229: Filter Lifespan in Anticoagulation-Free Continuous Renal Replacement Therapy (CRRT)

A80 229 FILTER LIFESPAN IN ANTICOAGULATION-FREE CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) Sam Wu, Arasu Gopinath, Jeffrey Berns, Sidney Kobrin Renal, Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA Clotting of the extracorporeal circuit is a common problem in CRRT. A variety of anticoagulation methods, each associated with potential complications, have been utilized to prevent circuit clotting. There have been few studies in the literature examining the filter longevity of CRRT therapy performed without anticoagulation. We conducted a retrospective case-series examining 75 consecutive filters from 21 patients undergoing continuous venovenous hemodialyis (CVVHD) using the NxStage system. The usual blood flow rate was 300 cc/min. No patients received systemic or regional anticoagulation prescribed specifically for CVVHD. The lifespan and reason for termination for each filter was examined. In addition to evaluating filter life for all circuits, we performed a separate analysis for an adjusted group that excluded circuits that were terminated for nonCRRT related reasons (ie. death, renal recovery, etc.)

Anticoagulation-free CVVHD performed at a blood flow of 300 cc/min is associated with an acceptable filter life that is comparable to use of heparin and citrate-based anticoagulation. CVVHD without anticoagulation should be strongly considered especially in patients at high-risk for bleeding.

230 COMPARISON OF COSTS BETWEEN PARICALCITOL AND DOXERCALCIFEROL IN HEMODIALYSIS PATIENTS Steven E. Marx, J. Ruth Wu-Wong, Dennis Andress, Paul Audhya, Abbott Laboratories, Abbott Park, IL, USA In hemodialysis patients, decreased vitamin D receptor (VDR) activation is one of the key contributors to the development of secondary hyperparathyroidism (SHPT). The VDR activator paricalcitol (Zemplar) is the standard of care for controlling SHPT. Recent clinical observations found that paricalcitol therapy is associated with reduced hospitalization and mortality risk for dialysis patients beyond PTH control compared to calcitriol. However, there is limited evidence of differential costs associated with paricalcitol compared to doxercalciferol. This study evaluated the costs incurred by hemodialysis patients with a focus on comparing paricalcitol (n=443) and doxercalciferol (n=199) therapy. Cost values were obtained from the Thompson Medstat MarketScan database (active employees, 18 years and over) that initiated paricalcitol or doxercalciferol claim between 1/1/2005 and 3/31/2006, and remained enrolled for at least 90 days. Many patients were on other medications including phosphate binders and cinacalcet. Patients who received both drugs during this period were excluded. Cost per patient year was used for normalization in each treatment group. The drug acquisition cost alone was significantly greater for paricalcitol; however, after adjusting for all the costs associated with hospitalization and non-hospitalization events when all costs are included in the analysis, the difference in the total cost per patient year was only 4% between the two groups. These descriptive results suggest the greater cost of paricalcitol may be off-set by a reduction in overall costs when compared to doxercalciferol. These results are consistent with previous findings that paricalcitol therapy is associated with reduced hospitalization and improved survival. Further comparative studies are necessary to validate these results.

NKF 2009 Spring Clinical Meetings Abstracts 231 STATINS NOT ASSOCIATED WITH IMPROVED PATIENT OR GRAFT SURVIVAL IN KIDNEY TRANSPLANT (KTX) RECIPIENTS RECEIVING TACROLIMUS Nizar Younas, Christine Wu, Ron Shapiro, Jerry McCauley, James Johnston, Henkie Tan, Amit Basu, Heidi Schaefer, Cynthia Smetanka, Wolfgang Winkelmayer, Mark Unruh University of Pittsburgh, Pittsburgh, PA, USA. The beneficial effects of early statin use in kidney transplant (Ktx) recipients, especially those on tacrolimus, is not well established. We evaluated the predictors of statin use in such a population and examined its association with subsequent patient and kidney allograft survival. We examined 715 consecutive patients who underwent Ktx between January 1998 and January 2002. Statin use was assessed at baseline and 3, 6, 9, and 12 months post transplant. Patients were followed prospectively for allograft and patient survival. Twenty three percent of our Ktx recipients were exposed to statins. Greater than ninety percent of our patients received tacrolimus based immunosuppression. Older age and higher triglyceride levels were associated with higher rate of statin use. Severe liver disease, CMV IgG seropositivity, higher creatinine at 3 months, and use of an antibody induction and tacrolimus monotherapy protocol were associated with lower rate of statin use. There was no association between statin use and a diagnosis of cardiovascular disease. Patients in the statin group received statins within the first year after the transplant. Graft and patient survival were examined beginning one year after kidney transplantation and up till a mean follow up period of 6.6 years. There was no difference in patient survival [HR 0.99; 95%CI 0.72-1.37] or graft survival [HR 0.97; 95% CI 0.76-1.24]. After adjustment for multiple variables including age, history of myocardial infarction, sex, baseline creatinine and tolerance protocol, statins were not associated with improved patient or graft survival. Statin use was not associated with a history of cardiovascular disease suggesting the need for more evidence of efficacy of statins in this population. In a Ktx population primarily receiving tacrolimus based immunosuppression, early statin use was not associated with improved patient or graft survival.

232 CKD AND INCIDENCE OF ARRHYTHMIAS IN PATIENTS WITH INTERNAL CARDIAC DEFIBRILLATORS Marc Zelkowitz, Sri Bonam, Nandita Singh, Salman Waheed, Ashok Talreja, Flavio Rivera, Ofer Sagiv, Jay Gross, Hillel Cohen and Anjali Acharya, Jacobi Medical Center/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA Epidemiological studies have shown a significant rise in the numbers of patients with CKD. However, there is a steep drop between stages III-V and those actually starting dialysis, which is attributed to the high mortality rate of this population. Furthermore, there is an undeniable link between kidney dysfunction and cardiovascular risk, including ventricular arrhythmias and sudden cardiac death. The purpose of this study was to study the association, if any, of decreasing estimated GFR (eGFR) in CKD with incidence of arrhythmias. We performed a retrospective chart review of 235 patients, age > 18 years, who underwent first-time internal cardiac defibrillator (AICD) placement between January 2004 and December 2006, with a minimum follow up of one year. Demographic characteristics and MDRD GFR (using serum creatinine levels at the time of AICD implant) were recorded. eGFR was dichotomized as <30 or ≥30 ml/min, and was divided into 3 categories: <30, 30-60 and 61-90 ml/min. Outpatient and inpatient AICD interrogation reports were reviewed to determine occurrence of any subsequent shock, anti-tachycardia overdrive pacing (ATP), or other arrhythmia, as well as time to first shock. eGFR of <30 ml/min was significantly associated with shock occurrence (p=.048 by chi-square) but not with ATP, or other arrhythmias such as Atrial Fibrillation/Flutter, SVT, NSVT, etc. Time to first shock (Cox analysis) also showed increased hazard of eGFR <30 ml/min, while adjusting for age and sex. No significant associations were found for eGFR categories 30-60 or 61-90 ml/min. In summary, severely reduced renal function, defined as eGFR <30 ml/min, was associated with a significant increase in the incidence of AICD shocks, which might otherwise have been fatal arrhythmias. eGFR > 30 eGFR <30 P-Value Hazard Ratio % Pts with 22.1% 40.9% .048 2.2 (95% CI Shock (N=47) (N=9) 1.1-4.5), p=.03