WCIM 2014
36 32nd World Congress of Internal Medicine (October 24-28, 2014)
OS-NEP-06 Nephrology
Paraoxonase-1 Activity in Patients with Anemia with or Without Chronic Renal Failure
Yildiz OKUTURLAR1, Nilgul AKALIN2, Ozlem HARMANKAYA1, Nurten TURAN GUNER3, Deniz YILMAZ1, Asuman GEDIKBASI4, Ozlem SOYLUK5, Meral MERT5, A.Baki KUMBASAR1
Bakirköy Dr. Sadi Konuk Research and Training Hospital, Internal Medicine, Turkey1, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Nephrology, Turkey2, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Radiology, Turkey3, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Biochem- istry, Turkey4, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Endocrinology and Metabolism, Turkey5
Background: Paraoxonase (PON)-1 is an antioxidant enzyme. It has three known activities, paraoxonase, arylesterase and diazoxonase. It has been reported that PON-1 defi ciency is related to increased susceptibility to development of atherosclerosis and cardiovascular disease. The aim of this study is to evaluate antioxidative status and carotid intima-media thickness (CIMT) in patients with anemia with/without chronic renal failure.
Methods: 42 patients with anemia and a control group of 47 patients were enrolled in to the study. Patients were divided into two groups as Group 1 with iron defi ciency anemia and Group 2 with chronic renal failure and anemia of chronic disease and Group 3 as the healthy control group. In all three groups antioxidative status was evaluated by measuring free sulfhydryl groups (-SH = total thiol), paraoxonase and arylesterase levels. CIMT measurements were also performed at the same time.
Results: In all three groups, age, weight, average height, gender, presence of diabe- tes and smoking habit were not signifi cantly different (p>0.05). Hemoglobin levels were 7.85 ± 1.25 in Group 1, 8.62 ± 1.09 in Group 2 and 13.45±1.63 in Group 3. We have found that Arylesterase and -SH levels were decreased both in Group 1 and 2 according to Group 3. Bilateral CIMT was increased only in Group 2. Between group 1 and group 2 the only difference was the the more signifi cant decrease in Arylesterase levels in group 2 (Table 1-2).
Conclusion: PON-1 activity and -SH levels may be independently associated with the presence of atherosclerosis.
OS-NEP-07 Transplantation
Effect of Donor Kidney Volume on Graft Functions in Living Donor Kidney Transplantation: 5 Years Follow Up
Tolga YILDIRIM1, Hadim AKOGLU1, Rahmi YILMAZ1, Gonca ELDEM2, Tuncay HAZIROLAN2, Tuncay AKI3, Mustafa ARICI1, Bulent ALTUN1, Yunus ERDEM1
Hacettepe University Medical Faculty, Turkey1, Hacettepe University Medical Faculty, Turkey2, Hacettepe University Medical Faculty, Turkey3
Background: Immunosuppressive protocols decreased the rates of acute rejection in kidney transplantation however long term graft survival has not changed signifi cantly.
Nephron underdosing may be one of the factors affecting the long term prognosis of the transplanted kidney. Aim of this study was to determine the impact of volume of transplanted kidney on long term allograft functions.
Methods: The study was conducted among sixty-two living renal transplant recipients (41 male, 21 female; mean age 30.6±10.2 years) who underwent transplantation be- tween years 2003-2007 and their respective donors (22 male, 40 female; age 41.9±9.9 years). Patients that suffered graft loss due to any cause within fi ve years after trans- plantation were excluded. Volume of the transplanted kidneys had been measured preoperatively via 3-D helical computerized tomography. Transplanted kidney volume/
recipient weight (Vol/weight) was calculated for each donor-recipient pair. Subjects were divided into two groups according to the median value of Vol/weight (2.35 cm3/ kg). Glomerular fi ltration rates (GFR) of the recipients were calculated for fi ve years.
Results: First and third year GFR’s of the patients was significantly higher in Vol/
weight>2.35 cm3/kg group compared to Vol/weight<2.35 cm3/kg group (73.7±17.6 vs.
61.6±19.3, p=0.01 and 72.3±20.7 vs. 60.0±17.3, p=0.01 respectively). However fi fth year GFR was similar in both groups (64.5±16.9 and 56.6±21.7, p=0.11). There was a signifi cant correlation between Vol/weight and both fi rst and third year GFR’s (r=0.409, p<0.001 and r=0.429, p<0.001; respectively). The correlation was not observed with the fi fth year GFR (r=0.133, p=0.303).
Conclusions: Volume of transplanted kidney adjusted for recipient weight is a signifi - cant predictor of early but not late graft functions.
OS-NEP-08 Nephrology
Could We Infl uence on Patient Survival by Dialysis Mo- dality?
Sonja KAPUN1
Dialysis Clinic Nefrodial, Slovenia1
Background: Hemodialysis (HD) has become a standard of renal replacement therapy.
Clearance of middle-to-large molecules can be increased by combining diffusive and convective transport through online hemodiafi ltration (oHDF). Recent data indicate the volume of substitution fl uid delivered as an indipendent mortality risk factor. Accord- ing to results of MPO and ESHOL Study, the convective volume (total volume of ultra- fi ltration achieved per HDF session) is very important. There is a lack of outcome data comparing oHDF with conventional HD. The aim of our study was to compare patient survival on three different treatment modalities: high-fl ux HD, low-volume oHDF and high-volume oHDF.
Methods: Epidemiological cohort study of 442 incident dialysis patients treated in 13 dialysis units in Slovenia, Bosnia and Herzegovina and Serbia was performed from January 1, 2007 to December 31, 2011. High-volume oHDF is defi ned as substitution volume higher than the median substitution volume infused otherwise low-volume.
Results: The median substitution volume used for post-dilution oHDF was 20.4 L (con- vective volume of 23-24L). Mean difference between the oHDF groups in substitution fl uid volume was 8.3 +5.2L (95%CI). The unadjusted hazard ratios (HR) with 95% CI compared to high-fl ux HD were 0.87 for low-volume oHDF and 0.29 for high-volume oHDF. oHDF is associated with signifi cant reductions in mean erythropoietin resistance index (ERI) and erythropoiesis stimulating agents (ESA) consumption. Only high-vol- ume oHDF is associated with improved survival compared to high-fl ux HD.
Conclusions: Awaiting for trials on patient survival we should focus on convective volume as clinically relevant surrogate indicator of the convective component. By achieving high substitution volumes, we can benefi cially effect on main cardiovascular risk factors. In view of these results, oHDF may become the fi rst line therapy option, but futher studies are needed.
OS-NEP-09 Nephrology
Can Augmentation Procedures Promote Arteriovenous Fistula Use Without Compromising Vascular Access Long Term Patency?
Hoon Suk PARK1, Kyung Yoon CHANG1, Hyung Wook KIM1, Bum Soon CHOI1, Cheol Whee PARK1, Young Ok KIM1, Chul Woo YANG1, Dong Chan JIN1
The Catholic University of Korea, St. Vincent Hospital, Korea1
Backgrounds: To increase the rate of arteriovenous fi stula (AVF) use, salvage therapies for augmenting immature fi stulae are strenuously performed these days. But, there are some controversies that AVF matured by these salvage therapies requires frequent intervention for maintaining its patency and may have resultant decreased long term patency.
Methods: From total three hundred and sixty one patients with native fi stulae, 266 with AVF matured by salvage therapies and 95 with AVF matured spontaneously with- out intervention were compared and we investigated the factors that may infl uence on patencies of AVF.
Results: The group with salvage therapies were older (years, 65 vs. 59; p = 0.005) and decreased preoperative venous diameter (mm, 2.74 vs. 3.18; p < 0.001) compared with the other group without it while the preoperative arterial diameters were comparable (mm, 2.73 vs. 2.84; p = 0.356). The other parameters such as sex, diabetes, presence of coronary artery disease and left ventricular ejection fraction were also comparable between two groups. Primary patency was decreased in the group with salvage ther- apies compared with the other group without it (p = 0.021). However, primary assisted patency and secondary patency were comparable between two groups (p = 0.517 & p = 0.127). In multivariate Cox regression analysis, the presence of salvage therapies before use was not signifi cantly associated with access survival (odds ratio [OR] 0.548, 95%
confi dence interval [CI]: 0.249–1.205; p = 0.135) whereas spontaneous maturation (OR 0.326, 95% CI: 0.159–0.667; p = 0.0026), history of thrombosis during use (OR 25.051, 95% CI: 11.015–56.970; p < 0.001) and preemptive intervention (OR 0.313, 95% CI:
0.108–0.910; p = 0.033) were signifi cantly associated with it.
Conclusion: Augmentation procedures can salvage immature fi stulae without compro- mising vascular access long term survival.
