178 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0508 Nephrology
A Case of the Dilated Cardiomyopathy after Pazopanib Therapy in the Metastatic Renal Cell Carcinoma
Jung Sub SONG1, Byoung Hun LIM1, Ju-Hung SONG1, Seon-Ho AHN1 Wonkwang University College of Medicine and Hospital, Korea1
Background: Renal cell carcinoma(RCC) is the most common kidney cancer. Advanced RCC is highly aggressive, with 5-year survival rates of approximately 10%. With the advent of targeted agents for the treatment of RCC, overall survival has improved.
All of these agents inhibit tumour angiogenesis, which is essential for tumour growth and metastasis. Pazopanib inhibits the tyrosine kinase activities of vascular endothelial growth factor receptors, platelet-derived growth factor, and stem cell factor receptor.
It is currently registered for the treatment of advanced or metastatic RCC. The adverse effects of the pazopanib include hypertension, arterial thromboembolic events, renal dysfunction, hemorrhage, and gastrointestinal trouble. Congestive heart failure is a rare but serious adverse event associated with VEGF-targeted agents.
Result: A 78 years old male patient visited our hospital because of chest discomport and dyspnea. He had a history of hypertension, CKD, and RCC with liver metastasis. He took the antihypertensive agent. In addition, from August 2013, he took 800mg once a day dose of pazopanib. The laboratory test showed elevated levels of the brain natriu- retic peptide (1805pg/ml). The echocardiography showed the diffuse left ventricular thining and akinesia. And ejection fraction(EF) was 25% in the echocardiogram. April 2013, preoperative echocardiography showed the concentric LVH and normal global systolic function(EF=67.7%). He was diagnosed as dilated cardiomyopathy and he dis- charged without any further treatment.
Conclusions: As these drugs are increasing used in the routine treatment of the ad- vanced or metastatic RCC and in the setting of clinical trials in combination with other agents, physicians and investigators should be aware of this adverse effect and should monitor patients receiving VEGFR-tyrosine kinase inhibitor, such as pazopanib, closely to offer early management and to optimize the balance between clinical benefi t and life threatening adverse events.
PS 0509 Nephrology
Comparison of Waist to Height Ratio and Body Indices for Prediction of Metabolic Disturbances in the Korean Population
Jun Young DO1, Seok Hui KANG1, Jong Won PARK1, Kyung Woo YOON1, Kyu Hyang CHO1
Yeungnam University Mecical Center, Korea1
Background: The aim of the present study of the general population was to provide additive information whether body indices using body composition are helpful for pre- dicting metabolic syndrome.
Methods: Those who had no information regarding renal function and/or metabolic markers, had no information regarding body composition, or were younger than 18 years of age were excluded. As a result, 15,965 participants were included in this study.
Results: For the male participants, the area under the curves (AUCs) were 0.754 for FM index, 0.685 for LM index, 0.573 for BMC index, and 0.823 for WHtR. For the female participants, the AUCs were 0.769 for FM index, 0.749 for LM index, 0.574 for BMC index, and 0.870 for WHtR. The WHtR had the highest AUC and was the best predictor of metabolic syndrome for both genders. In addition, the WHtR had the highest AUCs for components of metabolic syndrome. Multiple linear regression analyses were designed by using body indices, age, alcohol consumption, smoking, and physical activity. The standardized ß value for WHtR was greatest among body indices.
Multivariate logistic regression showed that male participants in the second, third, and highest quartiles had a 3.897-fold, 9.276-fold, and 35.257-fold increased risk of meta- bolic syndrome compared with patients in the lowest quartile and female participants in the second, third, and highest quartiles had a 4.154-fold, 17.352-fold, and 55.735-fold increased risk of metabolic syndrome compared with patients in the lowest quartile.
Conclusions: Among the classic body indices, WHtR is most useful to predict the presence of metabolic syndrome and insulin resistance in the Korean population.
PS 0510 Nephrology
Subjective Global Assessment of Nutritional Status and Mortality in Chronic Dialysis Patients: A Nationwide Prospective Observational Cohort Study in Korea
Nara SHIN1, Eunjin BAE1, Ji In PARK1, Sunhwa LEE1, Hajeong LEE1, Dong Ki KIM1, Yong-Lim KIM2, Shin-Wook KANG3, Chul Woo YANG4, Yon Su KIM1
Seoul National University Hospital, Korea1, Kyungpook National University Hospital, Korea2, College of Medicine, BK21, Yonsei University, Korea3, Seoul St. Mary’s Hospital, Korea4
Background: Malnutrition is a common and crucial problem because it is associated with higher mortality in chronic dialysis patients. Subjective global assessment (SGA) has been proven as a clinically adequate method for assessing nutritional status in dialysis patients. We explored the relationships between initial and transitions of SGA and all-cause mortality.
Methods: A nation-wide prospective observational cohort study included adult chron- ic dialysis patients. We selected patients who had baseline and 12 month follow-up SGA. SGA-7 score was categorized as well-nourished (SGA 6~7) and malnourished (SGA 1~5) groups. The changes of SGA were categorized by 4 groups (well-maintained, poorly-maintained, improving, and worsening group).
Results: A total of 2,600 patients were selected and mean age was 55.7±14 years old and 57.2% of patients were male. The mean follow-up period was 28.5 months.
During the follow-up period, 202 patients (7.8%) were died. The mortality rate in malnourished patients was higher in both incident (5.2% vs. 13%, p<0.001) and prev- alent patients (6.3% vs. 20.4%, p<0.001). The survival rate was signifi cantly higher in well-nourished patients in 12 month follow-up (p<0.001). Moreover, in terms of SGA transition, improving and well-maintained groups had better survival rate than worsening group and poor-maintained group. These fi ndings were reproducible even afteradjustment of age, gender, smoking, BMI, comorbidity, serum albumin, cholesterol and hs-CRP (HR 2.913, 95% CI, 1.856–4.573, p<0.001).
Conclusions: Malnutrition assessed by SGA was an independent predictor for all- cause mortality. Furthermore, the transition of SGA was also correlated with mortality in chronic dialysis patients.
PS 0511 Nephrology
Role of Serum Vascular Endothelial Growth Factor-C in Patients with Chronic Kidney Disease
Hyunjeong CHO1, Kyung Don YOO1, Seung Hee YANG1, Ran-Hui CHA2, Dong-Ki KIM1, Kwon Wook JOO1, Yon Su KIM1, Hajeong LEE1
Seoul National University Hospital, Korea1, National Medical Center, Korea2
Background: In chronic kidney disease (CKD), lymphangiogenesis is a common feature in tubulointerstitial fi brosis. Vascular endothelial growth factor (VEGF-C) is one of the most effi cient factors in lymphangiogenesis. The aim of study was to understand the role of VEGF-C in CKD progression.
Methods: We recruited CKD patients (n=205) and healthy volunteers (n=52) from April 2008 to May 2012. We stratifi ed patients into three groups according to tertiles of VEGF-C levels. Primary outcome was a composite of 50% decline in GFR, doubling of creatinine, progression to end-stage renal disease (ESRD), or all-cause mortality.
Secondary outcome was a change of blood pressure.
Results: In baseline characteristics, the mean age and gender were 58 ± 15 years and 62.4% men. Underlying causes of CKD were 19% diabetes and 61.5% hypertension.
The presence of diabetes in lower VEGF-C group is signifi cantly higher than higher VEGF-C group (30.9% in lower, 14.5% in middle, 11.8% in higher; p=0.009). There were no statistically signifi cant differences in age, gender, body mass index, blood pressure, GFR and proteinuria. VEGF-C levels was not related with GFR (r=0.029, p=0.690). Lower VEGF-C level was a signifi cant predictor for poor renal survival after adjustments for age, gender, body mass index, blood pressure and GFR (Hazard ratio, 2.52; 95% confi dence intervals, 1.11–5.74; p=0.028). However, the signifi cance was lost after adjustment for diabetes. Although it was insignifi cant, lower VEGF-C levels tended to decrease renal survivals in both diabetic (p=0.213) and non-diabetic CKD patients (p=0.989). There were no differences between VEGF-C levels and antihyper- tensive drug requirements (p=0.348).
Conclusion: Lower VEGF-C levels were associated with CKD progression. However, statistical signifi cance was lost after adjustment for diabetes. Diabetes may be a sig- nifi cant confounder. We need to evaluate the clinical relevance of VEGF-C in diabetic CKD patients.
