WCIM 2014 SEOUL KOREA 183
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0531 Nephrology
Correlational Study Between Ankle- Brachial Index and Quality of Life among End Stage Renal Dialysis Filipino Patients Using the Kidney Disease and Quality of Life Short Form (KDQOL-SF Tm Version 1.3) - Filipino Version
John Elmer Cabang QUILISADIO1, Aryeel Delacruz LLANOS1 Davao Regional Hospital, Philippines1
Background: The paper was conducted to determine whether there is a signifi cant association between ankle- brachial index and the quality of life among Filipino pa- tients on chronic hemodialysis using the Kidney Disease Quality of Life- Short Form (KDQOL-SF version 1.3) Filipino version questionnaire.
Methods: This study was a prospective, multi- center, analytical study which covered tertiary-level, government, training hospital and private hospitals in Davao del Norte.
Respondents include patients with end stage renal disease undergoing hemodialysis, ages 18 years old and above and those who could speak and understand Filipino lan- guage. ABI measurement was conducted using Doppler sonar equipment and a sphyg- momanometer. The KDQOL-SF version 1.3 Filipino version questionnaire was utilized. A complete enumeration is employed for the respondents.
Results: Results revealed that major cause of kidney disease was due to hypertension.
Most of them are college graduates, with more males than females, Asian ethnicity, married, ages 39 – 48 years old, housekeepers, and with gross annual income of above P100,000. Moreover, the respondents’ physical composite scores are below 43 and its mental composite scores are below 51. It is correlated with a higher risk of death based from the range defi ne by the KDQOL measure. When ABI was correlated with KDQOL results, only fi ve parameters have low correlation with the KDQOL: physical functioning, general health, problems and symptoms, effect of kidney disease and sleep domain.
Conclusions: The study revealed that there is a low correlation between ABI and KD- QOL. It is recommended that further study be conducted to establish more conclusive result on the role of ABIs in the quality of life among kidney patients.
PS 0532 Nephrology
Serum Ferritin Level is an Independent Risk Factor for All-Cause Mortality in Incident Hemodialysis Patients
Kyoung Sook PARK1, Hyung Jung OH1, Jung Tak PARK1, Seung Hyeok HAN1, Tae-Hyun YOO1, Yong-Lim KIM2, Yon Su KIM3, Chul Woo YANG4, Nam-Ho KIM5, Shin-Wook KANG1 Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Department of Internal Medicine, Kyungpook National University School of Medicine, Korea2, Department of Internal Medicine, Seoul National University College of Medicine, Korea3, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Korea4, Department of Internal Medicine, Chonnam National University Medical School, Korea5
Background: Serum ferritin has been regarded as an indicator of infl ammation as well as a marker of body iron storage in patients with end-stage renal disease (ESRD). In addition, high serum ferritin levels were significantly associated with poor clinical outcomes in prevalent dialysis patients. However, little is known about the prognostic impact of serum ferritin concentrations on the clinical outcome in incident hemodialysis (HD) patients.
Methods: A prospective cohort of 939 incident HD patients from 36 dialysis centers of the Clinical Research Center for ESRD in Korea was selected for this study. Serum ferritin levels were measured at the time of HD initiation. Patients were divided into tertiles according to log ferritin concentrations; <2.17, 2.17-2.50, and >2.50 ng/mL.
Cox proportional hazard analysis was performed to determine the independent prog- nostic value of serum ferritin levels for all-cause mortality.
Results: The median ferritin concentrations were 217.8 (118.7-381.1) ng/mL. Pearson’s correlation analysis showed that log ferritin levels were positively correlated with white blood cell counts (r=0.108, P=0.001) and log C-reactive protein concentrations (r=0.151, P<0.001), while negatively associated with serum albumin levels (r=-0.116, P<0.001). During a median follow-up duration of 20.7 months, 85 (9.1%) patients died.
Kaplan-Meier analysis showed that all-cause mortality rates were signifi cantly higher in the highest tertile ferritin group compared to the lowest tertile group (P<0.001).
Multivariate Cox proportional hazard analysis demonstrated that log ferritin was in- dependently associated with an increase in all-cause mortality risk after adjustment for confounding variables (per 1 ng/mL increase, hazard ratio=2.62, 95% confi dence interval=1.45-4.73, P=0.001).
Conclusions: Serum ferritin concentration was a signifi cant independent predictor of all-cause mortality in incident HD patients, suggesting that determining serum ferritin levels might be helpful to stratify mortality risk in these patients.
PS 0533 Nephrology
The Effect of GADD45gamma on the Production of Pro-Infl ammatory Cytokines by Monocytes in Hemodi- alysis Patients
Gyu-Tae SHIN1, Hwa Joung LEE1, Inhwee PARK1, Heungsoo KIM1 Ajou University Hospital, Korea1
Background: Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are pro-infl ammatory cytokines that are associated with poor survival in hemodialysis (HD) patients. We previously showed that GADD45gamma regulates TNF-alpha and IL-6 ex- pression in activated THP-1 monocyte cells (Shin GT, Infl amm Res. 2012). In this study, we investigated the effect of GADD45gamma knock-down on the production of these pro-infl ammatory cytokines in HD patients.
Methods: CD14 monocytes were negatively isolated by depletion of non-monocytes from peripheral blood mononuclear cells using magnetic beads. Using spinoculation methods, monocytes were infected with lentiviruses containing shRNA targeting GAD- D45gamma (lenti-GADD45gamma) or with negative control lentiviruses (lenti-control), and then cultured in RPMI media supplemented with GM-CSF and IL-4. Monocytes were stimulated with lipopolysaccharide and TNF-alpha and IL-6 production was evaluated by enzyme-linked immunosorbent assay (ELISA), fl ow cytometry (FACS), and confocal microscopy. MAPK protein activation was evaluated by western blot.
Results: The serum levels of TNF-alpha and IL-6 were signifi cantly higher in HD pa- tients compared to healthy controls. The FACS analysis of GFP showed that about 50 percent of monocytes could be infected by lentiviruses. The ELISA showed that TNF-alpha and IL-6 productions by monocytes were signifi cantly suppressed by GAD- D45gamma knock-down at both 3 day and 5 day time points after lentivirus infection.
The FACS analysis showed that TNF-alpha expressing cells were 13.6% in lenti-control infected cells, and the proportion was decreased to 6.6 % in lenti-GADD45gamma in- fected cells. Confocal microscopy also confi rmed that lenti-GADD45gamma could effi - ciently down-regulate the proportion of TNF-alpha expressing monocytes. The western blot analysis showed that all three activated MAPK proteins including phospho-p38, phospho-JNK and phospho-ERK were signifi cantly down-regulated by GADD45gamma knock-down.
Conclusions: The production of pro-infl ammatory cytokines by monocytes in HD pa- tients was signifi cantly suppressed by GADD45gamma knock-down.
PS 0534 Nephrology
One Case That Has Been Treated Successfully with Metal Stent Attract Recurrent Lt Brachiocephalic Vein Obstruction in Hemodialysis Patients with Central Vein Anomaly is Suspected
Jin Ho LEE1, Joong-Kyung KIM1, Seong Han YUN1, Joon Seok OH1, Seong Min KIM1, Yong Hun SIN1
Bongseng Memorial Hospital, Korea1
Background: Central vein stenosis is common complication after indwelling temporary catheter for hemodialysis. It can be asymptomatic, but can show symptoms of edema one upper extremity, nausea, and vomiting. The treatment choise is percutaneous transluminal angioplasy.
Results: 74-year-old female patient underwent dialysis with non-tunneled temporary catheter in the left internal jugular vein in July 30, 2013, then acheived diaylsis via arteriovenous fi stula. In May 26, 2014, left arm swelling occurred. She got the per- cutaneous transluminal angioplasy, then underwent 8mm balloon angioplasty in ther lesions suspected anomaly and 80% stenosis is seen. Since, edema was reduced, but edema of the left upper limb occurred again a week later. We treated metal stent(di- ameter:1cm, length:6cm) at restenotic lesion, then flow was improved. Upper arm edema was disappeared.
Conclusions: Percutaneous transluminal angioplasy is the treatment of choice for cen- tral venous stenosis. But metal stent with balloon angioplasty is the next treatment option for central vein restenosis that performed insuffi cient ballooning due to risk of central vein rupture or anomaly of vessel wall.
