Pathophysiology CKD 5D

Nephrology Dialysis Transplantation, May 2012

Introduction and Aims: Previous studies have shown that the prevalence of depression is high in patients with chronic kidney disease (CKD). Depression is associated with increased cardiovascular mortality and the higher rate of suicides in these patients. However, up to now, there is no data concerning the prevalence of depression in haemodialyzed patients in Poland. The aim of the study was to estimate the prevalence of depression in haemodialyzed patients in Upper Silesia region of Poland and to find the predisposing factors for depression development in these patients. Methods: Six hundred ninety seven (388 - 56% males; 309 - 44% females) haemodialyzed patients from 22 dialysis centers were enrolled into the study. Mean age was 59.1 ± 0.5 years, mean time of dialysis treatment was 43.2 ± 2.4 months. 76% of patients were dialyzed using the arteriovenous fistula and 24% with central catheter. 63% of patients were dialyzed in public and 37% in commercial dialysis centre. Appropriate understanding of given questions was obligatory before enrolment to the study. Each patient received 21 item Beck Depression Inventory (BDI) questionnaire for depression screening. BDI score cutoff for depression diagnosis was 16 points. Additional questions considering among others length of dialysis treatment, concomitant diseases, number of days spent in hospitals during last year were asked. In each patient the results of serum C-reactive protein concentration (CRP) were also obtained. Results: Depression was found in 268 (38.6%) patients. Patients with depression when compared to the patients with no depression were older (61.8 ± 0.8 vs. 57.5 ± 0.7 years; p = 0.0001), more often dialyzed using central catheter (27.6% vs. 18.2%; p = 0.0042) and tended to have higher CRP serum concentration (14.3 ± 1.3 vs. 11.1 ± 0.9 mg/l; p = 0.067). In depression group there were more patients than in no depression group with coronary artery disease (31.3% vs. 19.1%; p = 0.001), history of myocardial infarction (15.4% vs. 9.6%; p = 0.017), history of stroke (10.3% vs. 3.5% p < 0.0001) and chronic pulmonary obstructive disease (4.0% vs. 1.4% p = 0.025). Moreover, patients with depression spent in hospitals more days during the last year than patients without depression (24.3 ± 1.8 vs. 15.3 ± 1.0 days respectively; p < 0.0001). Significant positive correlation was found between BDI score and CRP serum concentration (r = 0.1625; p = 0.001) in the entire group of patients. Conclusions: 1. Depression is frequently observed in haemodialyzed patients of Upper Silesia part of Poland. 2. Advanced age, central catheter, inflammation and cardiovascular comorbidities are predisposing factors for development of depression in haemodialyzed patients.

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Pathophysiology CKD 5D

Walid Ahmed Abdel Atty Mohamed 2 3 8 10 12 15 18 Walid Ahmed Abdel Atty Mohamed 1 2 7 11 14 17 Farouk Mohame Khamis Zaki 0 2 6 13 16 Wessam Harby Mohamed Bekhit 2 5 9 20 Ibrahim Sobhy Sherif 2 4 19 0 Qabbary Specialized Hospital , Qabbary, Alexandria, Egypt 1 Alexandria University Hospital, Department of Internal Medicine , Alexandria, Egypt 2 Alicja E. Grzegorzewska 3 Alexandria University Student Hospital , Elshatby, Alexandria, Egypt 4 Elshefaa Hospital , Sidi Gaber, Alexandria, Egypt 5 Abu Keer General Hospital , Abu Keer, Alexandria, Egypt 6 Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital , New Taipei City, Taiwan 7 Department of Paediatric Dentistry, Medical University of Lodz , Poland 8 Department of Kidney Transplantation Medical University of Lodz , Poland 9 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine , Taipei, Taiwan 10 Department of Pediatric Nephrology, Wroclaw Medical University , Wroclaw, Poland 11 Clinical Epidemiology Unit, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine 12 Higashikohri Hospital 13 Department of Medicine, Kidney Center, Tokyo Women's Medical University , Tokyo, Japan 14 Department of Blood Purification, Sangenjaya Hospital , Tokyo, Japan 15 Department of Blood Purification, Kidney Center, Tokyo Women's Medical University , Tokyo, Japan 16 Dialysis Unit , Mlawa, Poland 17 Nephrol Dept,Med Univ, Bialystok, Poland 18 Nephrology Department 19 Department of Hematology, Ankara University , Ankara, Turkey 20 Nephrol Dept, Med Univ, Bialystok, Poland The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: - Introduction and Aims: Previous studies have shown that the prevalence of depression is high in patients with chronic kidney disease (CKD). Depression is associated with increased cardiovascular mortality and the higher rate of suicides in these patients. However, up to now, there is no data concerning the prevalence of depression in haemodialyzed patients in Poland. The aim of the study was to estimate the prevalence of depression in haemodialyzed patients in Upper Silesia region of Poland and to find the predisposing factors for depression development in these patients. Methods: Six hundred ninety seven (388 - 56% males; 309 - 44% females) haemodialyzed patients from 22 dialysis centers were enrolled into the study. Mean age was 59.1 0.5 years, mean time of dialysis treatment was 43.2 2.4 months. 76% of patients were dialyzed using the arteriovenous fistula and 24% with central catheter. 63% of patients were dialyzed in public and 37% in commercial dialysis centre. Appropriate understanding of given questions was obligatory before enrolment to the study. Each patient received 21 item Beck Depression Inventory (BDI) questionnaire for depression screening. BDI score cutoff for depression diagnosis was 16 points. Additional questions considering among others length of dialysis treatment, concomitant diseases, number of days spent in hospitals during last year were asked. In each patient the results of serum C-reactive protein concentration (CRP) were also obtained. Results: Depression was found in 268 (38.6%) patients. Patients with depression when compared to the patients with no depression were older (61.8 0.8 vs. 57.5 0.7 years; p = 0.0001), more often dialyzed using central catheter (27.6% vs. 18.2%; p = 0.0042) and tended to have higher CRP serum concentration (14.3 1.3 vs. 11.1 0.9 mg/l; p = 0.067). In depression group there were more patients than in no depression group with coronary artery disease (31.3% vs. 19.1%; p = 0.001), history of myocardial infarction (15.4% vs. 9.6%; p = 0.017), history of stroke (10.3% vs. 3.5% p < 0.0001) and chronic pulmonary obstructive disease (4.0% vs. 1.4% p = 0.025). Moreover, patients with depression spent in hospitals more days during the last year than patients without depression (24.3 1.8 vs. 15.3 1.0 days respectively; p < 0.0001). Significant positive correlation was found between BDI score and CRP serum concentration (r = 0.1625; p = 0.001) in the entire group of patients. Conclusions: 1. Depression is frequently observed in haemodialyzed patients of Upper Silesia part of Poland. 2. Advanced age, central catheter, inflammation and cardiovascular comorbidities are predisposing factors for development of depression in haemodialyzed patients. INFLUENCE OF LOW-FAT DIET AND PHYSICAL ACTIVITY ON SERUM SALUSIN-ALPHA CONCENTRATION IN HEMODIALYSIS PATIENTS Introduction and Aims: Atherogenic serum lipid profile is associated in dialysis patients with cardiovascular diseases and increased death rate. Chronic salusinalpha infusion increased serum high density lipoprotein (HDL)-cholesterol (Ch) and decreased total-Ch in apolipoprotein E - deficient mice. In patients with essential hypertension decreased levels of salusinalpha were found. We aimed to examine whether low-fat diet in association with individually planned physical activity may in intermittent hemodialysis (IHD) patients affect serum salusin-alpha in relation to changes in serum lipid profile, antropometric parameters and blood pressure. Methods: Adult patients (n = 49) with over 3 month IHD vintage, having abnormal serum lipid profile according to Kidney Disease Outcomes Quality Initiative clinical practice guidelines (2003) and not taking lipid lowering medication, were enrolled into the prospective study. Low-fat diet (defined as a diet allowing a maximum of 30% of the daily energy intake from fat) and individually increased physical activity were initiated and are continued. The first 4 weeks were the introduction phase (education of patients, correction of diet, teaching self-control). During the entire study patients are consulted and argued to keep diet and maintain exercise schedule. Anthropometric (height - He; dry body mass; waist - W, hip - Hi and mid-upper arm circumferences; triceps skinfold thickness) and systolic and diastolic arterial blood pressure measurements as well as fasting blood samples for the laboratory data (salusin-alpha, total- Ch, HDL-Ch, triacylglycerols - TG) were taken after 4 and 8 weeks from the study beginning. Serum low density cholesterol (LDL)-Ch concentration, lipid indices (HDL-Ch/LDL-Ch, HDL-Ch/total Ch, TG/HDL-Ch), anthropometric indices (body mass index, W/Hi ratio, W/He ratio, mid upper arm muscle circumference) as well as pulse pressure and mean arterial pressure were calculated. Serum salusin level was determined by radioimmunoassay method (Phoenix Pharmaceuticals, USA). The statistical analysis was performed in 45 patients who finished the 8-week period of the study (64.1 10.1 years, 19 women, dialysis vintage 39 33 months). Results: In the first measurement serum salusin-alpha in IHD patients was 14.3 2.6 pmol/L and correlated with LDL-Ch (r = -0.334, p = 0.025). Gender-age matched healthy volunteers had serum salusin-alpha of 15.2 3.3 pmol/L. Between 4th and 8th week of maintained diet and physical activity serum lipid indices improved (HDL-Ch: 37.9 9.9 mg/dL vs 43.5 9.2 mg/dL, p = 0.010; HDL-Ch/LDL-Ch: 29.4 11.2% vs 36.7 14.5%, p = 0.006; HDL- Ch/total Ch: 18.8 5.0% vs 21.8 5.6%, p = 0.004, TG/HDL-Ch: 5.03 2.79% vs 5.25 2.74%, p = 0.065), but serum salusin-alpha concentration (15.5 7.0 pmol/L) was not significantly different from the initial measurement. The examined anthropometric and blood pressure direct measurements and calculated indices did not change significantly. In 14 patients there was no increase in serum HDL-Ch. If data of these patients were excluded from the analysis, serum level of salusin-alpha still remained unchanged (14.1 2.3 pmol/L vs 14.6 4.4 pmol/L) despite the increase of HDL-Ch in every case. Conclusions: In IHD patients short-term lipid lowering therapy with low-fat diet and physical activity causes an increase in serum HDL-Ch, but it does not result in feed-back changes in serum salusin-alpha level. ( number, NCT01448174) SODIUM THIOSULFATE (STS): A NEW OPTION FOR HEMODIALYSIS PATIENTS WITH UREMIC PRURITUS Introduction and Aims: Pruritus is a common and bothersome symptom among patients with end-stage-renal-disease (ESRD) on hemodialysis (HD). The pathophysiology is incompletely understood and it is often difficult to eradicate although symptoms can usually be mitigated. One study, for example, examined the relationship between skin mast cells and the severity of itching. . Neither the plasma phosphate nor intact parathyroid hormone levels were statistically related to itching or to mast cell number, but itching did appear to be related to the plasma calcium concentration. In 2004, Dr. Momose of Hirosaki, Japan and colleagues had found that Uremic Pruritus is mainly due to abnormal deposition of Calcium ions in the skin of HD patients (1). Sodium Thiosulfate (STS) is a potent antioxidant that is used as a chelating agent in cases of Cyanide toxicity encountered during the use of plant pesticides and it is also used in cases of Calciphylaxis as it increases the solubility of subcutaneous calcium deposits(2). We accidently discovered, during the treatment of one HD patient with calciphylaxis using STS, marvelous improvement of his pruritus symptoms. The aim of our study was to measure the efficacy of STS in alleviating Uremic pruritus and, thus, improving the quality of life in a group of HD patients and comparing them to another group of HD patients who were taking placebo. Methods: We randomly assigned 45 HD patients who were complaining of severe pruritus as scored using the Dermatological Life Quality Index (DLQI) as permitted by one of its inventors (Prof. Andrew Y Finlay) into 2 groups namely group 1 and group 2 respectively. (3) Then we assigned 25 patients (group 1) to receive IV infusion of STS at dose of 12.5g/50 NS during the last hour of every dialysis session for 6 months and we compared them to 20 patients (group 2) who were assigned to receive placebo. We then compared the DLQI of both groups at different time periods (baseline, 2wks, 1month, 2months, 4months and 6months). The DLQI is a Questionnaire which consists of 10 Questions answered by the patient then it is scored from 0-30. A person is considered to have severe pruritus if he/she has a DLQI from 11-30. Results: We found that STS had significantly improved pruritus symptoms and, thus, the DLQI of group1 at different time periods after 2wks, 4wks, 2 months, 4 months till the time the study was finished after 6 months(7/25, 9/25,15/25,19/25 and 21/25 SAP598 Figure (1): KPercentage of patients with DLQI less than 10 in the two studied groups at different periods of follow up. SAP598 Figure (2): DLQI in the two studied groups at different period of follow up. respectively) as compared to the placebo group at the same time periods (2/20,2/ 20,3/20,1/20 and 5/20 respectively) [ P value = 0.0001]. Conclusions: We have concluded that STS is a new cheap and promising option for HD patients with uremic pruritus with very mild and rare adverse effects (hypotension, nausea/vomiting, hypersensitivity reactions, contact dermatitis and local irritation). We also found that STS had significantly improved the quality of life of those patients. One of the drawbacks of this drug was that it had to be prepared by professional pharmacist. We recommend that STS should be further studied. SERUM FETUIN A AND ITS RELATIONSHIP WITH HEPATIC STEATOSIS AND SERUM CHEMERIN LEVEL IN MAINTENANCE HEMODIALYSIS PATIENTS Introduction and Aims: Fetuin A is synthesized in hepatocytes and is an inhibitor of calcium and phosphate precipitation. A deficiency of fetuin A is linked to cardiovascular calcification and mortality in dialysis patients. In addition, high levels of fetuin A are correlated with insulin resistance in the general population and liver fat content in obese patients. The aim of this study was to investigate the associations between fetuin A, hepatic steaosis, and adipokines in hemodialysis (HD) patients. Methods: 216 prevalent HD patients were enrolled into this cross-sectional study. All participants received abdominal ultrasound to estimate hepatic steatosis, which was also quantified by the hepato-renal index (HRI). Anthropometric parameters, serum fetuin A, adiponectin, chemerin levels and lipid profiles were recorded. Results: Data from 103 women and 113 men (mean age 60 12 years) were analyzed. Eighty subjects had hepatic steatosis and their HRIs were significantly higher than those without hepatic steatosis (P < 0.001). Serum fetuin A levels were positively associated with HRIs (P < 0.001), but not with waist-height ratio (WHtR). In multi-variable linear regression analysis, fetuin A was independently associated with HRIs after adjustments. Fetuin A was also positively associated with chemerin and negatively associated with adiponectin levels. Patients with higher serum chemerin levels had higher WHtRs (all P < 0.05). Conclusions: Serum fetuin A levels were higher in prevalent HD patients with hepatic steatosis, and positively correlated with chemerin levels. Chemerin levels were also associated with visceral fat accumulation in the HD patients. CAN PAST HISTORY OF VARICELLA INFECTION PREDICT SEROPOSITIVITY FOR VARICELLA ZOSTER VIRUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE? Soroush Shojai1, Uday Udayaraj2 and Parastoo Shojai3 1Southmead Hospital, Bristol, England, 2Southmead Hopital, The North Bristol NHS Trust, Bristol, UK, 3Southmead Hospital, Thenorth Bristol NHS Trust, Bristol, UK Introduction and Aims: Varicella Zoster virus (VZV) can be life threatening in adults and particularly in immunocompromised patients with the risk of fulminating varicella pneumonia and systemic diseases. Secondary infection rate with varicella Zoster Virus (VZV) from a household contact is as high as 90%. VZV vaccine is not part of routine national immunisation program in the UK and some other countries but it is estimated that 90% of adults in the UK are immune from childhood exposure to VZV. The Department of Health (UK) recommendations for post exposure management of pregnant women and healthcare workers are based on the self-reported past history of varicella infection without the need for testing for VZV seropositivity. Patients with End Stage Renal Disease (ESRD) suffer from general suppression of immune system. Unfortunately there is no specific recommendation for management of patients with Chronic Kidney Disease(CKD) stage V/ESRD. Moreover the predictive value of the self-reported past history of varicella infection for seropositivity in this population has not been validated. We conducted this cross sectional study to define the predictive value of past history of VZV infection in adults with CKD stage V/ESRD for seropositivity for VZV. Methods: All patients on waiting list for kidney transplantation on 28.02.2010 were included. They all were interviewed by a recipient transplant co-ordinator/ Specialist Nurse as part of their assessment prior to activation on transplant waiting list and have been asked to report history of chickenpox or shingles, or any scar attributed to those infectious diseases. Subsequently, their serum anti VZV antibody was also measured in line with usual practice as part of their pre-listing assessment. Immune status was determined by using the VIDASVaricella-Zoster Virus IgG Immunoassay (ELISA) kit; equivocal or negative results were confirmed by using Euroimmune Indirect Immunofluorescence Test(Anti VZV IIFT). Results: Of 405 patients on transplant waiting list, 74(18.2%) patients were excluded (68 and 6 due to lack of data on past history of varicella infection and serology results respectively). 331(81.8%) patients were included. Overall 98.5% of patients listed for kidney transplantation were seropositive for VZV. Positive predictive value of past history of VZV infection for seropositivity was 98.7%.For other results see table below. Conclusions: Past history of varicella infection is a reliable predictor of seropositivity for VZV in adult patients with CKD stage V/ESRD. National recommendations on post exposure management of VZV without the need to test for seropositivity can be extended to the CKD population. IS THE FEELING OF THIRST A PRIMARY CAUSE OF EXCESSIVE WEIGHT GAIN IN PATIENTS ON MAINTAINING HEMODIALYSIS? Introduction and Aims: The large inter-dialytic weight gain after dialysis-free weekend break is regarded as a factor increasing mortality in hemodialysis (HD) patients. The uncontrolled thirst leading to unrestrained fluid consumption, exacerbated by a long gap between HD sessions, may be crucial in this regard. However the feeling of thirst is strictly connected with sodium intake and its serum concentration but the inter-dialytic weight gain cannot be so easily explained. The ii | Abstracts SAP601 Table 1. Results of logistic regression evaluation excessive weight gain. DM- diabetes mellitus, ACEi / ARB angiotensin converting enzyme inhibitors / angiotensin receptors blockers aim of the study was to explore which of numerous variables may explain the excessive inter-dialytic weight gain. Methods: The thirst questionnaire survey, comprising of seven questions scored 1-5 (min 7 to max 35 points), was carried out in 150 patients (male 95, female 55) on maintained hemodialysis (mean vintage 13.6 6.6 months), mean age 59.6 13.3 years. The excessive inter-dialytic weight gain was recognized as dry body mass overweight = 3kg. All participants were carefully instructed to obey fluid and salt restriction. The inter-dialytic weight gain, pre-, post- dialysis sodium concentration, its gradient and serum urea concentration were assessed during a first session after dialysis-free weekend break. Patients records were evaluated to collect other data including concomitant diseases and medication which may be regarded as contributory. Results: The logistic regression evaluation indicated that the older patient and the longer vintage (time from first hemodialysis) the higher chance for excessive weight gain. Patients treatment with angiotensin converting enzyme inhibitors (ACEi) / receptor blockers (ARB) reduced the inter- dialytic weight gain. The feeling of thirst had the strongest influence on weight gain. The higher thirst survey scores were connected with occurrence of excessive overhydration. No other variable, including patients gender, diabetes and serum concentration of sodium, urea or Na+ gradient (table 1) was a contributory factor. Conclusions: The excessive inter-dialytic weight gain was explained mainly by increased feeling of thirst. Additional contributory factors were patients age and dialysis vintage. HSP27 AS A NEW MARKER OF APOPTOSIS IN CHILDREN ON CHRONIC DIALYSIS Introduction and Aims: Intracellular heat shock protein (Hsp) 27 is a potent anti-apoptotic factor that, among other activities, inhibits the extracellular signaling pathway of programmed cell death. In detail, Hsp27 unables the binding of membrane death receptor Fas to its ligand FasL, thus preventing the subsequent caspase activation. However, the potential role of extracellular Hsp27 and possibilities to control it have not been clarified yet. Moreover, there are no data on relations between Hsp27, sFas/sFasL system, and its regulators, matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), in patients with chronic kidney disease (CKD)neither children or adults. The aim of our study was to evaluate serum concentrations of Hsp27 and their potential regulators (sFas, sFasL, MMP-7, TIMP-1), in children with CKD and on chronic dialysis. We searched for differences between pre-dialysis and dialysis subjects, as well as for discrepancies between various dialysis modalities. We also assessed the potential correlations between those parameters and markers of inflammation (hsCRP) and endothelial dysfunction (sE-selectin). Methods: 26 CKD children, 19 patients on hemodialysis (HD) and 22 children on automated peritoneal dialysis (APD) were examined. 30 age-matched healthy children served as controls. Serum concentrations of Hsp27, sFas, sFasL, MMP-7, TIMP-1 and sE-selectin were assessed by ELISA, hsCRPby nephelometry. Results: Median values of Hsp27 were significantly elevated in all dialyzed patients vs. those in pre- dialysis period and vs. controls, the highest values being observed in subjects on HD. The rest of the examined parameters (sFas, sFasL, MMP-7 and TIMP-1) followed the same pattern. Regression analysis revealed that MMP-7, TIMP-1, sFas and sFasL were the best predictors of Hsp27 concentrations in dialyzed patients, whereas no connections between Hsp27, markers of inflammation or endothelial dysfunction, independent of the analyzed group, were observed. Conclusions: Children with CKD are prone to Hsp27 dysfunction, aggravated by the dialysis commencement and more pronounced in patients on hemodialysis. Correlations between Hsp27 and examined parameters suggest the potential role for Hsp27 as a marker of apoptotic activity in the pediatric population on chronic dialysis. ASSOCIATION OF IL12 POLYMORPHIC VARIANTS WITH DEVELOPMENT OF ANTIBODIES TO SURFACE ANTIGEN OF HEPATITIS B VIRUS IN HEMODIALYSIS PATIENTS IN RESPONSE TO HEPATITIS B VIRUS VACCINATION OR INFECTION Alicja E. Grzegorzewska1, Wobszal Piotr M.2, Adrianna Mostowska3 and Pawel P. Jagodzinski3 1Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznan , Poland, 2Department of Nephrology, Transplantology and Internal Diseases, University of Medical Sciences, Poznan , 3Department of Biochemistry and Molecular Biology, University of Medical Sciences, Poznan Introduction and Aims: Cytokines, involved in Th1 system, play a role in regulation of the hepatitis B virus (HBV) clearance and immune response to HBV antigens during natural infection or planned vaccination. Our aim was to examine whether in hemodialysis (HD) patients polymorphic variants of IL12 are equally associated with development of antibodies to HBV surface antigen (anti-HBs) in the case of HBV vaccination or HBV infection. Methods: In 563 HD patients with negative antibodies to HBV core antigen (anti-HBc) vaccinated against HBV (group I) as well as in 230 anti-HBc positive HD patients who were infected with HBV in the past (group II), IL12A rs568408 3 untranslated region (UTR) G > A and IL12B rs3212227 3UTR A > C polymorphisms were analyzed in relation to anti-HBs development. In group I there were 197 patients, who did not develop a titre of anti-HBs > 10 IU/L considered as protective (subgroup Ia), whereas in group II 51 patients had anti-HBs titre < 10 IU/L (subgroup IIa). Patients of groups I and II, who developed anti-HBs > 10 IU/L were included into subgroups Ib and IIb, respectively. The associations between IL12A and IL12B genotypes and risk of impaired anti-HBs development were estimated by computing the odds ratios (OR) and their 95% confidence intervals (CI) using logistic regression analyses. To address the possibility of a gene-gene interaction effect between analyzed SNPs, a nonparametric and genetic model-free Multifactor Dimensionality Reduction (MDR) approach was used. Results: There was no significant differences in the frequencies of IL12A and IL12B polymorphic variants between HD patients of subgroups Ia and Ib. HD patients of subgroup IIa had higher frequency of CC IL12B compared to patients of subgroup IIb (13.7% vs 2.2%). The higher risk to remain anti-HBs negative after HBV transmission was shown for patients bearing CC rs3212227 IL12B compared to patients having wild type AA rs3212227 IL12B (OR 5.25, 95% CI 1.4519.0, p = 0.011) or AA/AC rs3212227 IL12B (OR 6.96, 95% CI 1.9524.9, p = 0.003). Differences between subgroups IIa and IIb in IL12A polymorphic variants did not reach statistical significance, but when IL12A and IL12B effects were combined it was shown that patients bearing both GG rs568408 IL12A and CC rs3212227 IL12B had lower chance to develop anti-HBs compared to patients having both GG rs568408 IL12A and AC rs3212227 IL12B (OR 10.1, 95% CI 0.4654.8, p = 0.011) or both GA rs568408 IL12A and AC rs3212227 IL12B (OR 9.33, 95% CI 1.14 76.7, p = 0.045). Carriers of both GG rs568408 IL12A and CC rs3212227 IL12B had 4.99-fold (95% CI 1.08 -23.1) lower chance for anti-HBs development than carriers of all others genotypes ( p = 0.045). MDR approach scores of at least 0.55, being considered interesting, were shown for gene-gene interactions in groups IIa and IIb (testing balance accuracy 0.568), however, they did not reach statistical significance evaluated using a 1,000-fold permutation test. Conclusions: IL-12B rs3212227 CC genotype seems to be individually related to impaired development of anti-HBs in response to HBV infection, but not in response to anti-HBV vaccination. In the case of HBV infection, HD patients bearing this genotype may be under 7-fold risk of persistent HBsAg positivity or isolated pattern of anti-HBc positivity than patients bearing AA/AC rs3212227 IL12B genotypes. IL12A rs568408 3UTR G > A is not individually associated with anti-HBs development, but its combined effects with IL12B rs3212227 3UTR A > C polymorphisms may exist. IMMUNOGENICITY AND SEROCONVERSION AFTER HEPATITIS B VACCINATION IN HAEMODIALYSIS PATIENTS: RESULTS OF TWO DIFFERENT VACCINATION SCHEDULES Vittorio Ortalda1, Paola Tomei2, Tewolde Yabarek3, Olga Tobaldini4, Concetta Gangemi2, Michele Giuseppe Messa4 and Antonio Lupo2 1Division Nephrology A.U.O.I Verona, 2Division of Nephrology,A.O.U.I., Verona, Italy, 3Nephrology, Ulss 22, Villafranca Verona, Italy, 4Division of Nephrology, A.O. U.I.Verona, Italy Introduction and Aims: Haemodialysis patients ( pts) are at relative high risk for exposure to hepatitis B virus (HBV) infection. Therefore, vaccination against HBV has been strongly recommended for the prevention of infection in HD patients. However, despite the availability of vaccination programs, antibody production against HBV surface antigen (anti HBs) achieved in patients with chronic renal disease is suboptimal. Methods: We evaluated a group of 141 patients ( pts) who start haemodialysis from 2003 to 2010. The first group of 95 pts (group A),mean age 56 17a,60 M and 35 F, were vaccinated for the first time with HBVAXPRO 20 mg in 3 doses (0-1-6 months) intramuscularly(IM) during the dialysis session. The second group of 46 pts (group B) who started HD in 2010 (mean age 68 10a.)24 M and 12 F, were vaccinated with 3 doses of HBVAXPRO with the same timing of the group A but with a double dose (40 mg )by intradermal (ID)injection at the end of the dialysis session. Results: The immune response results assessed by blood levels of Ab to Hb surface 3-6-12 months after vaccination showed in group A a good Ab response at 6 months in 39 pts (41%) with a titre between 10 and 1000 IU/L (R) and no titre ( < 10 IU/L) in 56 pts (59%) (NR). In the group B we obtain a sufficient antibody response with values ranging from 13 to 139 U/L at 6 months after vaccination in 20 pts (43.4%) (R1) and 26 pts (56.6%) were non responders with a titre < 10 IU/L (NR1). We didnt find any significant difference between R and NR,R1 and NR1 of the two groups regarding weight, sex, Hb, inflammatory and nutritional markers, dialysis adequacy (Kt/V), dialysis membrane (HF and LF) and T cells CD4+/CD8+ ratio. Only younger age seems to be associated with improved seroconversion in group A and in a group B ( p = 0.052) vs elderly patients. Conclusions: The weak response to HBV vaccination in haemodialysis patients seems to be independent from vaccine dose (20 or 40 mg), route of injection (IM vs ID), timing (during or at the end of HD session), type of dialysis and T cell setting (CD4 +/CD8+ ratio). To achieve a satisfactory protection in these population we have probably to use a booster dose of vaccine with an aluminium hydroxide adjuvants or vaccinate patients in predialysis (CKD 4-5) PRESSURE-VOLUME RELATIONSHIPS IN THE INTERSTITIAL COMPARTMENT OF PATIENTS WITH RENAL DYSFUNCTION AND OEDEMA; CLINICAL CORRELATES AND IMPLICATIONS FOR VOLUME ASSESSMENT Leonard Ebah1, Milind Nikam1, Angela Summers1, Idalia Dawidowska1, Anuradha Jayanti1, Helge Wiig2, Paul Brenchley1 and Sandip Mitra1 1Manchester Royal Infirmary, Manchester, UK, 2University of Bergen Introduction and Aims: Subcutaneous interstitial pressure (ISP) and volume changes play a vital role in compartmental fluid shifts in salt and water retention states such as renal disease. The accumulated excess fluid alters subcutaneous compartmental volumes and pressures to variably manifest as clinical oedema, an imprecise tool to characterise these changes. ISP and the pathophysiological characteristics in the expanded interstitial tissues that lead to oedema formation have not been studied, and their relationship with clinical correlates in renal impairment is unknown. We wished to define the subcutaneous compartmental pressures, volumes and fluid kinetics in patients with renal dysfunction and variable states of oedema, their inter-relationships and their correlation with traditional clinical determinants of volume status. Methods: Clinical characteristics of oedema, total and segmental bioimpedance fluid volumes using SFB7 machine and subcutaneous interstitial pressure (ISP) by the wick-in-needle technique were measured in 10 healthy controls and 21 oedematous patients with renal dysfunction. Results: ISP was variably raised but significantly higher in oedematous patients compared to healthy controls (4.48 1.04mmHg vs. -0.9 0.4; p = 0.0007). Total body water (TBW), extracellular fluid volume (ECFV), interstitial fluid volume (IFV), ECFV/TBW and segmental ECFV were much higher in patients than in controls even when normalised to body weight, height or BMI (0.02 > p < 0.0001). ECFV/ TBW (r = 0.98, p < 0.001) and IFV (r = 0.80, p = 0.09) were the strongest predictors of ISP. Oedema of less than 2 weeks duration tended to have higher ISPs ( p = 0.01). The time taken for a pit on the medial malleolus to disappear, the depitting time (DT) showed a significant inverse correlation with ISP, bioimpedance volume parameters and duration of oedema, with the segmental ECFV as its strongest predictor (r = 0.93, p = 0.002). There was no correlation between ISP and albumin, mean arterial pressure, the extent of oedema, or use of diuretics. Conclusions: ISP is raised in oedematous patients, is inversely correlated to duration of oedema, has a well- defined non-linear relationship with compartmental volume changes, poorly correlates to blood pressure and clinically correlates best with DT. We propose DT as a potentially more refined clinical tool for volume assessment and a useful index of interstitial tissue characteristics, volume shifts and pressure changes in subcutaneous fluid retention states in renal dysfunction. SAP606 Figure 1:: Changes of HbA1C by the introduction of vildagliptin. Introduction and Aims: GIP (gastric inhibitory polypeptide) and GLP-1 (glucagon-like peptide-1) are known as incretin. Incretins are synthesized in the ilium gut wall in response to food digestion. Incretions not only stimulate insulin secretion from pancreatic islet b-cells but also suppress glucagon secretion from pancreatic islet a-cells. However, incretins are readily cleaved by dipeptidyl peptidase-4 (DPP-4). Therefore, DPP-4 inhibitors are noted as a newer class of antidiabetic agents. DPP-4 inhibitors vary in metabolism in vivo. As vildagliptin is different from the other DPP-4 inhibitors in that it is hydrolyzed by the liver and is excreted in urine, its metabolite accumulates in the body in patients with renal dysfunction. However, since hydrolyzed vildagliptin is harmless, vildagliptin has few adverse effects in renal dysfunction. Therefore, vildagliptin may be more useful than sulfonylureas or intermediate- or long-acting insulin, since these agents have the potential to induce prolonged hypoglycemia especially in hemodialysis patients. However, reports about introduction of vildagliptin are still scarce in hemodialysis patients. Here we report some cases on maintenance hemodialysis with type 2 diabetes to whom vildagliptin was introduced. Methods: We investigated the glycemic control and adverse effects of vildagliptin, after we introduced this new agent to 8 hemodialysis patients with type 2diabetes who had received any antidiabetic agent. Since the dose of vildagliptin was recommended in Japan to be less than 50mg/day in patients with renal or liver dysfunction, we prescribed this dosage and kept it constant. After we introduced vildagliptin, we stopped the pre-intervention antidiabetic drug (4 patients had been on insulin therapies, 3 on sulfonylureas and the other on a a-glucosidase inhibitor). We followed laboratory parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin, C-reactive protein, albumin, blood glucose, and glycosylated hemoglobin (HbA1C). Results: The average age was 68.9 years and all patients except for one were male. Although the major adverse effect of DPP-4 inhibitors is reported to be liver dysfunction, AST and ALT did not increase by the introduction of vildagliptin. In patients who had received sulfonylureas, HbA1C tended to increase (6.0 1.06%?6.8 0.83%) (figure 1). However, multiple episodes of hypoglycemic attack in 3 intermediate-acting insulin users or 2 sulfonylurea users completely disappeared. Conclusions: We did not observe any adverse effects such as prolonged hypoglycemia or liver dysfunction. Insufficient dose of vildagliptin may explain the increase of HbA1C. Vildagliptin is useful especially for hemodialysis patients who suffer from episodes of hypoglycemic attack by the use of intermediate-acting insulin or sulfonylurea. CLINICAL EFECTIVNESS OF VACCINATION AGAINST INFLUENZA IN DIALYSIS PATIENTS Pavlina Dzekova-Vidimliski1, Aleksandar Sikole1, Saso Gelev2, Gjulsen Selim1 and Lada Trajceska3 1University Clinic of Nephrology, 2University Clinic of Nephrology, Skopje, Fyr Macedonia, 3University Clinic of Nephrology-Skopje, Macedonia Introduction and Aims: In order to improve the influenza vaccination rate in our dialysis center we offered in-Centre vaccination for the period of October 1, 2009, to October 1, 2011. The project goal was to reduce the number episodes of respiratory infections per patient year and the need of antibiotics. Methods: Trivalent influenza vaccine (ROCHE) was offered in three consecutive years. Patients were followed for 24 months, up until death, kidney transplantation or until the end of the observational period. Data was collected on respiratory infection episodes and requirement of antibiotics. The results were compared between patients vaccinated and not vaccinated in respect of annual rates of respiratory infections. Results: 179 patients participated in the study. The influenza vaccination rate represented no substantial progress toward the third season in 2011: 20%, 23%, 26%, respectively. The annual follow up was finished in 123 patients in 2010 and 113 patients in 2011. In the groups of vaccinated patients the rates of infection episodes per patient year were significantly lower than in non-vaccinated patients (0.86 vs. 0.97, p = 0.001); (0.57 vs. 0.92, p = 0.001), respectively for 2010 and 2011. Odds for a infection episode were higher in non-vaccinated patients in 2010 (OR 1.7 CI: [1.49-1.97], p = 0.0001), as also in 2011 (OR 1.2 CI:[0.88-1.38], p = 0.0001). Conclusions: We conclude that influenza vaccination of dialysis patients may be effective in a clinically relevant way. The lower rates of respiratory infection are clinical evidence supporting this theory. The low vaccination rate we explain with low socioeconomic status and low percentage of dialysis patients with good compliance. LOW LEVELS OF EICOSAPENTAENOIC ACID (EPA)/ ARACHIDONIC ACID (AA) RATIO IN JAPANESE HEMODIALYSIS PATIENTS Introduction and Aims: Large amounts of n-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA), lowers the risk of cardiovascular events/death and serum EPA/arachidonic acid (AA) ratio may potentially be a predictor of these events. Cardiovascular disease (CVD) is the most common cause of death in hemodialysis (HD) patients. Therefore, we examined the serum EPA and AA levels, and the factors contributing to the EPA/AA ratio in these patients. Methods: We enrolled 122 patients (female 42 / male 80) receiving maintenance HD for more than three months. Patients with taking ethyl-icosapentate (n = 4) and positive CRP (n = 9) were excluded. Informed consent was obtained from all patients. The mean age of the patients was 68.5 12.1 years old and the duration of HD was 7.0 6.4 years. The primary causes of renal failure were 37 chronic glomerulonephritis, 27 nephrosclelosis, 43 diabetes mellitus and 15 others. Forty-one patients had a history of CVD (cardiac origin; 27, cerebrovascular; 20) before this study. The serum levels of EPA, AA, docosahexaenoic acid (DHA), and dihomogamma- linolenic acid (DHL-A) were measured by gas chromatography (SRL, Tokyo, Japan), and those of high sensitivity CRP (Hs-CRP) by ELISA using an N Latex high-sensitivity CRP kit (Dade Behring Holdings, Inc). Results: The mean levels of EPA/AA ratio was 0.399 0.178. The concentrations of EPA/AA were not different between male and female, but negatively correlated with age (r = 0.184, p = 0.043). Compared with age-matched control subjects (n = 60, mean age; 60.3 years), the levels of EPA/AA in HD patients (n = 66, mean age; 60.1 years) were low (0.501 0.235 vs. 0.377 0.193). However, there were no statistical differences in the EPA/AA ratio among the patients with four causes of primary renal diseases, and between those with and without the past history of CVD. Levels of EPA/AA was significantly correlated with DHA (r = 0.425, p = 0.000). Patients were divided into two groups (n; 63 vs. 59, 0.540 0.115 vs. 0.249 0.086) based on the median of the EPA/AA level. The low EPA/AA group showed longer HD duration, higher Hs-CRP level, lower BUN level and higher albumin level compared with the high EPA/AA group. Multivariate logistic analysis showed that the low EPA/ AA group was significantly associated with lower age (HR 0.960, 95% CI 0.924-0.997, p = 0.035), longer HD duration (HR 1.085, 95% CI 1.011-1.165, p = 0.024), lower BUN level (HR 0.947, 95% CI 0.919-0.977, p = 0.001) and high Hs-CRP group (HR 2.930, 95% CI 1.167-7.357, p = 0.022) adjusted for sex, primary renal disease, albumin, non-HDL cholesterol, and the past history of CVD. Conclusions: Low levels of EPA/AA ratio was demonstrated in Japanese HD patients. In younger patients, there may be few dietary intakes of fish-derived n-3 polyunsaturated fatty acids. The correlation between the EPA/AA and hs-CRP levels may account for high cardiovascular events in HD patients. CHARACTERISTICS OF PATIENTS RECEIVING EXTREMELY LONG TERM HEMODIALYSIS THERAPY Introduction and Aims: With advances in strategies for hemodialysis therapy, the number of long-term survivors of chronic kidney disease receiving hemodialysis has been increasing. Since hardly any reports have mentioned patients on hemodialysis for more than 30 years, we examined the clinical information in such patients. Methods: Seventy outpatients receiving maintenance hemodialysis (including 18 for more than 30 years) were enrolled in this study. We classified the patients according to the duration of hemodialysis therapy (10 > years (n = 34), 10-20 years (n = 9), 20-30 years (n = 9), or 30 < years (n = 18)) and compared them. Clinical information were collected from the patient records. The muscle mass was assessed by measuring the mid-upper arm muscle area (AMA). The mid- arm circumference (AC) was measured on the side not containing the vascular access using a plastic measuring tape. The triceps skinfold (TSF) was measured using a pair of skinfold calipers. The mid-arm muscle circumference (AMC) was calculated using a previously described equation (AMC = AC - TSF). AMA was calculated as the AMC in centimeters squared divided by 4p. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry scans. The absolute BMD values for the 1/3 distal radius on the side not containing the vascular access were reported. Results: Mean age was 64.4 6.6 years in the 30 < group and no significant difference was observed among 4 groups. The mean age of the patients at the start of dialysis therapy was 30.5 7.7 years in the 30 < group, and younger than that of other groups (61.8 15.4 years in the 10 > group, p < 0.001, 49.2 14.5 years in the 10-20 group, p < 0.001, 42.8 10.1 years in the 20-30 group, p = 0.024). The cause of the renal failure was chronic glomerulonephritis in all the cases of the 30 < group. Hypertension was observed in 55.6 % of the 30 < group but in 97.1 % of the 10 > group (P < 0.001). HCV antibody was positive in 27.8 % of the 30 < group but in 0 % of the 10 > group ( p = 0.001). No significant differences in total protein, albumin, total cholesterol, triglyceride or C-reactive protein levels were observed among 4 groups. The body mass index (BMI) was significantly lower in the 30 < group than in the 10 > group (19.6 2.3 kg/m2 versus 22.0 4.5 kg/m2, p = 0.028). The AMA was significantly lower in the 30 < years group than in the 10 > group (33.2 6.3 cm2 versus 42.6 10.7 cm2, P = 0.002). The BMD was significantly lower in the 30 < group than in the 10 > group (0.431 0.132 g/cm2 versus 0.618 0.164 g/cm2, P < 0.001). Seventeen (94.4 %) patients had undergone operation for carpal tunnel syndrome, and 7 (38.9 %) had undergone surgery for cervical destructive spondyloarthropathy in the 30 < group. Conclusions: We studied the characteristics of patients on hemodialysis therapy for more than 30 years. They were young at the start of hemodialysis. All of their causes of renal failure were chronic glomerulonephritis. Hypertension was not so common. The BMI, AMA and BMD were reduced, whereas nutritional markers such as the total protein, albumin, total cholesterol and triglyceride levels were preserved. Hemodialysis-associated amyloidosis was common among them. HEPARIN-FREE (EVODIAL) DIALYSIS DOES NOT ACTIVATE ACTIVIN A Alicja Rydzewska-Rosolowska1, Joanna Gozdzikiewicz1, Jacek Borawski1, Tomasz Hryszko2, Ewa Koc-Zorawska1 and Michal Mysliwiec3 1Department of Nephrology and Transplantation, Medical University of Bialystok, Bialystok, Poland, 2Department of Nephrology and Transplantation, Medical University of Bialystok, 3Medical University of Bialystok, Bialystok, Poland Introduction and Aims: Activin A (Act A) is an interesting cytokine that can: activate transcription processes which take part in wound healing, organogenesis, osteoporosis, induce fibrosis, has neuroprotective properties and many others. Act A is released during hemodialysis (HD), mainly by heparin but the question remains whether dialysis itself (via leukocyte activation and subsequent cytokine release) also contributes to the process. We evaluated the influence of heparin-free dialysis on plasma Act A during a single HD session in comparison to a standard HD procedure. Methods: 11 clinically stable patients (8 women) (aged 20 - 82; mean 54,5 years) on chronic HD for at least 4 months were enrolled in this crossover study. First HD sesion was performed with low-flux polysulfone membranes and a bolus of enoxaparin (Clexane, Sanofi Aventis) was used for anticoagulation as usual. Another HD session was prescribed with the use of a special unfractioned heparin-grafted polyacrylonitrile (AN69ST) membrane (Evodial, Gambro Diaverum) without any systemic heparin. Blood samples were collected before HD (T0) and after 10 min (T10) and 120 min (T120) of its duration. Plasma activin A was measured using a referential ELISA kit. Results: Plasma Act A concentration increased significantly 10 minutes after enoxaparin bolus (T0 = 797.09 pg/ml, T10 = 3593.12 pg/ml, p < 0,0001) and then decreased 120 minutes after, but remained elevated as compared to the baseline concentration (T120 = 1442.93, p < 0,0001). During HD with AN69ST membrane plasma Act A level remained stable. Conclusions: Heparin-free dialysis does not cause Act A release therefore probably lacks some of the extra- anticoagulant properties as compared to low-molecular-weight heparins (i.e. enoxaparin). Whether it has protective or detrimental effects on hemodialysed patients remains to be seen. OPTIMIZATION OF 2D-DIGE ANALYSIS IN PLASMA AND ULTRAFILTRATE FOR IDENTIFICATION OF NEW UREMIC TOXINS Marta Arias1, Marta Arias2, Elisenda Baon-Maneus1, Amanda Sole1, Natalia Hierro-Garcia1, Jordi Rovira1, Maria Jose Ramrez-Bajo1, Luis Fernado Quintana1, Fritz Diekmann1, Daniel Moya-Rull1, Francisco Maduell1 and Josep Maria Campistol1 1Hospital Clinic, Barcelona, Spain, 2Hospital Clinic Barcelona Introduction and Aims: Uremic toxicity results in the dysfunction of multiple organic systems with the consequent morbi-mortality. To date, only 90 solutes have been catalogued as uremic toxins. Application of proteomic analysis can constitute a useful and reproducible tool for qualitative and quantitative monitoring of protein abnormalities in uraemia and for identification of an increased number of uremic toxins. Our objective was to identify new uremic toxins in plasma and ultrafiltrate (UF) of plasma of end-stage renal disease (ESRD) patients on haemodialysis (HD) using a recently described proteomic analysis (2D-DIGE). Methods: Plasma at the beginning and end of dialysis and UF at the start of dialysis of 24 patients with ESRD on HD was obtained, as well as plasma in 12 healthy controls with normal renal function. After applying different methods of precipitation in plasma (albumin depletion) and UF (trichloroacetic acid and acrylamide gels at 10%) the proteins obtained were labelled with different fluorochromes and fractionated by two-dimensional difference gel electrophoresis (2D-DIGE ). Readings were made with Typhoon scanner (Amersham) and results analyzed with DeCyder 5.1 software (GE Healthcare). The differentially expressed spots were identified by mass spectrometry. Results: 2D-DIGE analysis allowed the detection of 14 differentially expressed proteins in plasma samples obtained at the start of HD compared with UF samples ( p < 0.05) in at least 33/42 images which could behave as potential uremic toxins, expression increased in 5, decreased in 9. By comparing plasma samples at the start of HD with plasma from control subjects, we detected 11 differentially expressed proteins, most included in the previous group, but expressed to a lesser extent. 130 spots were obtained from gels. Of these, 80% were identified by mass spectrometry, 54% being secreted proteins, 31% were located at an extracellular level, 7% in the cytoplasm and 5% in the cell membrane. Conclusions: A promising tool for proteomic analysis (2D-DIGE) has been developed, which represents a clear advance in the comparative analysis of differential protein expression in samples of plasma and UF of ESRD in HD. We have detected with this method 14 differentially expressed polypeptides between serum and UF of patients obtained at the beginning of dialysis and 11 polypeptides between serum of patients and serum of healthy controls that could behave as potential uremic toxins. FACTORS INFLUENCING HYPERVISCOSITY IN MAINTENANCE HEMODIALYSIS PATIENTS Introduction and Aims: Many factors also could affect plasma viscosity as white blood cell, platelet count, iron deficiency and drugs in maintenance hemodialysis (MHD) patients. Increased risk for thrombosis is the main factor limiting the use of erythropoietin stimulating agents (ESA). In this present study, we investigated the clinical and laboratory factors influencing plasma viscosity in MHD patients. Methods: 84 MHD patients (30 female, age; 54.7 13.7 years) (TSAT ratio range > 30 and mean ferritin level: 553,39 ng/ml) were included. Patients with iron deficiency, chronic inflammatory disease and malignancy were excluded. Plasma viscosities of all subjects were measured at 37C in a Brookfield DV II + Cone Plate Viscometer (Brookfield, Stoughton, MA, USA). Data including iron parameters, hemoglobin, albumin, CRP, calcium, phosphorus, parathyroid hormone levels and monthly ESA requirements were retrospectively collected from patient charts. Patients were grouped according to plasma viscosities as upper and lower halves. Patients were also grouped according to their ESA requirements as no (n: 21), low (n: 31), high (n: 32) ESA requiring patients. Results: MHD patients had high plasma viscosity compared to healthy subjects in literature (range 1.6- 3.9m Pas, 2.52 0.65 mPas vs 1.10-1.30 mPa.s.). The demographical characteristics, prevelance of diabetes mellitus, coronary heart disease and peripheral artery disease were similar in hyperviscosity groups. Iron parameters, hemoglobin, CRP, albumin and other biochemical characteristics were also similar. However we found that subjects in higher viscosity group used higher ESA dose in previous year (224.4 237.8 260.4 340.5 U/kg/month, p: 0.038). The plasma viscosity level in no EPO, low EPO and high EPO groups were 2.5 0.6, 2.4 0.7 and 2.6 0.5 respectively ( p > 0,05). 68.8% of the patients in the high ESA requirement group intersected with higher viscosity group while this was 38.7% in the low ESA group ( p: 0.001) despite similar hemoglobin levels. Conclusions: According to our findings, majority of MHD patients have increased plasma viscosity compared to previously reported healthy subjects. Also we think that high dose ESA usage might increase plasma viscosity despite similar hemoglobin levels achieved when iron deficiency is excluded. RENALASE, STROKE AND HYPERTENSION IN HEMODIALYZED PATIENTS Introduction and Aims: Hypertension and kidney disease have been associated with increased incidence of stroke. Renalase, newly discovered hormone, is secreted by the kidney and circulates in blood and its gene polymorphism was associated with hypertension and stroke. The aim of the study was to assess possible correlations between renalase, blood pressure, stroke and cardiovascular status in prevalent hemodialyzed patients. Methods: Renalase was assessed using commercially available assay Echocardiography was performed in each patient. Results: The mean serum renalase concentration in the study cohort was 17.51 6.73 g/mL and it was significant higher when compared to the healthy volunteers 3.99 1.73 g/ml ( p < 0.001). Serum renalase was significantly lower in hemodialyzed patients with a history of stroke (21%) (13.25 3.97 g/ml vs. 18.61 6.91 g/ml, p < 0.05,), than in patients without it. Similarly renalase was significantly lower hypertensive patients (82%) when compared to normotensive (16.47 5.86 g/ml vs. 22.34 8.91 g/ml, p < 0.05,), with proximal a-v fistula (29%) vs distal a- v fistula (16.55 6.39 g/ml vs. 24.61 5.14 g/ml, p < 0.05), and higher in patients with glomerulonephritis (26%) vs other etiologies of ESRD (21.93 5.52 g/ml vs. 15.91 6.49 g/ml, p < 0.05). Serum renalase was significantly higher in patients given anticoagulated during HD with unfractionated heparin relative to enoxaparin (18.79 6.82 g/ml vs. 13.13 5.26 g/ml, p < 0.05). Serum renalase correlated with creatinine (r = 0.43, p < 0.05), residual renal function (r = -0.39, p < 0.05), transferrin saturation-TSAT (r = 0.37, p < 0.05), presence of hypertension (r = -0.35, p < 0.05), and presence of dysfunction of mitral valve (r = -0.40, p < 0.05). Dysfunction of mitral valve was described as hemodynamically significant mitral valve insufficiency on echocardiography. The only predictor of renalase in multiple regression analysis was presence of hypertension (beta value was -0.63, p = 0.043), explaining 90% of the renalase variations. Conclusions: Our preliminary results suggest that renalase, probably due to the sympathetic nervous system hyperactivity could be associated with hypertension and cardiovascular complications, including stroke in hemodialyzed patients. However, further studies are needed to establish the possible role of renalase in these complications.

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Marcin Adamczak, Andrzej Wie¸cek, Łukasz Nowak, Alicja E. Grzegorzewska, Leszek Niepolski, Dominik Pajzderski, Walid Ahmed Abdel Atty Mohamed, Walid Ahmed Abdel Atty Mohamed, Farouk Mohame Khamis Zaki, Wessam Harby Mohamed Bekhit, Ibrahim Sobhy Sherif, Chien-Chu Lin, Hung-Yuan Chen, Yen-Lin Chiu, Shih-Ping Hsu, Mei-Fen Pai, Ju-Yeh Yang, Yu-Sen Peng, Tun-Jun Tsai, Kwan-Dun Wu, Soroush Shojai, Uday Udayaraj, Parastoo Shojai, Rafal Zwiech, Agnieszka Bruzda-Zwiech, Kinga Musial, Danuta Zwolinska, Alicja E. Grzegorzewska, Wobszal Piotr M., Adrianna Mostowska, Pawel P. Jagodzinski, Vittorio Ortalda, Paola Tomei, Tewolde Yabarek, Olga Tobaldini, Concetta Gangemi, Michele Giuseppe Messa, Antonio Lupo, Leonard Ebah, Milind Nikam, Angela Summers, Idalia Dawidowska, Anuradha Jayanti, Helge Wiig, Paul Brenchley, Sandip Mitra, Satoshi Mikami, Takayuki Hamano, Osamu Iba, Mitsunobu Toki, Hiroshi Mikami, Yoshihiro Takamitsu, Masamitsu Fujii, Pavlina Dzekova-Vidimliski, Aleksandar Sikole, Saso Gelev, Gjulsen Selim, Lada Trajceska, Shouichi Fujimoto, Hiroko Inagaki, Keiichi Fukudome, Fumitaka Ebihara, Naoto Yokota, Yuji Sato, Takashi Akiba, Shigeru Otsubo, Kosau Nitta, Alicja Rydzewska-Rosolowska, Joanna Gozdzikiewicz, Jacek Borawski, Tomasz Hryszko, Ewa Koc-Zorawska, Michal Mysliwiec, Marta Arias, Marta Arias, Elisenda Bañon-Maneus, Amanda Sole, Natalia Hierro-Garcia, Jordi Rovira, Maria Jose Ramírez-Bajo, Luis Fernado Quintana, Fritz Diekmann, Daniel Moya-Rull, Francisco Maduell, Josep Maria Campistol, Mehtap Erkmen Uyar, Selami Kocak Toprak, Hatice Saglam, Emre Tutal, Meltem Bay, Osman Ilhan, Siren Sezer, Jolanta Malyszko, Jacek Malyszko, Piotr Kozminski, Ewa Koc-Zorawska, Edyta Zbroch, Michal Mysliwiec. Pathophysiology CKD 5D, Nephrology Dialysis Transplantation, 2012, ii511-ii516, DOI: 10.1093/ndt/gfs246