Abstracts
(HR) for the incidence of all-cause deaths was significantly increased in Q4, compared
with Q3 (HR 1.49, 95% confidence interval 1.15-1.95, P < 0.01). No significant interac-
tion was observed between uric acid and all confounders. In subgroup analyses, a high
HR in Q4 for mortality was observed, especially in young subjects (<65 years), and
subjects with diabetes, proteinuria, and eGFR <45 (HR 1.70-1.92). The association of
serum uric acid levels with cardiovascular mortality showed a similar trend to that with
all-cause mortality, however it did not reach a statistical significance.
CONCLUSIONS: This study showed that serum uric acid level is significantly
associated with the mortality in the community-based population with CKD.
MP396 RISK FACTORS FOR PROGRESSION OF CORONARY ARTERY
CALCIFICATION IN PATIENTS WITH CHRONIC KIDNEY
DISEASE
Jiang He1, Joshua Bundy1, Jing Chen2
1
Department of Epidemiology Tulane University New Orleans LA United States and
2
Department of Medecine Tulane University New Orleans LA United States
INTRODUCTION AND AIMS: Coronary artery calcification (CAC) is common
among patients with chronic kidney disease (CKD) and predicts the risk for
cardiovascular disease (CVD). We examined the associations of novel risk factors with
progression of CAC among patients with CKD.
METHODS: In a random subsample of 1,123 participants from the Chronic Renal
Insufficiency Cohort (CRIC) Study, CAC was measured at baseline and a follow-up
visit using electron beam computed tomography (CT) or multidetector CT. Multiple
logistic regression was used to evaluate risk factors for CAC progression, defined as an
increase of Agatston score 100 units during follow-up. Mixed-effects regression was
used to evaluate the change in square root transformed CAC score during follow-up.
RESULTS: Over an average of 3.3-year follow-up, 332 (29.6%) participants had CAC pro-
gression. After adjusting for age, gender, race/ethnicity, clinical site, follow-up time
between CT scans, baseline CAC score, history of CVD, and established atherosclerotic
risk factors, lower estimated-glomerular filtration rate (eGFR) (OR 1.22, 95% CI 1.01-
1.47, p=0.04), higher cystatin C (OR 1.18, 95% CI 1.00-1.40, p=0.049), and higher serum
phosphate (OR 1.29, 95% CI 1.08-1.55, p=0.005), were associated with CAC progression.
Additionally, lower eGFR and serum calcium, and higher 24-hour urine albumin, cystatin
C, serum phosphate, fibroblast growth factor-23, total parathyroid hormone, interleukin-
6, and tumor necrosis factor-a were associated with increase in CAC score.
CONCLUSIONS: These data suggest that reduced kidney function, calcium and
phosphate metabolism disorders, and inflammation, independent of established CVD
risk factors, might play a role in CAC progression among patients with CKD.
MP397 HYPERKALEMIA INCIDENCE AND PATTERNS OF CARE IN
PATIENTS TREATED WITH RENIN-ANGIOTENSIN-
ALDOSTERONE SYSTEM INHIBITORS - A RETROSPECTIVE
CLAIMS DATA ANALYSIS TO ASSESS HEALTHCARE
OUTCOMES IN GERMANY
Jennifer Haas4, Peter Braunhofer2, Lorraine Zakin3, Viatcheslav Rakov3, Thomas
Hardt1, Dominic Meise4, Christopher Maas4, Sebastian Braun4
1
Market Access & Business Development Vifor Pharma Deutschland GmbH Munich
Germany, 2Global Pricing & Markt Access Vifor Pharma Ltd. Glattbrugg Switzerland,
3
Medical Affairs Vifor Pharma Ltd. Glattbrugg Switzerland and 4Real World Evidence
Xcenda GmbH Hannover Germany
INTRODUCTION AND AIMS: Hyperkalemia (HK) refers to increased serum
potassium levels, which can have severe effects on health including major cardiac
arrhythmias. The prevalence of HK is estimated at 2-3% for the general population,
whereas it is higher in patients suffering from chronic kidney disease with or without
associated chronic heart failure and can be increased by the use of certain medications,
especially the renin-angiotensin-aldosterone-system inhibitors (RAASi). Hence,
patients are often forced to reduce the dose or discontinue treatment with these
disease-modifying medications proven to reduce cardio-renal morbidity and mortality.
The aim of this analysis was to descriptively compare healthcare outcomes and costs in
patients treated with RAASi with those patients who had to either discontinue or lower
RAASi dose and identify HK cases in Germany.
METHODS: For this analysis, we utilized pooled claims data from the InGef research
database, which comprises data from around 75 German health insurances on an
anonymized individual level. Patients initiating RAASi therapy in 2011 were identified
by ATC codes and were required to having stayed on therapy until the end of 2013. For
2014, the cohorts were subdivided into subgroups depending on RAASi use:
Continuous use without dose changes (1), dose reduction (2) and those discontinuing
(3). For cohort 1 an index quarter was assigned to each patient based on the
distribution of the index quarters of the respective comparison group. The index
quarter in the respective groups was defined by either discontinuation or dosage
reduction. This procedure lead to two different cohorts 1a and 1b. Relevant outcomes
were assessed over a one year period and included healthcare costs, incidence of HK,
hospitalizations and mortality. Patients who deceased in the follow-up period were
excluded for the descriptive comparison of healthcare outcomes.
RESULTS: In total, 23,114 patients above 18 years of age were newly treated with
RAASi therapy in 2011 and remained on therapy until December 31st, 2013. Out of
iii574 | Abstracts
Nephrology Dialysis Transplantation
these, 18,503 stayed on RAASi throughout 2014, 557 patients reduced their initial dose
of RAASi therapy and 4,054 patients discontinued their therapy. Mortality was highest
in the discontinuation cohort with 11.7% (p<0.001). Patients with either dose
reduction or discontinuation showed higher average all-cause hospitalizations and
healthcare costs in the post-index period in comparison to the persistent group. HK
diagnosis recorded in the index quarter or during the post-index period was low, how-
ever highest in cohort 3 (1.37%, p<0.001).
CONCLUSIONS: The incidence of HK was low within all observed cohorts. However,
the descriptive comparison of patients staying on RAASi vs. patients who discontinued
or reduced revealed important differences in terms of all-cause hospitalizations and
average total healthcare costs. HK is a known factor influencing the continuous use of
RAASi therapy. However, as HK treatment is highly heterogeneous and the causality of
dose reductions and change couldn’t be assessed within this analysis, further research is
warranted.
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MP398 STEROID INDUCED DIABETIC MELLITUS AND RELATED
RISK FACTORS IN PATIENTS WITH PRIMARY NEPHROTIC
SYNDROME
Aiqin Sheng3, Yuanmao Tu3, Jinzhou Guo2, Hong Du1, Zhihong Liu3, Shijun Li3
1
Jinling Hospital, Nanjing University School of Medicine Department of Endocrinology
Nanjing China, 2Jinling Hospital, Nanjing University School of Medicine Nationa
Clinical Research Center of Kidney Diseases Nanjing China and 3Jinling Hospital,
Nanjing University School of Medicine National Clinical Research Center of Kidney
Diseases Nanjing China
INTRODUCTION AND AIMS: Glucocorticoids are drugs that have been used
extensively in a variety of conditions. Glucocorticoids have several side effects,
hyperglycemia being one of the most common and representative.Steroid-induced
diabetes mellitus(SDM) is a common medical problem in patients with non-diabetic
chronic kidney disease.However,little information is available regarding the risk factors
of SDM in patients with primary nephrotic syndrome.
METHODS: A total of 2,398 patients with primary nephrotic syndrome were
registered in Jinling Hospital.All patients with primary nephrotic syndrome received
prednisolone(PSL) at least 30mg/day orally for more than 4 weeks. A retrospective
study was conducted.
RESULTS: 2398 patients,total of 580(24.2%) patients presented abnormal glucose
metabolism after accepting glucocorticoid therapy and 128(5.3%) cases were diagnosed
as SDM.80.5% of the 128 cases diagnosed as SDM occurred within the first 1 years of
glucorticosteroid therapy,and the median onset time was 106 days.We analyzed 128
patients newly treated with glucocorticoid who did not have diabetes mellitus
(age:39.4615.5years, PSL initial dosage:0.9060.39mg/kg.d,PSL cumulative total
dose:840~28800mg),and 51.6% were women.The patients were divided into two
groups on the basis of whether SDM had developed (128 patients) or not (1818
patients). Sex,age,body mass index,family history of diabetes,blood pressure,combined
medication,pathologic types,PSL initial dosage,the proportion of intravenous use of
glucocorticoid,serum total cholesterol (TC),triglyceride(TG),low densith
lipoprotein(LDL),high densith lipoprotein(HDL),estimated glomerular filtration
rate(eGFR),serum albumin,24 hours proteinuria,hemoglobin A1C levels (HbA1c) and
fasting plasma glucose(FPG) were compared between the groups.Between the two
groups,sex,age,body mass index(BMI),blood pressure,pathologic types,the routes of
administration for glucocorticoid,triglyceride(TG),estimated glomerular filtration
rate(eGFR) and fasting plasma glucose(FPG) were different
significantly(P<0.05).Multivariate logistic regression analysis demonstrated that the
risk of SDM was independently higher in every 1 year old increment of age with OR
1.055,(95% confidence interval 1.034-1.076),in lower rates of males with OR 1.971
(1.151 - 3.376),in elevated fasting plasma glucose with OR 1.664 (1.057 - 2.622),in
every 1% increment of HbA1c with OR 3.243(1.002 - 4.124),in hypertension with OR
2.108 (1.138 - 3.903),in hypertriglyceridemia with OR 2.416(1.424 - 4.100),and in
simultaneous use of tacrolimus with OR 2.916(1.581 - 5.377).
CONCLUSIONS: The incidence of abnormal glucose metabolism in patients with
primary nephrotic syndrome who have started glucocorticoid therapy is high. The
findings of this population-based study quantify the risk of developing SDM.Prior to
glucocorticoid prescribing,clinicians should be aware of the possibility of SDM,and
identification of individuals who are at a high risk of developing SDM is of great
importance.Once start glucocorticoid therapy, glucose metabolism monitoring should
be initiated routinely for patients with high risk of SDM to avoid complications accom-
panied by hyperglycemia.
MP399 LOW SUBENDOCARDIAL VIABILITY RATIO IS ASSOCIATED
WITH MORTALITY IN PATIENTS WITH CHRONIC KIDNEY
DISEASE
Robert Ekart3,1, Sebastjan Bevc2,3, Nina Hojs3,1, Nejc Piko1, Radovan Hojs2,3
1
Dept. of Dialysis University Medical Centre Maribor Maribor Slovenia, 2Dept. of
Nephrology University Medical Centre Maribor Maribor Slovenia and 3Medical faculty
University of Maribor Maribor Slovenia
INTRODUCTION AND AIMS: Chronic kidney disease (CKD) is a well-known risk
factor for mortality. Radial artery pulse wave analysis is a simple method to assess