- Email: [email protected]
Effect of Patiromer on Urine Calcium and Phosphate Excretion in Healthy Adults
NKF 2016 Spring Clinical Meetings Abstracts
Case Report 45 ALBUMINURIA – A NEGLECTED PREDICTOR OF MORTALITY: JL Bragg-Gresham, B Gillespie, V Shahinian, N Powe, D Tuot, R Saran. UM–KECC, Ann Arbor, MI; UCSF, San Francisco, CA; CDC, Atlanta, GA. Prior studies have shown that lower eGFR and albuminuria are independently associated with mortality. We reexamined these associations in a representative sample of the US population to ascertain the potential benefit of albuminuria testing for mortality risk stratification. Using mortality-linked NHANES data (1999-2010) on 25,160 adults aged ≥20 yrs, not on dialysis, we investigated the association of eGFR (CKD-Epi) and albuminuria (urine albumin/creatinine ratio >30 mg/g) on mortality using survey weighted Cox models, adjusted for age, sex, race, BMI, DM, HTN, HTN meds. Median follow-up was 71 months. Hazard ratios for mortality by eGFR category, with and without albuminuria, are shown (Figure). In the eGFR 60+ category, 6.7% (12.6 million US adults in 2009-2010) had albuminuria and fewer than 2% were aware that they had “weak or failing kidneys”, though they experienced nearly twice the mortality rate compared to the ref group.
These results suggest that albuminuria testing, even among those with normal eGFR, could provide the impetus for preventive measures to lower mortality risk.
46 COMORBIDITY AND DEMOGRAPHIC CHARACTERISTICS OF DIALYSIS PATIENTS WITH HEPATITIS C: Jane Brzozowski, John Larkin, Sheetal Chaudhuri, Len Usvyat, Jeffery Hymes, Terry Ketchersid, Franklin W Maddux, Fresenius Medical Care North America, Waltham, MA, USA The comorbidities and demographic profiles of dialysis patients with hepatitis C (HCV) have not been well characterized. We aimed to determine the comorbidities and demographic characteristics of incident dialysis patients with an HCV infection in a large national cohort. We utilized data from all incident hemodialysis (HD) and peritoneal dialysis (PD) patients who initiated chronic dialysis in Fresenius Medical Care North America clinics from January 1, 2005 to November 30, 2014 for this analysis. Patients were stratified into HCV positive (HCV+) and HCV negative (HCV-) groups based on laboratory results from the first year of dialysis. The patients’ demographic and comorbid characteristics were collected and comparisons were made between groups using t-tests. Data from 236,412 patients was used in this analysis (16,383 HCV+ & 220,029 HCV-). The demographic profile of patients was (±std dev): mean age 57.7 ±11 HCV+ vs 63.2 ±15.3 HCV- (p<0.0001); Black 50.2% HCV+ vs 27.4% HCV- (p<0.0001); Hispanic 12.3% HCV+ vs 14.2% HCV- (p<0.0001); male 66.4% HCV+ vs 55.7% HCV(p<0.0001). The comorbid characteristics of patients were: diabetic 62.1% HCV+ vs 63.1% HCV- (p=0.013); arrhythmias 2.8% HCV+ vs 4.6% HCV- (p<0.0001); cerebrovascular accident (CVA) 2.8% HCV+ vs 3.1% HCV- (p=0.028); congestive heart failure (CHF) 9.8% HCV+ vs 10.0% HCV- (p=0.467); chronic obstructive pulmonary disease (COPD) 3.7% HCV+ vs 3.6% HCV- (p=0.610); hypertension 21.8% HCV+ vs 22.1% HCV- (p=0.397); ischemic heart disease (IHD) 6.6% HCV+ vs 8.4% HCV- (p<0.0001); myocardial infarction (MI) 0.7% HCV+ vs 1.0% HCV- (p=0.0006); peripheral artery disease/peripheral vascular disease (PAD/PVD) 4.8% HCV+ vs 5.6% HCV- (p<0.0001); number of comorbidities 6.5 HCV+ vs 6.3 HCV- (p=0.003). Dialysis patients with an HCV infection tend to be much younger, are more likely to be Black, are more likely to be male, and have a lower prevalence of DM, arrhythmias, CVA, IHD, MI, and PAD/PVD.
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EVOLUTION OF BLOOD PRESSURE IN INCIDENT HOME DIALYSIS PATIENTS: Jane Brzozowski, Sheetal Chaudhuri, Hao Han, Dugan Maddux, Jodi Conti, John Larkin, Len Usvyat, Franklin W Maddux, Fresenius Medical Care North America, Waltham, MA, USA Prior studies in in-center hemodialysis (HD) patients demonstrated that 1, Laith Al-Rabadi, systolic blood pressure (SBP) drops immediately after dialysis initiation but MBBS, * Rivka then increases over the first year on renal replacementJennifer therapy. However, the E. Ballard, MD,2,y Alan longitudinal patterns of SBP in home dialysis patients have not been well David J. Salant, MD,1 defined. We analyzed data from 2,500 incident peritoneal dialysis (PD) patients who initiated dialysis at Fresenius Medical Care North America clinics between Jan 2011 and Oct 2015. Intradialytic SBP for Home There PD patients wasinformation captured is little about pregnancy o using 1 of 4 types of home monitoring devices capable of those centralized datacirculating autoantibod especially with capture. “Days from start” ordinal was computed as a number of days from the autoantigen in primary MN. We present what first measure of SBP reading per patient to each SBP measurement; SBP a 39-year-old woman measurements were averaged for the entire cohort per day. We applied linearwith PLA2R-associate (albumin, 1.3-2. regression methods to characterize the trajectoryanasarca, in mean dailyhypoalbuminemia SBP during the first 365 days on dialysis. opsy revealed MN with staining for PLA2R, a
Pregnancy in a Patient Wit and Circulating Anti-P
She did not respond to conservative therapy a Several weeks after presentation, she was fou further immunosuppressive treatment. Protei Circulating anti-PLA2R levels declined but w without proteinuria at birth or at her subseque had detectable circulating anti-PLA2R of imm low titers. Only trace amounts of IgG4 ant discrepancy between anti-PLA2R levels in th Am J Kidney Dis. 67(5):775-778. ª 2016 by
We observed that the mean daily SBP significantly decreases over time in home PD patients during the first year (estimated β =-0.24mmHg per Membranous month; INDEX WORDS: nephropathy ( p<0.0001) (Figure). receptor (PLA R); autoantibody; placenta; ritu This study indicates that intradialytic SBP decreases over time for2home PD patients during the first year on renal replacement therapy. This trajectory is different than what was previously shown for pre-dialysis SBD for in-center HD patients. Further analyses are needed to understand dynamics in SBP in home regnant patients with autoimmune disease and in-center patients.
P
deliver newborns with a spectrum of cl manifestations due to the transplacental passa 48 circulating autoantibodies. Pregnant patients EFFECT OF PATIROMER ON URINE CALCIUM AND lupus or myasthenia can deliver babies PHOSPHATE EXCRETION IN HEALTHY ADULTSgravis D 2 Bushinsky1, D Spiegel2, C Gross , W Benton2, J disease Fogli 2, K Hill corresponding in the neonate.1,2 Neo Gallant3, C Du Mond2, G Block4, M. Weir5, B Pitt6; 1Univ of 2 Relypsa, Redwoodnephropathy City, CA; 3Purdue(MN) not associated Rochester, Rochester, NY; membranous 4 5 congenital infection was CO;first Univdescribed in 199 Univ, West Lafayette, IN; Denver Nephrologists, Denver, 6 Univ of Michigan, Arbor, MItransfer of maternal of Maryland, Baltimore, MD; attributed to theAnn passive Patiromer is a non-absorbed potassium (K) binding polymer that uses 3 bodies toion. putative renal antigens. More than a d calcium (Ca) as the counter-exchange The released Ca has the 4 later, Debiec et al identified the first antigen inv potential to bind phosphate (P) in the GI tract. To determine the effect ofin patiromer urine Caas (uCa) and P (uP) we such oncases neutral endopeptidase (NE performed 2 separate studies in healthy adults on controlled diets in metalloprotease present on the surface of the pod metabolic units, given patiromer up to 25.2 g/d divided doses TID for 8 and involved in the proteolytic regulation of va d (study 101) or 25.2 g/d in a cross-over design in random order as QD or divided (BID or TID) doses 18 d (study 102). 24-hret urine tiveforpeptides. Debiec al was described a mother w collected to measure Ca andmutation P excretionpreventing at steady state. NEP expression who had fo In study 101, there was a dose dependent increase in uCa and a anti-NEP antibodies due to fetomaternal alloi parallel decrease in uP (p<0.001; Fig). uCa increased by <75 mg/d on nization from a previous miscarriage; these antib the maximum recommended patiromer dose (25.2 g/d). In study 102 were to cross the placenta and cause subepit deposits in the fetal kidney of a subsequent nancy. M-type phospholipase A2 receptor (PL was later identified as the major autoantigen fo mary MN in adults.5 Little literature exists pregnancy outcomes in patients with nephrotic drome due to primary MN, with no data ava uCa was lower with QD patiromer vs BID orinTID). about (p<0.05 pregnancy PLA2R-associated disease In addition to its ability to eliminate K, patiromer decreases uP present what we believe to binds be the first known ca excretion, suggesting that some of the released Ca in the GI tract pregnancy a patient with P and decreases P absorption. The increasein in uCa excretion at steadyPLA2R-associated state is modest suggesting little is absorbed. whoCawas seropositive for anti-PLA2R autoantib throughout the course of her pregnancy. Am J Kidney Dis. 2016;67(5):A1-A118
Case Report 45 ALBUMINURIA – A NEGLECTED PREDICTOR OF MORTALITY: JL Bragg-Gresham, B Gillespie, V Shahinian, N Powe, D Tuot, R Saran. UM–KECC, Ann Arbor, MI; UCSF, San Francisco, CA; CDC, Atlanta, GA. Prior studies have shown that lower eGFR and albuminuria are independently associated with mortality. We reexamined these associations in a representative sample of the US population to ascertain the potential benefit of albuminuria testing for mortality risk stratification. Using mortality-linked NHANES data (1999-2010) on 25,160 adults aged ≥20 yrs, not on dialysis, we investigated the association of eGFR (CKD-Epi) and albuminuria (urine albumin/creatinine ratio >30 mg/g) on mortality using survey weighted Cox models, adjusted for age, sex, race, BMI, DM, HTN, HTN meds. Median follow-up was 71 months. Hazard ratios for mortality by eGFR category, with and without albuminuria, are shown (Figure). In the eGFR 60+ category, 6.7% (12.6 million US adults in 2009-2010) had albuminuria and fewer than 2% were aware that they had “weak or failing kidneys”, though they experienced nearly twice the mortality rate compared to the ref group.
These results suggest that albuminuria testing, even among those with normal eGFR, could provide the impetus for preventive measures to lower mortality risk.
46 COMORBIDITY AND DEMOGRAPHIC CHARACTERISTICS OF DIALYSIS PATIENTS WITH HEPATITIS C: Jane Brzozowski, John Larkin, Sheetal Chaudhuri, Len Usvyat, Jeffery Hymes, Terry Ketchersid, Franklin W Maddux, Fresenius Medical Care North America, Waltham, MA, USA The comorbidities and demographic profiles of dialysis patients with hepatitis C (HCV) have not been well characterized. We aimed to determine the comorbidities and demographic characteristics of incident dialysis patients with an HCV infection in a large national cohort. We utilized data from all incident hemodialysis (HD) and peritoneal dialysis (PD) patients who initiated chronic dialysis in Fresenius Medical Care North America clinics from January 1, 2005 to November 30, 2014 for this analysis. Patients were stratified into HCV positive (HCV+) and HCV negative (HCV-) groups based on laboratory results from the first year of dialysis. The patients’ demographic and comorbid characteristics were collected and comparisons were made between groups using t-tests. Data from 236,412 patients was used in this analysis (16,383 HCV+ & 220,029 HCV-). The demographic profile of patients was (±std dev): mean age 57.7 ±11 HCV+ vs 63.2 ±15.3 HCV- (p<0.0001); Black 50.2% HCV+ vs 27.4% HCV- (p<0.0001); Hispanic 12.3% HCV+ vs 14.2% HCV- (p<0.0001); male 66.4% HCV+ vs 55.7% HCV(p<0.0001). The comorbid characteristics of patients were: diabetic 62.1% HCV+ vs 63.1% HCV- (p=0.013); arrhythmias 2.8% HCV+ vs 4.6% HCV- (p<0.0001); cerebrovascular accident (CVA) 2.8% HCV+ vs 3.1% HCV- (p=0.028); congestive heart failure (CHF) 9.8% HCV+ vs 10.0% HCV- (p=0.467); chronic obstructive pulmonary disease (COPD) 3.7% HCV+ vs 3.6% HCV- (p=0.610); hypertension 21.8% HCV+ vs 22.1% HCV- (p=0.397); ischemic heart disease (IHD) 6.6% HCV+ vs 8.4% HCV- (p<0.0001); myocardial infarction (MI) 0.7% HCV+ vs 1.0% HCV- (p=0.0006); peripheral artery disease/peripheral vascular disease (PAD/PVD) 4.8% HCV+ vs 5.6% HCV- (p<0.0001); number of comorbidities 6.5 HCV+ vs 6.3 HCV- (p=0.003). Dialysis patients with an HCV infection tend to be much younger, are more likely to be Black, are more likely to be male, and have a lower prevalence of DM, arrhythmias, CVA, IHD, MI, and PAD/PVD.
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EVOLUTION OF BLOOD PRESSURE IN INCIDENT HOME DIALYSIS PATIENTS: Jane Brzozowski, Sheetal Chaudhuri, Hao Han, Dugan Maddux, Jodi Conti, John Larkin, Len Usvyat, Franklin W Maddux, Fresenius Medical Care North America, Waltham, MA, USA Prior studies in in-center hemodialysis (HD) patients demonstrated that 1, Laith Al-Rabadi, systolic blood pressure (SBP) drops immediately after dialysis initiation but MBBS, * Rivka then increases over the first year on renal replacementJennifer therapy. However, the E. Ballard, MD,2,y Alan longitudinal patterns of SBP in home dialysis patients have not been well David J. Salant, MD,1 defined. We analyzed data from 2,500 incident peritoneal dialysis (PD) patients who initiated dialysis at Fresenius Medical Care North America clinics between Jan 2011 and Oct 2015. Intradialytic SBP for Home There PD patients wasinformation captured is little about pregnancy o using 1 of 4 types of home monitoring devices capable of those centralized datacirculating autoantibod especially with capture. “Days from start” ordinal was computed as a number of days from the autoantigen in primary MN. We present what first measure of SBP reading per patient to each SBP measurement; SBP a 39-year-old woman measurements were averaged for the entire cohort per day. We applied linearwith PLA2R-associate (albumin, 1.3-2. regression methods to characterize the trajectoryanasarca, in mean dailyhypoalbuminemia SBP during the first 365 days on dialysis. opsy revealed MN with staining for PLA2R, a
Pregnancy in a Patient Wit and Circulating Anti-P
She did not respond to conservative therapy a Several weeks after presentation, she was fou further immunosuppressive treatment. Protei Circulating anti-PLA2R levels declined but w without proteinuria at birth or at her subseque had detectable circulating anti-PLA2R of imm low titers. Only trace amounts of IgG4 ant discrepancy between anti-PLA2R levels in th Am J Kidney Dis. 67(5):775-778. ª 2016 by
We observed that the mean daily SBP significantly decreases over time in home PD patients during the first year (estimated β =-0.24mmHg per Membranous month; INDEX WORDS: nephropathy ( p<0.0001) (Figure). receptor (PLA R); autoantibody; placenta; ritu This study indicates that intradialytic SBP decreases over time for2home PD patients during the first year on renal replacement therapy. This trajectory is different than what was previously shown for pre-dialysis SBD for in-center HD patients. Further analyses are needed to understand dynamics in SBP in home regnant patients with autoimmune disease and in-center patients.
P
deliver newborns with a spectrum of cl manifestations due to the transplacental passa 48 circulating autoantibodies. Pregnant patients EFFECT OF PATIROMER ON URINE CALCIUM AND lupus or myasthenia can deliver babies PHOSPHATE EXCRETION IN HEALTHY ADULTSgravis D 2 Bushinsky1, D Spiegel2, C Gross , W Benton2, J disease Fogli 2, K Hill corresponding in the neonate.1,2 Neo Gallant3, C Du Mond2, G Block4, M. Weir5, B Pitt6; 1Univ of 2 Relypsa, Redwoodnephropathy City, CA; 3Purdue(MN) not associated Rochester, Rochester, NY; membranous 4 5 congenital infection was CO;first Univdescribed in 199 Univ, West Lafayette, IN; Denver Nephrologists, Denver, 6 Univ of Michigan, Arbor, MItransfer of maternal of Maryland, Baltimore, MD; attributed to theAnn passive Patiromer is a non-absorbed potassium (K) binding polymer that uses 3 bodies toion. putative renal antigens. More than a d calcium (Ca) as the counter-exchange The released Ca has the 4 later, Debiec et al identified the first antigen inv potential to bind phosphate (P) in the GI tract. To determine the effect ofin patiromer urine Caas (uCa) and P (uP) we such oncases neutral endopeptidase (NE performed 2 separate studies in healthy adults on controlled diets in metalloprotease present on the surface of the pod metabolic units, given patiromer up to 25.2 g/d divided doses TID for 8 and involved in the proteolytic regulation of va d (study 101) or 25.2 g/d in a cross-over design in random order as QD or divided (BID or TID) doses 18 d (study 102). 24-hret urine tiveforpeptides. Debiec al was described a mother w collected to measure Ca andmutation P excretionpreventing at steady state. NEP expression who had fo In study 101, there was a dose dependent increase in uCa and a anti-NEP antibodies due to fetomaternal alloi parallel decrease in uP (p<0.001; Fig). uCa increased by <75 mg/d on nization from a previous miscarriage; these antib the maximum recommended patiromer dose (25.2 g/d). In study 102 were to cross the placenta and cause subepit deposits in the fetal kidney of a subsequent nancy. M-type phospholipase A2 receptor (PL was later identified as the major autoantigen fo mary MN in adults.5 Little literature exists pregnancy outcomes in patients with nephrotic drome due to primary MN, with no data ava uCa was lower with QD patiromer vs BID orinTID). about (p<0.05 pregnancy PLA2R-associated disease In addition to its ability to eliminate K, patiromer decreases uP present what we believe to binds be the first known ca excretion, suggesting that some of the released Ca in the GI tract pregnancy a patient with P and decreases P absorption. The increasein in uCa excretion at steadyPLA2R-associated state is modest suggesting little is absorbed. whoCawas seropositive for anti-PLA2R autoantib throughout the course of her pregnancy. Am J Kidney Dis. 2016;67(5):A1-A118