained in the prior 12 months it had declined more in diabetics than non-diabetics (2.3 ± 6.2 vs. 1.5 ± 5.8, ml/min/1.73m², p<.05). More diabetics had renal clinic visits (23% of the diabetic patients vs. 12% of non-diabetics, p<.001). Compared to non-diabetics, diabetics had more coronary artery disease (43% vs. 32%, p<.001), hypertension (89% vs. 79%, p<.001) and congestive heart failure (16% vs. 10%, p<.01) but not peripheral vascular disease or chronic obstructive pulmonary disease. In diabetics vs. non-diabetics, there was more use of angiotensin converting enzyme inhibitors (54% vs. 32%), angiotensin receptor blockers (17% vs. 9%) and statins (69% vs. 49%), all at p<.001. In comparison to non-diabetic chronic kidney disease (CKD), diabetic CKD is associated with more rapid decline in renal function and more cardiovascular disease, but more use of renal protective medications and more nephrology referrals, in our elderly cohort.