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Hospitalizations resulting from congestive heart failure in patients with end stage renal disease resulting from diabetes after renal transplantation compared with patients on the renal transplant waiting list
TENTH ANNUAL CLINICAL NEPHROLOGY MEETING ABSTRACTS 33 DEVELOPMENT OF SECONDARY HYPERPARATHYROIDISM (HPT) IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY. Nabila Hnssain, Sergio Acchiardo,Kim Huch.Nephrology, Ochsner Medical Institute, New Orleans, LA and University of Teunessee, Memphis, TN. Metabolic bone disease is associated with high morbidity and mortality in ESILD patients. Secondary HPT commences in early renal insufficiency and despite the extensive work done in past our knowledge is still limited. We evaluated 70 patients with CRI, senma creaimine>l.8 mg/dl. All patients were black, mean age 52±14 yrs, 54% were males and main causes of renal disease were HTN 47% and Diabetes 28.5%. We measured serum ereatinine, iPTH levels, serum calcium and phosphorus levels. The patients were divided in 3 groups. Group I: I8 patients with mean serum ereatinine 2.19±0.2 rag/d1 and iPTH I33±89 pg/ml. Group 2:33 patients with mean serum creatinine 3.72i0.6 nlg/dl and iPTH 319±237 pg/ml and Group 3:19 patients with mean serum creathiine 7.24:t:2 mg/dl and iPTH 441±248 pg/mt. In all groups senun creatiulrte correlated with iPTH levels as does corrected serum calcium levels. In all patients expect one phosphorus levels were <6.0 mg/dl and did not correlate with iPTH. Age also correlated with iPTH, elderly patients tend to have lower iPTH levels at the same degree uf renal insufficiency. Even after adjustments for other factors females had higher iPTH levels than males. The same was tree for patients with rapid decline of renal functions. Conclusions: females, young age and rate ufprogressiun of renal disease irrespective of etiology correlated with severity of HPT in patients with chronic renal insufficiency.
34 PSYCHOSOCLALFACTORS AND NONCOMPLIANCE IN HEMODIALYSIS (HE)) PATIENTS (PTS). Nabila Hussain; Joanna Q. Hudson Saba Sile, Patricia Cowan, Naseeruddin Khan, Sergio Acehiardo.Nephrningy, Ochsner Medical Institute, New Orleans, LA and University of Tennessee, Memphis, TN. Noncompliance is common in HD pts and results in poor quality of dialysis. Data on the role of psychohigical factors in noncompliance is limited. Depression is the most prevalent psychological problem in HD pts. This study determined the relationship between depression scores (Becks Depression Inventory=BDl) and compliance with HD (# missed or shortened HD sessions, interdialytic weight gain), adequacy of dialysis (Kt/V), nutritional status (albumin, phosphorus), anemia, and demographic data using Pearson's Correlations. Subjects completed the BDI and HD data were collected for the preceding 6-month period. Differences in variables between groups with varying severity of deprassion were determined using ANOVA. Subjects (n=74) were predominantly black (99%), unemployed (85%), male (55%), lived with family or a significant other (70%), had a mean age of 51.5±14.4 yrs (range 21-93) and a mean time on HD of 5.1±5.0 yrs (range 0.6-21). BDI score was not significantly associated with missed or shortened HD, weight gain, Kt/V, phosphorus, albumin, age, education, or yrs on HD. Older age was associated with less weight gain (r=-.26, p=0.02), lower phosphorus (';=-.36, p=.002) and lower albumin (r=-.36, p=.03). There was a trend toward an increased number of shortened HI) sessions (r=.22,13=.06)with longer time on HD. Groups with increased severity of depression tended to have poorer Kt/V I Groups based upon Becks Depression Inventory Normal Mild Moderate Severe (n=28) (n=24) (n=16) (n=6) KtfV 1.35:t:0.15 1.39±0.22*^ 1.29±0.19" 1.23±0.18" Missed 1.96 • 2.87 1.42 ± 2.08 i .25 ± 1.61 2.33± 2.42 : ~Sbortened 12.4:t:15.4 11.6~:11.55 12.3::10.21 12.7:k10.60 i Wt gain (Ibs) 7.8 ± 2.64 7.4 ± ;2.08 7.7 ± 1.45 7.85 ±:2.64 ; ?hqs. ~mg/dl) 5.73± 1.77 5.85 ± 1.50 5.94± 1.52 5.73 ± 1.77 Mb. (g/dI) 3.73± 0.35 4.01 ± 0.49 3.88 ± 0.28 3.73 ± 0.35 Note: Values reported as mean ± SD. * or ^ p<0.10 between groups with like symbols. Increasing severity of deprassion did not result in greater noncompliance. Adequacy of dialysis contributes to severity of depression in HD pts.
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35 ACUTE CORONARY SYNDROMES IN PATIENTS WITH END STAGE RENAL DISEASE RESULTING FROM DIABETES AFTER RENAL TRANSPLANTATION COMPARED WITH PATIENTS ON THE RENAL TRANSPLANT WAITING LiST liman O. Hvnolite. 2Jay Bucci, M.D., 2Christina M. Ynan, M.D., 3Allan Tayl'o~; M.D., 4panl Hshieh, Ph.D., 4David Cmess, Ph.D., 5Lawranee Y.C. Agodoa, MD, 2Kevin C. Abbott, M.D. Ioffiee of Minority Health Research Coordination, National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 2Nephrology Service, Walter Reed Army Medical Center (WRAMC), Washington, D.C., and Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 3Cardiology Service, WRAMC, Washington, D.C 4Epidemiology and Biostatistics, USUHS, Bethesda, MD 5NIDDK, NIH, Bethesda, MD Background: The possible impact of renal transplantation on acute coronary syndromes (ACS) in patients with ESRD due to diabetes has not been studied in a national population. Methods: Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994-30 June t997. Cox nonproportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for time to the most recent hospitalization for ACS (including acute myocardial infarction, unstable angina, or other acute coronary syndromes, ICD9 Code 410.x or 4l l.x) for a given patient in the study perind, controlling for demographics and comorbidities in the medical evidence form (HCFA 2728). Results: After renal transplantation, patients had an ingidenee of ACS of 0.79% per patient year, compared to 2.59% per patient year prior to transplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for ACS (HR 0.38, 95% confidence interval, 0.30-0.49). Conclusions: Accounting for selection bias, patients with ESRD due to diabetes on the renal transplant waiting Iist were much less likely to be hospitalized for ACS after renal transplantation, despite the presumed atherogenic risk of immunosuppressive medications.
36 HOSPITALIZATIONS RESULTING FROM CONGESTIVE EI~EART FAILURE IN PATIENTS WITH END STAGE RENAL DISEASE RESULTING FROM DIABETES AFTER REN&L TRANSPLANTATION COMPARED WITH PATIENTS ON THE RENAL TRANSPLANT WAITING LIST iIman O. Hwolite, 2Jay Bucci, M.D., 2Christina M. Yuan, M.D., 3AlIan Taylor, M.D., 4paul Hshieh, Ph.D., 4David Cmess. Ph.D., 5Lawrence Y.C. Agndoa, MD, 2Kevin:C. Abbott, M.D. !Office of Minority Health Research Coordination; NationaI Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 2Nephrology Service, Walter Reed Army Medical Center (WRAMC), Washington, D.C., and Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 3Cardiology Service, WRAMC, Wash:ington, D.C 4Epidemiology and Biostatistics, USUHS, Bethesda, ME) 5NIDDK, NIH, Bethesda, MD Background: The possible impact of renal transplantation on congestive heart failure (CHF) hi patients with ESRD due to diabetes has not been studied in a national population. Methods: Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas ~canspIant waiting list from 1 July 1994-30 June 1997. Cox nonproportional hazards regression models were used to calculate adjusted, time-dependent relative risks (FIR) for time to the most recent hospitalization for CHF (ICD9 Code 428.x) for a given patient in tile study period, controlling for both demographics and eomorbidities in the medical evidence form (HCFA 2728). Results: After renal transplantation, patients had a rate of CHF of 0£8% per patient year, compared to 2.58% per patient year prior to trunsplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for CHF (HI{ 0.64, 95% confidence interval, 0.54,-0.77), as were a history of hemndialysis (vs. peritoneal dialysis), increased age, higher hematocrit at presentation to ESRD, and a history of prior CHF. Conclusions: Accounting for selection bias, patients with ESRD due to diabetes on the renal transplant waiting list were much less likely to be hospitalized for CHF after renal transplantation, despite post transplant complications due to immunosuppression.
34 PSYCHOSOCLALFACTORS AND NONCOMPLIANCE IN HEMODIALYSIS (HE)) PATIENTS (PTS). Nabila Hussain; Joanna Q. Hudson Saba Sile, Patricia Cowan, Naseeruddin Khan, Sergio Acehiardo.Nephrningy, Ochsner Medical Institute, New Orleans, LA and University of Tennessee, Memphis, TN. Noncompliance is common in HD pts and results in poor quality of dialysis. Data on the role of psychohigical factors in noncompliance is limited. Depression is the most prevalent psychological problem in HD pts. This study determined the relationship between depression scores (Becks Depression Inventory=BDl) and compliance with HD (# missed or shortened HD sessions, interdialytic weight gain), adequacy of dialysis (Kt/V), nutritional status (albumin, phosphorus), anemia, and demographic data using Pearson's Correlations. Subjects completed the BDI and HD data were collected for the preceding 6-month period. Differences in variables between groups with varying severity of deprassion were determined using ANOVA. Subjects (n=74) were predominantly black (99%), unemployed (85%), male (55%), lived with family or a significant other (70%), had a mean age of 51.5±14.4 yrs (range 21-93) and a mean time on HD of 5.1±5.0 yrs (range 0.6-21). BDI score was not significantly associated with missed or shortened HD, weight gain, Kt/V, phosphorus, albumin, age, education, or yrs on HD. Older age was associated with less weight gain (r=-.26, p=0.02), lower phosphorus (';=-.36, p=.002) and lower albumin (r=-.36, p=.03). There was a trend toward an increased number of shortened HI) sessions (r=.22,13=.06)with longer time on HD. Groups with increased severity of depression tended to have poorer Kt/V I Groups based upon Becks Depression Inventory Normal Mild Moderate Severe (n=28) (n=24) (n=16) (n=6) KtfV 1.35:t:0.15 1.39±0.22*^ 1.29±0.19" 1.23±0.18" Missed 1.96 • 2.87 1.42 ± 2.08 i .25 ± 1.61 2.33± 2.42 : ~Sbortened 12.4:t:15.4 11.6~:11.55 12.3::10.21 12.7:k10.60 i Wt gain (Ibs) 7.8 ± 2.64 7.4 ± ;2.08 7.7 ± 1.45 7.85 ±:2.64 ; ?hqs. ~mg/dl) 5.73± 1.77 5.85 ± 1.50 5.94± 1.52 5.73 ± 1.77 Mb. (g/dI) 3.73± 0.35 4.01 ± 0.49 3.88 ± 0.28 3.73 ± 0.35 Note: Values reported as mean ± SD. * or ^ p<0.10 between groups with like symbols. Increasing severity of deprassion did not result in greater noncompliance. Adequacy of dialysis contributes to severity of depression in HD pts.
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35 ACUTE CORONARY SYNDROMES IN PATIENTS WITH END STAGE RENAL DISEASE RESULTING FROM DIABETES AFTER RENAL TRANSPLANTATION COMPARED WITH PATIENTS ON THE RENAL TRANSPLANT WAITING LiST liman O. Hvnolite. 2Jay Bucci, M.D., 2Christina M. Ynan, M.D., 3Allan Tayl'o~; M.D., 4panl Hshieh, Ph.D., 4David Cmess, Ph.D., 5Lawranee Y.C. Agodoa, MD, 2Kevin C. Abbott, M.D. Ioffiee of Minority Health Research Coordination, National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 2Nephrology Service, Walter Reed Army Medical Center (WRAMC), Washington, D.C., and Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 3Cardiology Service, WRAMC, Washington, D.C 4Epidemiology and Biostatistics, USUHS, Bethesda, MD 5NIDDK, NIH, Bethesda, MD Background: The possible impact of renal transplantation on acute coronary syndromes (ACS) in patients with ESRD due to diabetes has not been studied in a national population. Methods: Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994-30 June t997. Cox nonproportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for time to the most recent hospitalization for ACS (including acute myocardial infarction, unstable angina, or other acute coronary syndromes, ICD9 Code 410.x or 4l l.x) for a given patient in the study perind, controlling for demographics and comorbidities in the medical evidence form (HCFA 2728). Results: After renal transplantation, patients had an ingidenee of ACS of 0.79% per patient year, compared to 2.59% per patient year prior to transplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for ACS (HR 0.38, 95% confidence interval, 0.30-0.49). Conclusions: Accounting for selection bias, patients with ESRD due to diabetes on the renal transplant waiting Iist were much less likely to be hospitalized for ACS after renal transplantation, despite the presumed atherogenic risk of immunosuppressive medications.
36 HOSPITALIZATIONS RESULTING FROM CONGESTIVE EI~EART FAILURE IN PATIENTS WITH END STAGE RENAL DISEASE RESULTING FROM DIABETES AFTER REN&L TRANSPLANTATION COMPARED WITH PATIENTS ON THE RENAL TRANSPLANT WAITING LIST iIman O. Hwolite, 2Jay Bucci, M.D., 2Christina M. Yuan, M.D., 3AlIan Taylor, M.D., 4paul Hshieh, Ph.D., 4David Cmess. Ph.D., 5Lawrence Y.C. Agndoa, MD, 2Kevin:C. Abbott, M.D. !Office of Minority Health Research Coordination; NationaI Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 2Nephrology Service, Walter Reed Army Medical Center (WRAMC), Washington, D.C., and Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD 3Cardiology Service, WRAMC, Wash:ington, D.C 4Epidemiology and Biostatistics, USUHS, Bethesda, ME) 5NIDDK, NIH, Bethesda, MD Background: The possible impact of renal transplantation on congestive heart failure (CHF) hi patients with ESRD due to diabetes has not been studied in a national population. Methods: Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas ~canspIant waiting list from 1 July 1994-30 June 1997. Cox nonproportional hazards regression models were used to calculate adjusted, time-dependent relative risks (FIR) for time to the most recent hospitalization for CHF (ICD9 Code 428.x) for a given patient in tile study period, controlling for both demographics and eomorbidities in the medical evidence form (HCFA 2728). Results: After renal transplantation, patients had a rate of CHF of 0£8% per patient year, compared to 2.58% per patient year prior to trunsplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for CHF (HI{ 0.64, 95% confidence interval, 0.54,-0.77), as were a history of hemndialysis (vs. peritoneal dialysis), increased age, higher hematocrit at presentation to ESRD, and a history of prior CHF. Conclusions: Accounting for selection bias, patients with ESRD due to diabetes on the renal transplant waiting list were much less likely to be hospitalized for CHF after renal transplantation, despite post transplant complications due to immunosuppression.