National Thirty Day Readmission Rates in Patients with End Stage Renal Disease on Peritoneal Dialysis

NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA RECURRENT THROMBOTIC MICROANGIOPATHY IN A RENAL 59 ALLOGRAFT: Sevelamer Induced DiffuseCONUNDRUM. Crystal Colitis:Campa, A CaseOlivia Report of A CLINICAL Morfin, a Rarely Reported Side Effect Jose A, University of California Davis, Sacramento, CA USA Atypical hemolytic uremic syndrome (aHUS), type, is Samir Brahmbhatt, Michael Cruise, James non-diarrheal Simon. Cleveland caused by a defective complement regulation that is often sporadic in Clinic Foundation, Cleveland, OH, USA nature. The syndrome is characterized by renal failure, 61 thrombocytopenia, An Unusual and Case of Hyponatremia Attributed have to hemolytic anemia. Genetic abnormalities Trimethoprim-Sulfamethoxazole Therapy been described accounting for 50 to 60% of the cases. The diagnosis can be inconspicuous in nature andSheffield, thus requiresRoberto a high index of Adam Bsiso, Michael Collazoclinical suspicion. We describe a case that illustrates the challenge of Maldonado. Methodist Dallas Medical Center, Dallas, TX, the diagnosis and the consequences on the survival of a renal allograft. USA A 35 year old Latina woman who is status post a Living Related Transplant (LRKT)Causing presents Bacterial-Endocarditis to our hospital with worsening 62 Kidney Enteroccous Species Assoallograft She had a history presumptive post-partum TTP ciated function. Glomerulonephritis in anofAt Risk Population treated with plasmapheresis and plasma exchange 5 years prior. She Emma Bueno, Keyrillos Rizg, Mario Juan Chique had minimal recovery of kidney function andCisneros, was deemed dialysis Figueroa, Ryan Kunjal, Andreea Poenariu, Raafat dependent so underwent kidney transplant from her brother with noF Makaray. University She of was Florida College of Medicineimmediate complications. placed on dual immunosuppression Jacksonville, Jacksonville, with excellent allograft function.FL, Six USA months post-transplant, she had of proteinuria, hematuria and an elevated creatinine to 4.30. 65 onset Recurrent Thrombotic Microangiopathy in a Renal AlloFurther evaluation revealed urine protein/creatinine ratio 4.5, platelets graft: A Clinical Conundrum count at 110,000, hemoglobin 8.5, and a blood smear with occasional Olivia Campa, A. biopsy Morfin. University of California schistocytes. A renalJose allograft showed severe thrombotic microangiopathy (TMA)CA, with USA segmental glomerulosclerosis without Davis, Sacramento, antibody medicationBartter rejection. She was placed on 68 evidence A RareofCase of Neonatal Syndrome plasmapheresis, and pulse steroids. Unfortunately, she had minimal 1 2 1 Tushar Chaturvedi Rupeshand Raina . Akron Nephrology improvement in allograft, function thus returned to hemodialysis. 2 Cleveland Clinic Associates, Akron, OH,a normal USA; ADAM13 Further testing demonstrated essay, ShigaAkron Toxin, ANA, Anti-Phoslipid Ab. However, genetic testing showed General, Akron, OH, USA gene mutation for factorAnion H complement. casewith 71 heterozygous An Unusual Case of Negative Gap in a This Patient illustrates a common presentation of an uncommon syndrome, in a Hypercalcemia patient found to have a factor H complement mutation resulting in Avantika Chenna, Pradeep Thodima, Rasib Raja. recurrent atypical hemolytic uremicReddy syndrome in the renal allograft. Albert Einstein, Philadelphia, PA, USA 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 66 Vamsi Chilluru, Jay Hawkins. University of Nebraska Medical Center, Omaha, NE, USA NATIONAL ESTIMATES OF THIRTY DAY UNPLANNED IN PATIENTS ON MAINTENANCE 86 READMISSIONS Prosthetic Valve Endocarditis from Mycobacterium 1 1 1 HEMODIALYSIS: Lili ChanCausing , Kinsuk Chauhan , Priti Poojary , Chimaera1 Infection Granulomatous Interstitial 2 Aparna Saha , Elizabeth Hammer , Lindsay Jubelt1, Bart Ferket1, Nephritis 1 1 1 Steven G Coca , Girish N Nadkarni , Icahn School of Medicine at Jonathan Da Costa, Ahmed Ivan Porter, Peter Mount Sinai, New York, NY, USA; 2Abdalrhim, New York University – Lutheran Hospital, New York, NY, USA Fitzpatrick, Cherise Cortese, Nabeel Aslam. Mayo Clinic, Patients with endFL, stage renal disease (ESRD) on hemodialysis (HD) Jacksonville, USA have high 30-day unplanned readmission rates; however, there are 87 limited Health A Case of an Unusual Cause of Severe dataoronBeauty: reasons and predictors of readmissions. Hypercalcemia Utilizing the National Readmission Database, we describe the epidemiology of 30-day unplanned readmissionsHilmer in ESRDNegrete. patients onSt. Gulshan Dangol, Sashi Ariyaratne, HD, assess clinical reasons for index admissions and associated Elizabeth Youngstown Hospital, Youngstown, OH, USA readmissions and identify characteristics of increased readmissions. 88 In Recurrent Disease: Report of Two Cases with 2013, thereDense were 390,627 indexAhospitalizations and 102,585 readmissions HD patients, with an overall 30-day readmission rate of Varying in Presentations, Pathologic Findings and Patient 22.3%. Hospitalizations with readmissions were younger, more female Outcomes and with comorbidities including AIDS, alcohol and drug abuse. The Dilini Daswatta,diagnoses SharonwithGraves, Ellis.rateEmory initial hospitalization the highestCarla readmission University, Atlanta, GA, USA(25.4%), diabetes mellitus included acute myocardial infarction and congestive heart failure (24.6%). The reasons for 90 (24.8%) Crystalglobulin-Induced Nephropathy and primary Keratopathy initial hospitalization and subsequent 30-day readmission were Matthew D’Costa, Sandhya Manohar, Joe Grande, discordant in 79.5% of admissions and varied by initial diagnosis.Samih Nasr, Marie C. Hogan. Mayodepression Clinic, Rochester, MN,95% USA Predictors of readmissions included (odds ratio 1.10, 1.05 – 1.15 abuse Nephropathy (odds ratio 1.41, 95% CI 1.31 – 91 CIVitamin C P<.001), Induceddrug Oxalate 1.51, P <.001), and discharge against medical advice (odds ratio 1.57, Matthew D’Costa, Herrera Sandra 95% CI 1.45-1.70, P<.001).Loren Furthermore, a groupHernandez, of high utilizers Herrmann. Mayo Rochester, MN, USA for 20% of which constituted 2.3%Clinic, of the population were responsible 92 allAreadmissions. Case of Severe Hyponatremia and Acute Kidney Injury In ESRD patients on HD, nearly a quarter of admissions are followed Eddy Nasr, Rabih. Lebanon Hospital by 30-day DeJesus, unplanned readmissions. MostBronx readmissions were for Center, Bronx,that NY, USA primary diagnoses were different from initial hospitalization. A proportion of patients accounted for a disproportionate number of 103 small Acute Glomerulonephritis Post Administration of readmissions. Interventions to reduce readmissions should be targeted Pegfilgrastim towards high-utilizers and potentially modifiable risk factors. Hatem Elabd, Naheed Ansari, Belinda Jim. Jacobi Medical Center, New York, NY, USA

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Am J Kidney Dis. 2017;69(4):A1-A105

108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome NATIONAL THIRTY DAY READMISSION RATES IN PATIENTS Thomas Frohwein, Kim, Isaiarasi Gnanasekaran. WITH END STAGE RENALSusan DISEASE ON PERITONEAL LincolnLili Medical andPoojary, Mental Health Bronx, NY, DIALYSIS: Chan, Priti Aparna Saha,Center, Kinsuk Chauhan, Rocco Ferrandino, Bart Ferket, Steven Coca, Girish Nadkarni, Jaime USA Uribarri, Icahn School of Medicine at Mount Sinai, New York, NY, 110 Diagnosis and Treatment of Renal Vein Thrombosis (RVT) USA in thewith Setting ofrenal Lupus Nephritis and Antiphospholipid Patients end stage disease (ESRD) on peritoneal dialysis (PD)Syndrome are a rapidly(APS) growing population. The Center for Medicare and Medicaid identified readmissions in ESRD patients to be a quality Pablohave Garcia, Felix Renneberg, Maanit Kohli, Steve Bibu, measure, however, there is aAnne paucityVan of studies examining readmissions Navya Kuchipudi, Hoven, Shaunak Dwivedi. in PD patients. Saint Peter’s University Hospital, Brunswick, NJ, USA This is a retrospective cohort study using New the National Readmission 111 Scleroderma Renal in the Setting Systemic Database for year 2013. WeCrisis aimed (SRC) to determine reasons for of admission, the associated readmission and independent predictors of Sclerosisrates SineofScleroderma (ssSSc) in Pregnancy readmissions in PD patients. Pablo Garcia, Shaylika Chauhan, Maanit Kohli, Navya In this nationally representative cohort, the top ten reasons for initial Kuchipudi, Dwivedi. Saint Peter’s University hospitalization wereShaunak due to implant/PD catheter complications (23.2%), Hospital,(5.5%), New septicemia Brunswick, NJ, USA hypertension (5.2%), diabetes mellitus (DM) (5.1%), surgical Insufficiency procedures/medical (3.5%), fluid 121 Redcomplications Eyes andofRenal in care A Middle Age and electrolyte disorders (4.3%), peritonitis (3.8%), congestive heart Gentleman failure (3.3%), pneumonia (2.9%), and acute myocardial infarction Maryam Gondal, Timbol,rateJeffery Turner. Yale (AMI) (2.0%). The overallHeidi 30 dayMae readmission was 14.6% and the highest readmission ratesHaven, were forCT, AMIUSA (21.8%), complications of University, New surgery procedure/medical care (19.6%), and DM (18.4%). 125 Atypical Case of Behcet’s Disease Leading to IGA Independent demographic predictors of readmissions included age 35Nephropathy 49 years compared to 18-34 years (adjusted odds ratio (aOR) 1.4 95% CI 1.1 – 1.7; P=0.006) female gender (aOR 1.3 95%Yorg CI 1.1 Al-Azzi. – 1.4; Sanjeev Gupta,and Anastasios Papanagnou, P<0.001). Comorbidities predictive of readmission included liver Westchester Medical Center, Westchester, NY, USA disease (aOR 1.4 95% CI 1.1 – 1.8; P=0.01), peripheral vascular 126 Cefepime as Status Epilepticus in a disease (aOR 1.3 Toxicity 95% CI 1.1Presenting – 1.6; P<0.001), and depression (aOR 1.2 End Stage Renal Disease 95%Patient CI 1.0 –with 1.5; P=0.04). 1 1 Our data demonstrate the most common reasons for admission Dasari , Aziz Bakhousand , Raed Mohit Gupta1, Jayaprakash readmissions1in PD patients and several which 1are Azzem , Donald Dumford1, comorbidities Patrick Gallegos , Rupesh predictive of readmissions. Targeted interventions towards these 1 1 Raina Clinic Akron General, OH, USA patients may. beCleveland of benefit in reducing readmission in Akron, this growing population. 129 Tenofovir Causing Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 68 Westchester Medical Center, Valhalla, NY, USA A RARE OF NEONATAL BARTTER SYNDROME 130 The CASE Significance of Anti-Phospholipase Antibodies in a 1, Rupesh Raina2 Tushar Chaturvedi Patient with Membranous Nephropathy 1Akron Nephrology Associates, Akron, OH, USA Mohit Gupta, Jayaprakash Dasari, Rupesh Raina, Pallavi 2Cleveland Clinic Akron General, Akron, OH, USA Reddy. Cleveland Clinic Akron General, Akron, OH, USA Bartter’s syndrome is a rare autosomal recessive, renal tubular 132 A Mystery Case of Blood Leak Alarm Going On disorder with an incidence of 1.2 per million people. A 28-year-old male was initiallyMaditz, referredSadichhya to us for evaluation Seifeldin Hakim, Rhyan Lohani, ofSami persistent hypokalemia. He had beenWilliam diagnosed with DistalHospital, Zarouk. Oakland University Beaumont Renal Tubular Acidosis and was on Bicarbonate therapy. He had Royal Oak, MI, USA been admitted multiple times in the past for repeated episodes of 133 Previously Undiagnosed ANCA Associated Vasculitis Preabdominal pain, nausea, vomiting and diarrhea. Despite the senting One Month After Kidney Transplantation above therapy, he continued to demonstrate a significant degree Ayman Hallab, Karthik Kannegolla, Mohammad S. be Yaqub. of hypokalemia in addition to metabolic alkalosis. This could University School of Medicine, due Indiana to intravascular volume depletion in the settingIndianapolis, of distal RTA.IN, USA Repeat laboratory analysis revealed the presence of an elevated spotCase potassium to creatinine ratio indicating a significant degree 149 Report of a Dialysis Dependent Immunotactoid of kaliuresis. Elevated with magnesium and rennin levels also Glomerulopathy Favorable Response to were Rituximab found. Genetic testing was performed and it was consistent 3with Bhojwani2, Glen Markowitz , Aaron Mehak Idrees1, Rohan Bartter’s syndrome type 1 (also referred to as Neonatal Bartter Dommu4. 1Griffin Hospital, Derby, CT, USA; 2Fairview Syndrome type 1). He was started on spironolactone, Hospital, Cleveland, OH, USA; 3Columbia University, New indomethacin and amiloride. His condition considerably improved York, NY, USA; 4Nephrology Associates, Bridgeport, CT, with treatment and his serum potassium normalized with the USA most recent level being 4.3 mmol/l. 150Neonatal De Novo Atypical Hemolytic Uremic types: Syndrome Bartter syndrome has two primary Type 1Fourteen Months After Renal Transplant (mutation in Sodium/Potassium Chloride Transporter) and Type 2 (mutation potassium voltage-gated channel subfamily OlusolainIsikalu, Jennifer Thompson, Maria AuroraJ Posadas member 1). Medical They are University characterized hypokalemic, Salas. ofbySouth Carolina, Charleston, hypochloremic SC, USA metabolic alkalosis with increased urinary loss of sodium, potassium, chloride and calcium ions. Potassium 151 “Lone” Lupus Nephritis: A Seronegative, Histopathological supplementation, indomethacin and volume resuscitation are the Diagnosis mainstay of therapy for Neonatal Bartter Syndrome. Jamal Janjua, Pratima Kamada, Aiman Riaz. Gundersen Health System, La Crosse, WI, USA

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