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Therapy Retention Experience of a Large Home Short Daily Hemodialysis (SDHD) Center
NKF 2012 Spring Clinical Meetings Abstracts
137
139 GENETIC VARIAION IN APOL1 GENE IS ASSOCIATED WITH CHRONIC KIDNEY DISEASE (CKD) IN NIGERIANS. 1Holly Kramer, 1Bamidele O. Tayo, 2Babatunde Salako, 3Omri Gottesman, 2Adesola Ogunniyi, 3Erwin P. Bottinger, 1Richard S. Cooper. 1Loyola Medical Center, Maywood, IL; 2University of Ibadan, Ibadan, Nigeria; 3Mount Sinai School of Medicine, New York, NY. APOL1 and MYH9 genetic variants show very strong associations with non-diabetic kidney disease in African Americans. This study examined the association between variants in the APOL1/MYH9 region and non-diabetic CKD phenotypes among Nigerians. Cases included individuals aged 16-70 years with non-diabetic CKD in absence of sickle cell disease, HIV, or hepatitis B. Cases were age matched with 79 healthy controls without CKD or hypertension who participated in the Genetics of Hypertension in Blacks Study. Genotyping of APOL1 and MYH9 single nucleotide polymorphisms (SNPs) was completed at Mount Sinai School of Medicine. Overall, 95 of the 98 cases had end-stage kidney disease. Table 1 shows the associations between APOL1 and MYH9 SNPs and non-diabetic CKD under a recessive model. No MYH9 SNP showed a statistically significant association with CKD under recessive model. Conclusions, APOL1 SNPs are significantly associated with non-diabetic kidney disease among Nigerians. SNP Gene MAF Model OR P Value rs73885319 rs60910145 rs71785313 rs11912763
APOL1 APOL1 APOL1 MYH9
35.51 40.86 11.58 33.33
Recessive Recessive Recessive Recessive
3.882 3.215 0.533 1.627
0.0137 0.006 0.6663 0.369
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CHANGE IN SF-36 SUMMARY SCORES & DIALYSIS SURVIVAL Eduardo Lacson, Jr., Nien-Chen Li, Shu-Fang Lin, Sandie GuerraDean, Michael Lazarus, Raymond Hakim, Franklin Maddux. Fresenius Medical Care, North America, Waltham, MA, USA. We previously reported (CJASN, 2010) the associaon between SF-36 physical and mental summary scores (PCS & MCS) with mortality risk in 44,395 chronic dialysis paents. Since A ≥ 5-point change in PCS or MCS has been shown to be clinically meaningful, we invesgated in a subset of 10,996 paents who had a second survey performed ~6 months later, whether a ≥ 5-point change in PCS or MCS will impact one year survival (from the date of 2nd survey) despite adjustment for the respecve baseline score. For PCS, 5,525 (50%) paents had no change (i.e. were within ± 5 from baseline) while 2,735 (25%) decreased and 2,736 (25%) increased their scores by ≥ 5 points. For MCS, 5,155 (47%) paents had no change, 2,858 (26%) decreased and 2,983 (27%) increased scores, respecvely. Hazard raos (HR) of death for PCS increase was 0.77 and for PCS decrease 1.42 (both p<0.0001) compared to no change (control), even aer adjusng for baseline PCS. With further case mix adjustment for age, gender, race, diabetes, dialysis modality, and vintage, HR=0.82 (p=0.002) for PCS increase and HR=1.33 (p<0.0001) for PCS decrease, respecvely. For MCS, HR=1.48 for a decrease in score, becoming HR=1.46 with addional case-mix adjustment (both p<0.0001). An increase in MCS trended towards improved survival but results were not stascally significant. Results from this analysis indicate improved survival associated with a ≥ 5 point increase in PCS while there was increased relave risk of death associated with a ≥ 5 point decline in either PCS or MCS. Prospecve cohort studies are needed to determine if these findings can be replicated.
140
THERAPY RETENTION EXPERIENCE OF A LARGE HOME SHORT DAILY HEMODIALYSIS (SDHD) CENTER. Michael Kraus, Catherine Cox, Yoojin Lee IU Health, Indianapolis, IN; Tufts University, Boston, MA. IU Health home dialysis program has trained over 200 pts since 2004. We retrospectively analyzed 169 pts that started home SDHD on the NxStage System One between 2005-10. Data included pt characteristics, social & employ status, partners, prescription and reasons for drop. Analysis included K-M and univariate Cox regression. Mean age was 54±14 yrs, 66% male, 48% AVF & 36% catheter, 85% prescribed 6 tx/wk, and 10% 5tx/wk. Mean dialysate vol was 22±5L/tx and 126±23L/week. 59% of pts were married, and 37% single. 55% of partners were spouse (40% wife), 12% child, 10% parent, and 5% self care. Mean time on therapy was 23±20 mths. 14% of pts dropped <3mths, 23% 3-12mths and 63% ≥12 mths. Reasons for drop incl death 25%, transplant 24%, burden of therapy 20% (10% partner, 10% pt), health issues 15% and other 16%. Fig below show 50% technique survival = 22 mths [95%CI 14, 28] and after censoring for death & transplant = 49 mths [95%CI 33, 64]. K-M (all drops)
K-M (censored for death & tx)
Regression analyses show higher risk of drop in older pts (>74)(HR = 2.5, p = 0.003) vs. pts ag 45-64, pts with catheters (HR 1.8, p = 0.005) vs. fistulas, and pts who use premixed dialysate bags (HR 2.0, p = <0.0001) vs. the NxStage PureFlow system. Incident pts trended towards improved technique survival (HR 0.3, p = 0.06) vs. prevalent. In conclusion, pts of all ages & char can be successful on SDHD, however, to ensure technique survival, factors such as age, vascular access & dialysate source need to be managed. We intend to further investigate the effects of patient and partner social status in SDHD.
Am J Kidney Dis. 2012;59(4):A1-A92
ADRENOCORTICOTROPIN HORMONE (ACTH) FOR THE TREATMENT OF PRIMARY FOCAL GLOMERULOSCLEROSIS (FSGS) Richard A Lafayee, Christa Root, Kshama Mehta Division of Nephrology, Stanford University, Palo Alto, CA, USA We wished to assess the potenal of ACTH to improve proteinuria through a prospecve pilot study in adults with biopsy proven primary FSGS, (eGFR ≥ 30ml/min and urine protein ≥ 2000 mg/day). Biopsies, medical histories and physical exams were used to rule out secondary forms of FSGS. All subjects were treated subcutaneously with ACTHar Gel, with an escalang dose to achieve 160 USP units per week by week 5 for a total 16-week treatment period. We monitored blood pressure (BP), weight, serum creanine, 24-hour urine protein excreon, lipid profile and blood sugar values. Eleven paents (7 men, 4 women) have completed the trial; median age 47 years, baseline creanine 1.8 ±0.9mg/dl, urine protein 3550 mg/day (range 2010-23,800), average weight 198 lbs., and one paent has dropped out (compliance). Median protein excreon dropped from 3550 to 2200mg/day (p=0.06). Six of 10 subjects had a reduction in proteinuria; there were two paral remissions and one complete remission. Renal funcon was stable overall with only one paent demonstrang progressive renal dysfuncon. No significant rebound of proteinuria was observed over an addional two months. Therapy was well tolerated overall with stable mean BP, lipids, and glucose. There were 2 adverse events of hypertension, and one adverse event of new onset diabetes, which was reversed by stopping ACTH. Paent response was inversely correlated with BMI and with degree of glomerular fibrosis. ACTH therapy may have the potenal to reduce proteinuria in paents with primary FSGS and is well tolerated. Further study will be needed to assess long term responses and ideal patients for therapy.
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137
139 GENETIC VARIAION IN APOL1 GENE IS ASSOCIATED WITH CHRONIC KIDNEY DISEASE (CKD) IN NIGERIANS. 1Holly Kramer, 1Bamidele O. Tayo, 2Babatunde Salako, 3Omri Gottesman, 2Adesola Ogunniyi, 3Erwin P. Bottinger, 1Richard S. Cooper. 1Loyola Medical Center, Maywood, IL; 2University of Ibadan, Ibadan, Nigeria; 3Mount Sinai School of Medicine, New York, NY. APOL1 and MYH9 genetic variants show very strong associations with non-diabetic kidney disease in African Americans. This study examined the association between variants in the APOL1/MYH9 region and non-diabetic CKD phenotypes among Nigerians. Cases included individuals aged 16-70 years with non-diabetic CKD in absence of sickle cell disease, HIV, or hepatitis B. Cases were age matched with 79 healthy controls without CKD or hypertension who participated in the Genetics of Hypertension in Blacks Study. Genotyping of APOL1 and MYH9 single nucleotide polymorphisms (SNPs) was completed at Mount Sinai School of Medicine. Overall, 95 of the 98 cases had end-stage kidney disease. Table 1 shows the associations between APOL1 and MYH9 SNPs and non-diabetic CKD under a recessive model. No MYH9 SNP showed a statistically significant association with CKD under recessive model. Conclusions, APOL1 SNPs are significantly associated with non-diabetic kidney disease among Nigerians. SNP Gene MAF Model OR P Value rs73885319 rs60910145 rs71785313 rs11912763
APOL1 APOL1 APOL1 MYH9
35.51 40.86 11.58 33.33
Recessive Recessive Recessive Recessive
3.882 3.215 0.533 1.627
0.0137 0.006 0.6663 0.369
138
CHANGE IN SF-36 SUMMARY SCORES & DIALYSIS SURVIVAL Eduardo Lacson, Jr., Nien-Chen Li, Shu-Fang Lin, Sandie GuerraDean, Michael Lazarus, Raymond Hakim, Franklin Maddux. Fresenius Medical Care, North America, Waltham, MA, USA. We previously reported (CJASN, 2010) the associaon between SF-36 physical and mental summary scores (PCS & MCS) with mortality risk in 44,395 chronic dialysis paents. Since A ≥ 5-point change in PCS or MCS has been shown to be clinically meaningful, we invesgated in a subset of 10,996 paents who had a second survey performed ~6 months later, whether a ≥ 5-point change in PCS or MCS will impact one year survival (from the date of 2nd survey) despite adjustment for the respecve baseline score. For PCS, 5,525 (50%) paents had no change (i.e. were within ± 5 from baseline) while 2,735 (25%) decreased and 2,736 (25%) increased their scores by ≥ 5 points. For MCS, 5,155 (47%) paents had no change, 2,858 (26%) decreased and 2,983 (27%) increased scores, respecvely. Hazard raos (HR) of death for PCS increase was 0.77 and for PCS decrease 1.42 (both p<0.0001) compared to no change (control), even aer adjusng for baseline PCS. With further case mix adjustment for age, gender, race, diabetes, dialysis modality, and vintage, HR=0.82 (p=0.002) for PCS increase and HR=1.33 (p<0.0001) for PCS decrease, respecvely. For MCS, HR=1.48 for a decrease in score, becoming HR=1.46 with addional case-mix adjustment (both p<0.0001). An increase in MCS trended towards improved survival but results were not stascally significant. Results from this analysis indicate improved survival associated with a ≥ 5 point increase in PCS while there was increased relave risk of death associated with a ≥ 5 point decline in either PCS or MCS. Prospecve cohort studies are needed to determine if these findings can be replicated.
140
THERAPY RETENTION EXPERIENCE OF A LARGE HOME SHORT DAILY HEMODIALYSIS (SDHD) CENTER. Michael Kraus, Catherine Cox, Yoojin Lee IU Health, Indianapolis, IN; Tufts University, Boston, MA. IU Health home dialysis program has trained over 200 pts since 2004. We retrospectively analyzed 169 pts that started home SDHD on the NxStage System One between 2005-10. Data included pt characteristics, social & employ status, partners, prescription and reasons for drop. Analysis included K-M and univariate Cox regression. Mean age was 54±14 yrs, 66% male, 48% AVF & 36% catheter, 85% prescribed 6 tx/wk, and 10% 5tx/wk. Mean dialysate vol was 22±5L/tx and 126±23L/week. 59% of pts were married, and 37% single. 55% of partners were spouse (40% wife), 12% child, 10% parent, and 5% self care. Mean time on therapy was 23±20 mths. 14% of pts dropped <3mths, 23% 3-12mths and 63% ≥12 mths. Reasons for drop incl death 25%, transplant 24%, burden of therapy 20% (10% partner, 10% pt), health issues 15% and other 16%. Fig below show 50% technique survival = 22 mths [95%CI 14, 28] and after censoring for death & transplant = 49 mths [95%CI 33, 64]. K-M (all drops)
K-M (censored for death & tx)
Regression analyses show higher risk of drop in older pts (>74)(HR = 2.5, p = 0.003) vs. pts ag 45-64, pts with catheters (HR 1.8, p = 0.005) vs. fistulas, and pts who use premixed dialysate bags (HR 2.0, p = <0.0001) vs. the NxStage PureFlow system. Incident pts trended towards improved technique survival (HR 0.3, p = 0.06) vs. prevalent. In conclusion, pts of all ages & char can be successful on SDHD, however, to ensure technique survival, factors such as age, vascular access & dialysate source need to be managed. We intend to further investigate the effects of patient and partner social status in SDHD.
Am J Kidney Dis. 2012;59(4):A1-A92
ADRENOCORTICOTROPIN HORMONE (ACTH) FOR THE TREATMENT OF PRIMARY FOCAL GLOMERULOSCLEROSIS (FSGS) Richard A Lafayee, Christa Root, Kshama Mehta Division of Nephrology, Stanford University, Palo Alto, CA, USA We wished to assess the potenal of ACTH to improve proteinuria through a prospecve pilot study in adults with biopsy proven primary FSGS, (eGFR ≥ 30ml/min and urine protein ≥ 2000 mg/day). Biopsies, medical histories and physical exams were used to rule out secondary forms of FSGS. All subjects were treated subcutaneously with ACTHar Gel, with an escalang dose to achieve 160 USP units per week by week 5 for a total 16-week treatment period. We monitored blood pressure (BP), weight, serum creanine, 24-hour urine protein excreon, lipid profile and blood sugar values. Eleven paents (7 men, 4 women) have completed the trial; median age 47 years, baseline creanine 1.8 ±0.9mg/dl, urine protein 3550 mg/day (range 2010-23,800), average weight 198 lbs., and one paent has dropped out (compliance). Median protein excreon dropped from 3550 to 2200mg/day (p=0.06). Six of 10 subjects had a reduction in proteinuria; there were two paral remissions and one complete remission. Renal funcon was stable overall with only one paent demonstrang progressive renal dysfuncon. No significant rebound of proteinuria was observed over an addional two months. Therapy was well tolerated overall with stable mean BP, lipids, and glucose. There were 2 adverse events of hypertension, and one adverse event of new onset diabetes, which was reversed by stopping ACTH. Paent response was inversely correlated with BMI and with degree of glomerular fibrosis. ACTH therapy may have the potenal to reduce proteinuria in paents with primary FSGS and is well tolerated. Further study will be needed to assess long term responses and ideal patients for therapy.
A49