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Abstract

K.C. Abbott and L.Y. Agodoa

¹Nephrology Service, Walter Reed Army Medical Center, Washington, D.C., and Uniformed Services University of the Health Sciences, Bethesda, MD, ²NIDDK, NIH, Bethesda, MD, USA
Background: The patient
characteristics and mortality associated with autosomal dominant polycystic kidney disease
have not been characterized for a national sample of end-stage renal disease (ESRD)
patients. Methods: 375,152 patients in the United States Renal Data System were
initiated on ESRD therapy (including patients who eventually received renal transplants)
between January 1, 1992 and June 30, 1997 and analyzed in an historical cohort study of
polycystic kidney disease. Results: Of the study population, 5,799 (1.5%) had
polycystic kidney disease. In logistic regression, polycystic kidney disease was
associated with Caucasian race (odds ratio 3.31, 95% CI, 3.09 – 3.54), women (1.10,
1.04 – 1.16), receipt of renal transplant (4.15, 3.87 – 4.45), peritoneal
dialysis (vs. hemodialysis, 1.37, 1.27 – 1.49), younger age, and more recent year of
first treatment for ESRD. Use of pre-dialysis EPO but not the level of serum hemoglobin at
initiation of ESRD was significantly higher in patients with polycystic kidney disease.
Patients with polycystic kidney disease had lower mortality compared to patients with
other causes of ESRD, but patients with polycystic kidney disease had a higher adjusted
risk of mortality associated with hemodialysis (vs. peritoneal dialysis) compared to
patients with other causes of ESRD (hazard ratio 1.40, 1.13 – 1.75). Conclusions:
Hematocrit at presentation to ESRD was not significantly different in patients with
polycystic kidney disease compared with patients with other causes of ESRD. Peritoneal
dialysis is a more frequent modality than hemodialysis in patients with polycystic kidney
disease, and patients with polycystic kidney disease had an adjusted survival benefit
associated with peritoneal dialysis, compared to patients with other causes of renal
disease.

Abstract

K.C. Abbott, P. Hshieh, D. Cruess, L.Y.C. Agodoa, P.G.Welch, A.J. Taylor and C.M. Yuan

¹Nephrology Service, Walter Reed Army Medical Center, Washington, DC, and Uniformed Services University of the Health Sciences, ²Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, ³NIDDK, NIH, Bethesda, MD, and ⁴Cardiology Service, Walter Reed Army Medical Center, Washington, DC, USA
Background: Patients with ESRD are at increased risk for heart valve calcification. It has not been established whether hospitalized valvular heart disease (VHD) is a substantial barrier to renal transplantation (RT) after transplant listing, or whether VHD progresses after RT. Methods: Using data from the USRDS, we studied 35,215 patients with ESRD enrolled on the renal transplant waiting list from July 1994 to June 1997. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for RT and VHD. Results: In comparison to maintenance dialysis (2.2/1,000 person years), RT was independently associated with a lower hazard for hospitalization for VHD (0.7/1,000 person years, HR 0.28, 95% confidence interval 0.17 – 0.47). Renal transplant recipients had much lower rates of VHD after transplant than before (rate ratio (RR) 0.49, 95% CI 0.47 – 0.52). Patients with VHD were significantly less likely to receive RT (adjusted rate for RT 0.38, 95% CI 0.20 – 0.45) but patients who received valve replacement surgeries (VRS) were not affected (adjusted rate for RT 1.10, 95% CI 0.52 – 2.32, not significant). Conclusions: VHD is an uncommon but serious barrier to RT after listing, while VRS is not a significant barrier to RT. Established VHD does not appear to worsen after RT. Clinicians should consider giving increased attention to the detection and treatment of VHD during the pre-transplant evaluation.

Abstract

K.C. Abbott¹, I.O. Hypolite² and L.Y. Agodoa³

¹Nephrology Service, Walter Reed Army Medical Center, Washington, DC, Uniformed Services University of the Health Sciences, Bethesda, MD, ²Office of Minority Health Research Coordination, NIDDK, NIH, Bethesda, MD, and ³National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
Background: The patient characteristics, including age at presentation to end-stage renal disease (ESRD) and mortality associated with sickle cell nephropathy (SCN) have not been characterized for a national sample of patients. Methods: 375,152 patients in the United States Renal Data System were initiated on ESRD therapy between January 1, 1992 and June 30, 1997 and analyzed in an historical cohort study of SCN. Results: Of the study population, 397 (0.11%) had SCN, of whom 93% were African-American. The mean age at presentation to ESRD was 40.68 ± 14.00 years. SCN patients also had an independently increased risk of mortality (hazard ratio 1.52, 95% CI: 1.27 – 1.82) even after adjustment for placement on the renal transplant waiting list, diabetes, hematocrit, creatinine, and body mass index. However, when receipt of renal transplantation was also included in the model, SCN was no longer significant (p = 0.51, HR = 1.10, 95% CI: 0.82 – 1.48). SCN patients were much less likely to be placed on the renal transplant waiting list or receive renal transplants in comparison to age and race matched controls, and results of survival analysis were similar in this model. Conclusions: SCN patients were much less likely to be listed for or receive renal transplantation than other comparable patients with ESRD. SCN patients were at independently increased of mortality compared with other patients with ESRD, including those with diabetes, but this increased risk did not persist when models adjusted for their low rates of renal transplantation.Correspondence to:
K.C. Abbott, LTC, MC; Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
Email: kevin.abbott@ na.amedd.army.mil

Abstract

F.P. Hurst¹,²,³, R.T. Neff¹,², A.R. Katz⁴, A.E. Buchholz⁵, D.M. Sasaki⁵, B.W. Berg³,⁶ and K.C. Abbott¹,²

¹Nephrology Service, Walter Reed Army Medical Center, Washington, DC, ²Uniformed Services University of Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, ³Department of Medicine, Tripler Army Medical Center, Honolulu, HI, ⁴Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honululu, HI, ⁵Hawaii Department of Health, Disease Outbreak Control Divison, and ⁶Telehealth Research Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
Background: Leptospirosis is an infrequent disease in the US, with most cases reported in the state of Hawaii. Renal involvement is common (44 – 67%), ranging from a mild prerenal azotemia in anicteric disease to renal failure requiring dialysis in Weil’s syndrome (severe leptospirosis with jaundice, renal failure, and hemorrhage). Methods: To describe the pattern of leptospiral renal disease at our institution, we performed a retrospective analysis (1992 – 2004) of all hospitalized cases of laboratory confirmed leptospirosis presenting with acute kidney injury (AKI), defined as a presenting serum creatinine > 1.5 mg/dl. Results: During this time period, 18 patients were hospitalized with laboratory confirmed leptospirosis. Among these patients, 12 had AKI on presentation, and hemodialysis was required in 3 patients. Renal biopsies were performed in 2 of these patients, revealing acute tubulointerstitial nephritis. Interestingly, the patients who required dialysis did not have Weil’s syndrome. They did not exhibit jaundice or hemorrhage, and serum AST (mean 51.7 U/l (range 36 – 60)), ALT (mean 51.0 U/l (range 38 – 64)), and total bilirubin (mean 1.2 mg/dl (range 0.8 – 1.8)) were either within normal limits or only slightly elevated, despite having the worst renal disease. Conclusions: This series adds to other evidence that severe AKI (requiring dialysis) can complicate anicteric leptospirosis in contrast to the notion that the AKI in anicteric disease is typically mild and prerenal. Leptospirosis should be considered in all patients who present with fever and AKI, especially if associated with thrombocytopenia or travel to an endemic area.Correspondence to:
F.P. Hurst, MD
Department of Nephrology
Walter Reed Army Medical Center
6900 Georgia Ave NW
Washington, DC 20307, USA
Email: [email protected]

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