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COLLAPSING GLOMERULOPATHY WITH TUBULORETICULAR INCLUSION IN HIV NEGATIVE PATIENT
NKF 2014 Spring Clinical Meetings Abstracts
277 EVALUATION OF THE CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS®) INCENTER HEMODIALYSIS (ICH) SURVEY: Carly J. Paoli1, Gavin Taylor-Stokes2, James Piercy2, Matthew Gitlin1, Ron D. Hays3 & Robert Wood2; 1) Amgen, Inc., Thousand Oaks, CA; 2) Adelphi Real World, Inc., Bollington, UK; 3) University of California, Los Angeles The CMS ESRD Prospective Payment System (PPS) Quality Incentive Program (QIP) reporting measure for patient experiences with care is the CAHPS-ICH survey; however, no data on the survey have been published. The purpose of this study was to evaluate the CAHPS-ICH in a sample of ESRD patients. Patient characteristics and CAHPS-ICH responses among HD patients in the Adelphi Real World Chronic Kidney Disease Program were collected and analyzed in 2012. The CAHPS-ICH yields 3 multiitem composites: Nephrologists’ Communication & Quality of Care are scored on a scale of 1-4 while Patient Information is scored 0-1. Three 0-10 global rating items (Kidney Doctors, Dialysis Center Staff, Dialysis Center) are collapsed into 3 scoring categories (1-3). Higher CAHPS-ICH scores indicate more positive experiences with care. There were 76 facilities treating 404 eligible HD patients. Mean patient age was 57 years, mean dialysis vintage was 3 years, and 44% were female. Facility means for each CAHPS-ICH score below. Mean SD Range 25th % 75th % Nephrologists’ 3.72 0.26 3.02 - 4.05 3.58 3.92 Communication Quality of Care 3.51 0.29 2.63 - 4.01 3.35 3.73 Patient Information 0.84 0.11 0.57 - 1.01 0.76 0.91 Global Rating2.72 0.36 1.52 - 3.07 2.52 2.99 Kidney Doctors Global Rating – 2.54 0.41 1.40 - 3.10 2.23 2.90 Dialysis Centre Staff Global Rating – 2.58 0.45 1.38 - 3.10 2.20 2.98 Dialysis Centre While this study demonstrates that facilities have CAHPS-ICH scores with large differences between the 25th and 75th percentiles (in effect sizes), the complexity of the scoring algorithms may pose a challenge in interpretation for clinicians.
278 COLLAPSING GLOMERULOPATHY WITH TUBULORETICULAR INCLUSION IN HIV NEGATIVE PATIENT: Ninad Parekh, Chetana Rondla, Geovani Faddoul, Suzanne El-Sayegh, Elie El-Charabaty, Staten Island University Hospital, Staten Island, NY, USA A 27-year-old African American female presented with intermittent fever, chills, diffuse arthralgia and myalgia. On Exam, she was febrile (T 102.40F). Other vital signs were unremarkable. Normal physical exam. Laboratory work showed mild leucopenia (WBC 3200/cumm) and normocytic anemia (Hb 11.0 gm/dl). No evidence of hemolysis. Serum chemistry was within normal limits. Urinalysis showed no hematuria and 24hour urine protein was 1.4 gram. Serologic work up showed positive ANA at 1:2560; otherwise negative serology.
Kidney biopsy showed FSGS, collapsing variant (figure) (one out of eight glomeruli), and negative IF staining. EM showed endothelial cell tubuloreticular inclusions (TRI) (figure). Endothelial cell TRI are described in patients with lupus, HIV and patients treated with interferon. This patient had lupus-like disease. However, findings of kidney biopsy were not typical for any class of lupus nephritis. This patient has preserved renal function and normal complement level. Therefore, she was treated conservatively with ACEi. Review of literature found two reported cases of collapsing glomerulopathy and TRI with negative IF staining in patients with lupus-like illness. This is a rare and atypical kidney biopsy finding. Moreover, it emphasizes importance of integrating pathologic finding with clinical presentation in order to guide clinical decision-making process.
A88
279 MEDICAL STUDENT ASSESSMENT OF TECHNOLOGY UTILIZATION IN NEPHROLOGY EDUCATION DURING PRECLINICAL YEARS: Kevin Pargeter, Udayan Bhatt, The Ohio State University Medical Center, Division of Nephrology, Columbus, OH 43210, USA Technology utilized in medical education is changing the landscape of medical schools. The use of clinical simulations, audience response systems and recorded lectures are changing the way nephrology is taught. Balanced with this is the real need to stimulate interest in nephrology as a career. The transition from live lectures to recorded presentations may alter the students’ reactions to nephrology, yet he impact of using technology in renal education has not been fully defined. Therefore, we examined the effectiveness and student reactions to the deployment of educational technologies for nephrology education in the preclinical years of medical school. The 2013-2014 academic year was the first year in expanding the use of medical education technology in teaching the renal block for students at The Ohio State University College of Medicine. The renal block used a combination of case studies, recorded lecture presentations, traditional lectures, and directed readings. Students were given the opportunity to evaluate the individual teaching-learning methods. The overall scores for the different teaching methods were tabulated and compared using analysis of variance. There was no difference in the students’ response to traditional lectures compared to electronic learning presentations. Also, case studies were reviewed quite positively while directed readings were not. The response of medical students to the utilization of recorded lecture technology tools was similar to the response from traditional lectures. Directed readings received poor responses. Case studies applying the presented material were very well received and may allow an opportunity to enhance student interest in nephrology.
280 REDUCTION OF TRANSFUSIONS IN DIALYSIS PATIENTS TAKING EPOETIN ALFA IN A PLACEBO-CONTROLLED RANDOMIZED CLINICAL TRIAL Grace S. Park, Allan Pollock, Maple Fung Amgen, Inc., Thousand Oaks, CA, USA ESAs are currently part of standard anemia care for reducing transfusions and potential exposure to their risks in patients (pts) with chronic kidney disease (CKD) despite recent safety concerns regarding ESA use. We evaluated previously unpublished data from a registrational placebo (PLC)-controlled epoetin alfa (EPO) study to examine Hb concentrations and risk of transfusion. Pts with CKD on hemodialysis were enrolled in a double-blind (DB), PLC-controlled study, randomized 1:1 to receive PLC or EPO TIW for 12 weeks. All were to receive EPO during the open-label (OL) extension period that followed. The study protocol was IRB-approved, and pts provided written informed consent. EPO 10,000 U/ml was administered by body weight (at study start 0.4 ml, 0.6 ml, 0.8 ml or1.0 ml which was adjusted to maintain hematocrit [Hct] between 32-38%). Fifty pts were randomized to PLC and 51 to EPO with 94% completing the DB period and 77% completing the OL period through week 52. At baseline, pts were a mean age of 49.7 y, 49% white, 47% male, with mean Hb of 7.6 g/dl, mean Hct of 23% and median weekly serum iron of 95 ng/ml. During the 3 months pre-study, 38 PLC and 31 EPO pts required transfusions. During the DB period, 31 PLC and 10 EPO pts received transfusions (compared to pre-study within groups, p=0.0522 for PLC and p<0.0001 for EPO by McNemar’s test). By week 24 in the OL period, 7 PLC and 2 EPO patients required transfusions (p<0.0001 compared to pre-study for both). Transfusionfree probabilities during the DB period differed between the groups (log-rank test, p<0.0001); they did not differ in the OL period (p=0.095). Mean Hbs within 1 week prior to transfusions were 7.0 and 10.4 g/dl for PLC and EPO groups during the DB period, respectively. This study provides additional support regarding EPO’s ability to reduce transfusion requirements in previously untreated dialysis pts. Future studies are needed in the dialysis population to more thoroughly examine the relationship between Hb and transfusion rates in contemporary practice settings.
Am J Kidney Dis. 2014;63(5):A1-A121
277 EVALUATION OF THE CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS®) INCENTER HEMODIALYSIS (ICH) SURVEY: Carly J. Paoli1, Gavin Taylor-Stokes2, James Piercy2, Matthew Gitlin1, Ron D. Hays3 & Robert Wood2; 1) Amgen, Inc., Thousand Oaks, CA; 2) Adelphi Real World, Inc., Bollington, UK; 3) University of California, Los Angeles The CMS ESRD Prospective Payment System (PPS) Quality Incentive Program (QIP) reporting measure for patient experiences with care is the CAHPS-ICH survey; however, no data on the survey have been published. The purpose of this study was to evaluate the CAHPS-ICH in a sample of ESRD patients. Patient characteristics and CAHPS-ICH responses among HD patients in the Adelphi Real World Chronic Kidney Disease Program were collected and analyzed in 2012. The CAHPS-ICH yields 3 multiitem composites: Nephrologists’ Communication & Quality of Care are scored on a scale of 1-4 while Patient Information is scored 0-1. Three 0-10 global rating items (Kidney Doctors, Dialysis Center Staff, Dialysis Center) are collapsed into 3 scoring categories (1-3). Higher CAHPS-ICH scores indicate more positive experiences with care. There were 76 facilities treating 404 eligible HD patients. Mean patient age was 57 years, mean dialysis vintage was 3 years, and 44% were female. Facility means for each CAHPS-ICH score below. Mean SD Range 25th % 75th % Nephrologists’ 3.72 0.26 3.02 - 4.05 3.58 3.92 Communication Quality of Care 3.51 0.29 2.63 - 4.01 3.35 3.73 Patient Information 0.84 0.11 0.57 - 1.01 0.76 0.91 Global Rating2.72 0.36 1.52 - 3.07 2.52 2.99 Kidney Doctors Global Rating – 2.54 0.41 1.40 - 3.10 2.23 2.90 Dialysis Centre Staff Global Rating – 2.58 0.45 1.38 - 3.10 2.20 2.98 Dialysis Centre While this study demonstrates that facilities have CAHPS-ICH scores with large differences between the 25th and 75th percentiles (in effect sizes), the complexity of the scoring algorithms may pose a challenge in interpretation for clinicians.
278 COLLAPSING GLOMERULOPATHY WITH TUBULORETICULAR INCLUSION IN HIV NEGATIVE PATIENT: Ninad Parekh, Chetana Rondla, Geovani Faddoul, Suzanne El-Sayegh, Elie El-Charabaty, Staten Island University Hospital, Staten Island, NY, USA A 27-year-old African American female presented with intermittent fever, chills, diffuse arthralgia and myalgia. On Exam, she was febrile (T 102.40F). Other vital signs were unremarkable. Normal physical exam. Laboratory work showed mild leucopenia (WBC 3200/cumm) and normocytic anemia (Hb 11.0 gm/dl). No evidence of hemolysis. Serum chemistry was within normal limits. Urinalysis showed no hematuria and 24hour urine protein was 1.4 gram. Serologic work up showed positive ANA at 1:2560; otherwise negative serology.
Kidney biopsy showed FSGS, collapsing variant (figure) (one out of eight glomeruli), and negative IF staining. EM showed endothelial cell tubuloreticular inclusions (TRI) (figure). Endothelial cell TRI are described in patients with lupus, HIV and patients treated with interferon. This patient had lupus-like disease. However, findings of kidney biopsy were not typical for any class of lupus nephritis. This patient has preserved renal function and normal complement level. Therefore, she was treated conservatively with ACEi. Review of literature found two reported cases of collapsing glomerulopathy and TRI with negative IF staining in patients with lupus-like illness. This is a rare and atypical kidney biopsy finding. Moreover, it emphasizes importance of integrating pathologic finding with clinical presentation in order to guide clinical decision-making process.
A88
279 MEDICAL STUDENT ASSESSMENT OF TECHNOLOGY UTILIZATION IN NEPHROLOGY EDUCATION DURING PRECLINICAL YEARS: Kevin Pargeter, Udayan Bhatt, The Ohio State University Medical Center, Division of Nephrology, Columbus, OH 43210, USA Technology utilized in medical education is changing the landscape of medical schools. The use of clinical simulations, audience response systems and recorded lectures are changing the way nephrology is taught. Balanced with this is the real need to stimulate interest in nephrology as a career. The transition from live lectures to recorded presentations may alter the students’ reactions to nephrology, yet he impact of using technology in renal education has not been fully defined. Therefore, we examined the effectiveness and student reactions to the deployment of educational technologies for nephrology education in the preclinical years of medical school. The 2013-2014 academic year was the first year in expanding the use of medical education technology in teaching the renal block for students at The Ohio State University College of Medicine. The renal block used a combination of case studies, recorded lecture presentations, traditional lectures, and directed readings. Students were given the opportunity to evaluate the individual teaching-learning methods. The overall scores for the different teaching methods were tabulated and compared using analysis of variance. There was no difference in the students’ response to traditional lectures compared to electronic learning presentations. Also, case studies were reviewed quite positively while directed readings were not. The response of medical students to the utilization of recorded lecture technology tools was similar to the response from traditional lectures. Directed readings received poor responses. Case studies applying the presented material were very well received and may allow an opportunity to enhance student interest in nephrology.
280 REDUCTION OF TRANSFUSIONS IN DIALYSIS PATIENTS TAKING EPOETIN ALFA IN A PLACEBO-CONTROLLED RANDOMIZED CLINICAL TRIAL Grace S. Park, Allan Pollock, Maple Fung Amgen, Inc., Thousand Oaks, CA, USA ESAs are currently part of standard anemia care for reducing transfusions and potential exposure to their risks in patients (pts) with chronic kidney disease (CKD) despite recent safety concerns regarding ESA use. We evaluated previously unpublished data from a registrational placebo (PLC)-controlled epoetin alfa (EPO) study to examine Hb concentrations and risk of transfusion. Pts with CKD on hemodialysis were enrolled in a double-blind (DB), PLC-controlled study, randomized 1:1 to receive PLC or EPO TIW for 12 weeks. All were to receive EPO during the open-label (OL) extension period that followed. The study protocol was IRB-approved, and pts provided written informed consent. EPO 10,000 U/ml was administered by body weight (at study start 0.4 ml, 0.6 ml, 0.8 ml or1.0 ml which was adjusted to maintain hematocrit [Hct] between 32-38%). Fifty pts were randomized to PLC and 51 to EPO with 94% completing the DB period and 77% completing the OL period through week 52. At baseline, pts were a mean age of 49.7 y, 49% white, 47% male, with mean Hb of 7.6 g/dl, mean Hct of 23% and median weekly serum iron of 95 ng/ml. During the 3 months pre-study, 38 PLC and 31 EPO pts required transfusions. During the DB period, 31 PLC and 10 EPO pts received transfusions (compared to pre-study within groups, p=0.0522 for PLC and p<0.0001 for EPO by McNemar’s test). By week 24 in the OL period, 7 PLC and 2 EPO patients required transfusions (p<0.0001 compared to pre-study for both). Transfusionfree probabilities during the DB period differed between the groups (log-rank test, p<0.0001); they did not differ in the OL period (p=0.095). Mean Hbs within 1 week prior to transfusions were 7.0 and 10.4 g/dl for PLC and EPO groups during the DB period, respectively. This study provides additional support regarding EPO’s ability to reduce transfusion requirements in previously untreated dialysis pts. Future studies are needed in the dialysis population to more thoroughly examine the relationship between Hb and transfusion rates in contemporary practice settings.
Am J Kidney Dis. 2014;63(5):A1-A121