Oral Presentations

Oral Presentations

15^th National Meeting of the Turkish Society of Hypertension and Renal Diseases

24–28 April, 2013

Maxx Royal Hotel & Convention Center

Belek, Antalya, Turkey

ORAL PRESENTATIONS (OP)

OP 1 THE ROLE OF HYPERVOLEMIA IN THE PATHOPHYSIOLOGY OF HYPERTENSION: A POPULATION BASED STUDY

ENDER HUR¹, MELİH OZİSİK², CİHAN URAL², GURSEL YİLDİZ³, KEMAL MAGDEN¹, SENNUR BUDAK KOSE⁴, FURUZAN KOKTURK⁵, M. CAGATAY BUYUKUYSAL⁵, IBRAHİM YİLDİRİM¹, GULTEKİN SULEYMANLAR⁶, KENAN ATES⁷, SONER DUMAN²

¹Bulent Ecevit University School of Medicine, Division of Nephrology, Zonguldak, Turkey; ²Ege University School of Medicine, Department of Internal Medicine, Izmir, Turkey; ³Ataturk State Hospital, Nephrology Unit, Zonguldak, Turkey; ⁴Istanbul Education and Research Hospital, Nephrology Clinic, Istanbul, Turkey; ⁵Bulent Ecevit University School of Medicine, Department of Biostatistics, Zonguldak, Turkey; ⁶Akdeniz University School of Medicine, Department of Nephrology, Antalya, Turkey; ⁷Ankara University school of Medicine, Department of Nephrology, Ankara, Turkey

BACKGROUND: Although the relationship between hypervolemia and hypertension is known in patients with renal disease it has not been widely investigated in normal populations. The present study determined the fluid distribution changes with relation to blood pressure.

METHODS: A population was surveyed in Turkey and demographics, height, weight, blood pressure, urine analysis and serum creatinine measurements were recorded. Bioimpedance was measured with the Body Composition Monitor.

RESULTS: A total of 2034 subjects were included in the survey (71.6% male, mean age 47±12.6 (18–89) years, systolic blood pressure (SBP) 134.7±20, diastolic blood pressure 77.9±11.6 mm Hg, body mass index (BMI) 28.5±4.5 (15.8–50.6) kg/m2 and the overall over hydration index was 0.05±1.05 L) There was a correlation between extracellular water (ECW)/Height and SBP (r=0.21, p<0.001). Age, BMI, ECW/Height and BSA were significantly higher in normotensives than hypotensives and were even higher in hypertensives than both normotensives and hypotensives (Table 1). Fat tissue index (FTI) was higher in hypertensives than both normotensives and hypotensives. Smoking rate was lower in hypertensives compared to normotensives. Risk factors for high SBP were increased ECW/Height, age, BMI and presence of diabetes. ECW/Height, FTI and SBP increased as BMI increased, (p<0.001) and in diabetics compared to non-diabetics (p<0.001). FTI and SBP were lower in smokers than non-smokers (p<0.001). Determinants of systolic blood pressure are given in Table 2.

Table 1. Study parameters in systolic blood pressure categories.

Parameter	Hypotensives (SBP<110 mmHg) (n=133)	Normotensives (SBP 110-139 mmHg) (n=1208)	Hypertensives (SBP ≥140 mmHg) (n=693)
BMI (kg/m2)	26.38±4.98	27.59±4.39 a	29.49±4.23 a* b*
ECW/height (L/m)	9.93±1.58	10.34±1.32 a*	10.78±1.32 a* b*
Age	41.47±11.69	44.36±12.38 a	52.84±11.23 a* b*
FTI (kg/m2)	10.46±5.12	11.22±5.26	13.23±5.14 a* b*
BSA (m2)	1.82±0.19	1.88±0.17 a*	1.91±0.16 a* b*
TBW (L)	38.10±7.14	39.88±6.56 a	40.29±6.64 a*
OH (L)	0.09±1.09	0.03±1.01	0.07±1.11

p< 0.05, a: Group versus Hypotensives, b: Group versus Normotensives

^*p< 0.001 SBP: Systolic blood pressure, BMI: Body mass index, ECW: Extracellular water, FTI: Fat tissue index, BSA: Body surface area, TBW: Total body water, OH: overhydration

Table 2. Logistic regression analysis for high systolic blood pressure.

	Odds ratio	95% CI	p value
DM	1.581	1.177–2.124	0.002
ECW/height	1.104	1.003–1.215	0.043
BMI	1.058	1.027–1.090	0.000
Age	1.053	1.043–1.063	0.000

DM: Diabetes mellitus, ECW: Extracellular water, BMI: Body mass index, CI: confidence interval. In Model: OH/ECW, E/I, TBW, ECW/Height, Age, Gender, BMI, LTI, FTI, DM, Time, Smoking.

CONCLUSION: High blood pressure may be accompanied by increased extracellular fluid volume indices. Volume status assessment could be useful in evaluating the effectiveness of pharmacological intervention in the treatment of hypertension.

OP 2 ANTIHYPERTENSIVE THERAPY IN PRIMARY GLOMERULAR DISEASES

OKTAY ÖZKAN¹, SAVAŞ ÖZTÜRK¹, HATİCE KÜÇÜK², MELTEM GÜRSU¹, EGEMEN CEBECݹ, ABDULLAH CEBECݹ, MEHMET KÜÇÜK³, RÜMEYZA KAZANCIOĞLU⁴

¹Haseki Training and Research Hospital, Division of Nephrology, İstanbul, Turkey; ²Haseki Training and Research Hospital, İstanbul, Turkey; ³Okmeydanỳ Training and Research Hospital, Division Nephrology, İstanbul, Turkey; ⁴Bezmi Alem University School of Medicine, Department of Nephrology, İstanbul, Turkey

BACKGROUND: The primary objective of our study was to investigate effects of antihypertensive treatment on the level of proteinuria in patients with idiopathic focal segmental glomerulosclerosis (FSGS) or membranous glomerulonephritis (MGN).

METHODS: The clinical and laboratory data of sixty-eight patients (38 male, 30 female) were recorded at three-month intervals during 18 months of follow-up (Table 1). Thirty-six patients had biopsy-proven idiopathic FSGS and 32 patients with MGN. All patients were on antihypertensive therapy including mostly renin-angiotensin system blocking agents (n=58), nondihydropyridine calcium channel blockers (NDHPCCB) (n=8), diuretics (n=16) and other antihypertensives (n=22). Thirty-six patients received additionally an immunosuppressive regimen.

Table 1. Patients′ biochemical data of 18 months follow up.

Parameter	0 m	3 m	6 m	9 m	12 m	15 m	18 m
Creatinine (mg/dl)	1.06±0.67	1.15±0.94	1.1±0.98	1.07±	1.03±0.72	0.92±0.32	1.03±0.68
Albumin (g/dl)	2.74±0.87	3.16±0.79	3.4±0.86	3.64±0.78	3.6±0.99	3.78±0.9	3.71±0.88
Total cholesterol (mg/dl)	301±107	263±74	242±70	221±83	211±77	209±74	203±77
Proteinuria (g/day)	4.19±3.85	3.43±2.95	2.73±2.47	2.55±3.18	2.33±3.12	1.95±5.63	1.49±2.56
Creatinine clearance (ml/min)	84±36	90±44	93±29	81±34	96±38	86±33	88±32

RESULTS: The mean age of the patients was 39.6±16.6 years. The patients with MGN were 7 years older than the FSGS group. At the beginning of the study, mean blood pressure was 129±25/81±15 mmHg; after the strict antihypertensive therapy period of 30 months it was decreased to 110±18/73±8 mmHg. Percentage of patients with systolic blood pressure < 125 mmHg was initially %54.4, then increased to 64.3 at 18th month and to %78.5 at 30th month. Percentage of patients with diastolic pressure < 75 mmHg improved from %30.9 at baseline to %53.5 to %57.1 at the end of the study. Proteinuria decreased from 4.19±3.85 g/day to 1.49±2.56 g/day after 18 months and then to 832±872 mg/day at 30th month.

CONCLUSION: Optimal blood pressure control is extremely important for reduction of proteinuria and preserving renal function in patients with idiopathic FSGS and MGN.

OP 3 LOCAL RENIN ANGIOTENSIN SYSTEM ACTIVATION IN PREECLAMPSIA

ZEHRA YİLMAZ¹, TOLGA YILDIRIM², RAHMİ YILMAZ², AYSUN AYBAL KUTLUGUN², BULENT ALTUN², TUNCAY KUCUKOZKAN¹, YUNUS ERDEM²

¹Dr Sami Ulus Women′s Health Teaching and Research Hospital, Obstetrics and Gynecology Department, Ankara, Turkey; ²Hacettepe University Medical Faculty, Nephrology Department, Ankara, Turkey

BACKGROUND: Pathogenic mechanisms underlying preeclampsia remain uncertain. The aim of this study is to determine urinary angiotensinogen levels, an indicator of local RAS activity in the kidney, and to evaluate the relationship between urinary angiotensinogen levels and blood pressure and urinary protein excretion in preeclamptic pregnant women.

METHODS: Sixty women ages between 20–39 years old (20 women with normotensive pregnancy, 20 women with newly diagnosed preeclampsia and 20 control subjects) were recruited to the study. Morning spot urine samples were collected to measure urinary angiotensinogen/creatinine ratio (UAGT/UCre). UAGT/UCre was logarithmically transformed (log [UAGT/UCre]) to achieve normal distribution. Log (UAGT/UCre) was compared in pregnant women with and without preeclampsia and control subjects.

RESULTS: There were no differences in demographic characteristics between control subjects and pregnant women with and without preeclampsia. In all pregnant women with or without preeclampsia; log (UAGT/UCre) levels were significantly higher than in controls (p=0.009 and p=0.0001 respectively). Although log (UAGT/UCre) levels in pregnant women with preeclampsia were slightly less than in pregnant women without preeclampsia, this difference did not reach statistical significance. Log (UAGT/UCre) levels were correlated positively with proteinuria in pregnant women with preeclampsia (r=0.42, p=0.001). However, log (UAGT/UCre) levels were not correlated with blood pressure, age, height, body weight, gestational age, body mass index, and serum creatinine.

CONCLUSION: This study showed that elevated local RAS activity was correlated with renal injury as evidenced by proteinuria in women with preeclampsia, despite the lack of association with blood pressure measurements.

OP 4 THE USE OF AMBULATORY BLOOD PRESSURE MONITORING IN CLINICAL PRACTICE

ZEYNEP KENDİ ÇELEBİ, ŞULE ŞENGÜL, SİM KUTLAY, KENAN KEVEN, GÖKHAN NERGİZOĞLU, ŞEHSUVAR ERTÜRK, KENAN ATEŞ, NEVAL DUMAN, OKTAY KARATAN, BÜLENT ERBAY

Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey

INTRODUCTION: Ambulatory Blood Pressure Monitoring (ABPM) is becoming increasingly an important tool for evaluation of hypertension. In this study, we have determined the characteristics of patients who had an ABPM in our hypertension program between January 2012- March 2013.

METHODS: We analyzed retrospectively data (age, gender, height, weight, body mass index, smoking, salt intake, office BP results, antihypertensive use and laboratory findings) from 437 patients who had an ABPM between January-March 2013. Hypertension was defined as patients using an antihypertensive medication or patients with office blood pressure ⩾140/90 mmHg. According to the ABPM results the patients were classified as: (1) sustained normotensive patients (both office blood pressure (BP) and ABPM were normal), (2) sustained hypertensive patients (both office and ABPM were high), (3) masked hypertensive patients (office BP were normal, but ABPM were high), (4) white coat hypertensive patients (office BP were above limits, but ABPM were normal).

RESULTS: Fifty-seven patients were excluded, because of missing data and 48 patients were excluded because they were on chronic hemodialysis. Total 332 patients (F/M: 199/133 and mean age: 53±15 years) included in the analysis. Requests for ABPM were made from clinics of nephrology (n=176, 53%), neurology (n=61, 18.4%), internal medicine (n=40, 12%), geriatrics (n=28, 8.4%), endocrinology (n=11, 3.3%), cardiology (n=14, 4.2%) and 2 unknown(0.7%). Patient characteristics according to ABPM results are given in Table 1. In patients with HT (n=259), white coat effect was observed in 36.3% of patients, and 55% of those patients were on antihypertensive treatment. Rate of masked HT was 6.2%, and none were on antihypertensive treatment. HT control rate was 56%.

Table 1. Patient characteristics and blood pressure measurements.

Parameters	SNT	SHT	Masked HT	White coat HT	Total
N (M/F)	35/75	50/50	12/13	36/61	133/199
Age (years)*	49±15	55±13	52±16	54±17	53±15
BMI (kg/m2 )	28±5	28±4	25±5	28±5	28±5
Serum Cr (mg/dL)	0.9±1.2	1.14±1.0	1.17±0.9	1.08±0.9	1.07±1.05
eGFR (MDRD)*	90±30	79±31	83±37	83±35	84±33
History of diabetes (n, +/−)	18/90	28/69	5/20	26/69	77/248
History of HT (n, +/-)	55/55	73/27	19/6	59/38	206/126
History of CKD (n, +/−/rtx)	14/89/3	27/66/4	7/16/2	21/73/1	69/244/10
Hyperlipidemia	48/49	61/31	17/7	53/35	179/122
Antihypertensive use (n, +/−)*	46/64	64/36	16/9	52/45	178/154
Salt restricted diet (n, +/−)	20/71	25/52	9/9	22/47	76/176
Smoking (n,+/−)	10/82	17/58	5/14	8/62	40/216
Office SBP (mmHg)*	120±12	159±19	127±7	152±15	141±23
Office DBP (mmHg)*	76±9	92±13	81±6	91±10	85±13
ABPM mean SBP (mmHg)*	114±10	142±14	136±9	120±9	126±16
ABPM mean DBP (mmHg)*	70±6	84±10	84±8	71±7	76±10

SNT: Sustained Normotension, SHT: Sustained Hypertension, HT: Hypertension, BMI: Body Mass Index, Cr: Creatinine, eGFR: Estimated Glomerular Filtration Rate, MDRD Modification of Diet in Renal Disease, CKD: Chronic Kidney Disease, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure,

^*p<0.05

CONCLUSION: ABPM can be a useful tool to identify and follow different patterns of hypertension, particularly masked hypertension.

OP 5 EARLY STAGE OF HYPERTENSIVE RETINOPATHY: IS IT REALLY IMPORTANT?

MURAT KARAMAN¹, SEYİD AHMET AY², YALCIN BOZKURT³, ÜMİT YOLCU ⁴, OMER KURT⁵, FATİH BULUCU⁵, LEVENT YAMANEL⁶, KENAN SAGLAM⁵, MUSATAFA CAKAR⁵

¹Erzincan Military Hospital; ²Eskisehir Military Hospital; ³Gölcük Military Hospital; ⁴Siirt Military Hospital; ⁵GATA Department of Internal Medicine and ⁶GATA Intensive Care Unit, Turkey

BACKGROUND: We investigated the relationship between endothelial dysfunction (ED) and vascular inflammation in patients with early stage hypertensive retinopathy (HT Rp).

METHODS: A total of 99 people consisting of patients with a diagnosis of HT (n = 73), healthy (n = 26) were included in the study. Flow mediated vasodilation (FMD) and nitroglycerin-mediated dilation (NMD) were measured to determine ED in patients. ADMA as a marker of ED, and hsCRP and sTWEAK levels were measured as markers of inflammation. Rp screening was done by the same person according to the Keith-Wagener staging.

RESULTS: 73 patients (f: 44 m: 29) and 26 healthy subjects (f: 20 m: 6), total 99 people were included. The mean age of the patient group was 48.74 ± 12.2, and the mean age of the control group was 38.62 ± 8.7 yr. In HT patients, mean hypertension duration was 6.7 ± 5.7 years. Of HT patients, 60.3% (n = 44) had Rp, 39.7% (n=29) did not. Of those with Rp, 52.1% were stage 1, and 8.2% were stage 2. Compared with controls, hsCRP, ADMA and sTWEAK levels were significantly higher in HT (+) group (p= 0.011, p = 0.001 and p= 0.001, respectively). FMD and NMD rates were significantly lower in patients with Rp (P = 0.033). The levels hsCRP, ADMA and STWEAK were significantly higher in patients Rp (+) (p=0,039, p=0,001 and p=0,001, respectively, compared to the Rp (−) patients). When the Rp (+) patients compared with Rp (−) patients, FMD-NMD measurements were significantly lower at Rp (+) group (P=0.012 and p=0.012, respectively). The patients with stage 1 and 2 Rp compared with healthy group had greater degree of ED.

CONCLUSION: Atherogenesis and vascular inflammation, which play an important role in ED, were more common in patients with early stage of Rp in hypertensive patients.

OP 6 ^*THE CHARACTERISTICS OF HOME SPHYGMOMANOMETERS IN A LARGE CITY IN TURKEY

KENAN TURGUTALP¹, TURKAY ÖZCAN ², YAVUZ GÖZÜKARA³, ZEYNEP EBRU ESER¹, AHMET KIYKIM¹

Mersin University School of Medicine, ¹Division of Nephrology, ²Department of Cardiology, and Mersin State Hospital, ³Department of Internal Medicine, Mersin, Turkey

BACKGROUND: Home blood pressure monitoring (HBPM) is one of the measures that improves patient compliance with treatment, and has great potential to improve hypertension control. HBPM requires a precise measurement technique and an accurate sphygmomanometer. Most of the devices available in the market have not been evaluated independently for accuracy. The aims of this study were to assess the characteristics of home sphygmomanometers in a large city in Turkey.

METHODS: We assessed the hypertensive patients who have been followed in our outpatient center, and their home sphygmomanometers (HS). We asked the reasons influencing their choice of their sphygmomanometer. General evaluation of the device included basic features, validation status, and cuff size.

RESULTS: We interviewed 452 patients with hypertension (HT) (Male, n:253; Female, n:199) and assessed a total of 452 HS. Mean duration of HT was 7.9±4.1 years. Two hundred and sixty nine (85 upper arm, 184 wrist) of the sphygmomanometers were automated and 149 of the devices were aneroid. Both the manufacturer and model were identifiable for all devices. We found only 24 devices listed in dabl Educational Trust website. The most common reason given for choosing the type and model of the sphygmomanometers that had been bought was familiarity with the device through advertisement (44%), followed by simplicity and ease of use (28.2%), physician recommendation (19.3%), belief in accuracy (<1%). None of the home sphygmomanometer owners bought the device based on documented validation.

CONCLUSION: Use of inadequate home sphygmomanometers is wide spread in our city. These characteristics may have a significant role in definition and control of HT.

*SECOND BEST ORAL PRESENTATION AWARD

OP 7 RELATIONSHIP BETWEEN UREMIA, VOLUME STATUS, AND ARTERIAL STIFFNESS IN PATIENTS NEWLY STARTED ON HEMODIALYSIS

UMUT ÇAKIROĞLU¹, HAKAN AKDAM², ALPER ALP², UFUK ERYILMAZ³, ÇAĞDAŞ AKGÜLLܳ, ÖZGÜL ÖZBEK⁴, ASLIHAN KARUL BÜYÜKÖZTÜRK⁵, HARUN AKAR², YAVUZ YENİÇERİOĞLU²

Adnan Menderes University School of Medicine, ¹Departments of Internal Medicine, ²Nephrology, ³Cardiology, ⁴Peritoneal Dialysis Unit and ⁵Biochemistry, Aydın, Turkey

BACKGROUND: Arterial stiffness in chronic kidney disease (CKD) is an independent predictor of cardiovascular disease risk. Hypervolemia-induced vessel wall tension increases arterial stiffness. In this study we investigated the effects of changes in volume status and removal of uremic toxins on arterial stiffness in ESRD patients who recently started dialysis therapy.

METHODS: We present data from the first 28 patients without known cardiovascular disease who were started on hemodialysis due to ESRD. Pro-BNP levels, measurement of left atrial diameter and area with echocardiography and left atrial volume calculation, pulse wave velocity (PWV) and augmentation index measurements with oscillometric pulse wave analysis, volume status measurement by bioimpedance were measured before the first hemodialysis session and when patients reached dry weight after dialysis.

RESULTS: After 5.67±1.82 sessions patients reached dry weight. When the patients reached their dry weight a statistically significant decrease in proBNP, cardiothoracic ratio, and left atrial volume was observed (Table 1). There were no correlations between augmentation index and pulse wave velocity with overhydration, pro-BNP, left atrial diameter and volume. Volume status and PWV relationship was not statistically significant. In addition, patients with ESRD have already increased adrenergic activity, which maybe further aggravated as a result of fluid removal during dialysis.

Table 1. Results.

	Before the first hemodialysis	Dry weight is reached	p-value
Weight (kg)	73.43±2.90	68.44±2.90	p<0.001
Pro-BNP (pg/ml)	369.34±101.88	193.37±59.56	p<0.009
Total body water (L)	34.42±1.06	29.78±0.91	p<0.001
Overhydration (L)	2.85±0.77	0.57±0.33	p<0.001
Cardiothoracic ratio (%)	54.96±1.55	47.75±1.03	p<0.001
Biplane left atrial volume (cm3)	56.75±5.33	40.16±2.88	p<0.001
Average arterial pressure (mmHg)	108.64±2.86	101.21±4.82	p<0.130
Pulse rate	83.64±2.43	90.82±2.97	p<0.032
Augmentation index	24.89±1.88	28.85±2.28	p<0.140
Pulse wave velocity (m/sn)	8.58±0.35	8.23±0.41	p<0.073

CONCLUSION: Findings show that increase in pulse rate is related to the activation of the adrenergic system. The long-term effects on arterial stiffness of achieving dry weight remain to be elucidated.

OP 8 THE ASSOCIATION BETWEEN FIBROBLAST GROWTH FACTOR-23 AND VASCULAR CALCIFICATION IS INDEPENDENT OF PHOSPHATE LEVEL

MEHMET NURİ TURAN¹, FATİH KİRCELLݹ, MUSTAFA YAPRAK¹, ALİ RIZA SİSMAN², OZKAN GUNGOR¹, SELEN BAYRAKTAROGLU³, MEHMET OZKAHYA¹, GULAY ASCݹ, ERCAN OK¹

¹Ege University School of Medicine, Division of Nephrology, Izmir, Turkey; ²Dokuz Eylul University School of Medicine, Department of Biochemistry, Izmir, Turkey; ³Ege University School of Medicine, Department of Radiology, Izmir, Turkey

BACKGROUND: High fibroblast growth factor-23 (FGF-23) levels are associated with poor overall and cardiovascular (CV) survival in hemodialysis (HD) patients. The aim of this cross-sectional study was to investigate the relationship between plasma FGF-23 levels and coronary artery calcification scores (CACs) in HD patients.

METHODS: We measured CACs by multi-slice computerized tomography and plasma intact FGF-23 levels by ELISA in 229 prevalent HD patients. Multivariate ordinal regression analysis was used to determine the predictors for CACs.

RESULTS: Mean FGF-23 level was 251±385 pg/ml and mean CACs was 478±984. The frequency of patients with severe calcification (CACs >400) was 28.8% 27.5% of cases had no calcification. FGF-23 level was positively correlated with serum calcium (r=0.337, p<0.001), phosphate (r=0.397, p<0.001) and CACs (r=0.218, p=0.001). The patients with higher CACs were older, more likely to be male, had higher frequency of diabetes and CV disease history, serum calcium, calcium-phosphate product and higher FGF-23 levels, compared to the patients with lower CACs. In adjusted ordinal regression analysis, FGF-23 level was an independent predictor for severe CACs together with age, presence of diabetes, CV disease history and gender (Model r²=0.36, p<0.001). Each 50-pg/ml increase in FGF-23 level was associated with 11% of increased risk for severe CAC (RR=1.11, 95%CI 1.02-1.21, p=0.01). The mean CACs was markedly higher in patients with high FGF-23 regardless of phosphate levels (p=0.03).

CONCLUSION: In hemodialysis patients, plasma FGF-23 level is significantly associated with coronary artery calcification, independently of serum phosphate level.

OP 9 THE ROLE OF AORTIC ELASTICITY AND PLASMA ATHEROGENIC INDEX IN THE INTRADIALYTIC HEMODYNAMIC INSTABILITY IN HEMODIALYSIS PATIENTS

GÜRSEL YILDIZ¹, ENDER HÜR², KEMAL MAĞDEN², FERHAN CANDAN³, EROL SAĞATLI¹, MEHMET BİRHAN YILMAZ³

¹Zonguldak Atatürk State Hospital , Zonguldak, Turkey; ²Bülent Ecevit University School of Medicine, Department of Nephrology, Zonguldak, Turkey; ³Cumhuriyet University School of Medicine, Department of Nephrology, Sivas, Turkey

BACKGROUND: Atherosclerosis risk is high in hemodialysis (HD) patients. Especially small-dense LDL particles are a major risk factor for atherogenesis. Atherogenesis index of the plasma (AIP) defined as logarithm of the ratio of HDL to plasma triglyceride [log (TG/HDL)], which correlates with lipoprotein particle size, can be used as an atherogenesis marker. In this study, we investigated the role of aortic elasticity and the AIP in the intradialytic hemodynamic instability in hemodialysis patients.

METHODS: According to intradialytic blood pressure changes, patients were categorized into hypertensive patients (group1), normotensives (group2), and hypotensive (group3) groups. M-mode echocardiographic data, aortic strain, distensibility, and stiffness indexes were calculated.

RESULTS: The groups were similar in terms of demographical and clinical characteristics. The number of patients with diabetes was significantly higher in hypotensive group (n = 9) than the other groups (p=0.0001). There were no differences between the groups in terms of aortic elastic properties and the AIP. Hemodynamic parameters SBP (162±32 mmHg) and pulse pressure (76±22 mmHg) were significantly higher in hypotensive group compared to the other groups (p=0.008, p=0.0001). In the hypotensive group an echocardiographic é parameter (6.1±1.8 cm/s) was significantly lower than the other groups (p=0.028). Platelet count (295±86 x103/μL), was significantly higher in hypertensive group than the other groups (p=0.008).

CONCLUSION: Intradialytic hypotension is associated with diabetes, low peak early diastolic myocardial velocity, high pulse pressure, and higher SBP, whereas intradialytic hypertension was associated with higher platelet count.

OP 10 COMPARISON OF CINACALCET PLUS PARICALCITOL TO CINACALCET PLUS CALCITRIOL THERAPY IN HEMODIALYSIS PATIENTS WITH SEVERE HYPERPARATHYROIDISM

SİREN SEZER¹, ZEYNEP BAL¹, EMRE TUTAL¹, ÖZNUR KAL¹, DEMET YAVUZ², İBRAHİM YILDIRIM³, BURAK SAYIN¹, RÜYA ÖZELSANCAK¹, SULTAN ÖZTÜRK³, SÜLEYMAN TÜRK⁴, NURHAN ÖZDEMİR ACAR¹

¹Baskent University Faculty of Medicine, Department of Nephrology, Ankara, Turkey; ²Sakarya Education and Training Hospital, Division of Nephrology, Adapazari, Turkey; ³Hitit University Faculty of Medicine, Division of Nephrology, Çorum, Turkey; ⁴Necmettin Erbakan University Faculty of Medicine, Department of Nephrology, Konya, Turkey

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a complication of maintenance hemodialysis (MHD) and severe SHPT is associated with high mortality. The aim of this study is to evaluate and compare the effectiveness of cinacalcet and paricalcitol or calcitriol treatment of MHD patients with severe SHPT.

METHODS: 146 patients with severe SHPT on chronic hemodialysis were enrolled into the study. Patients with normalized total serum calcium concentration < 10.5 mg/dL, serum Ca × P<75 and PTH level ⩾ 1000 pg/ml were divided into two groups who received either cinacalcet plus intravenous paricalcitol (Group CP) or cinacalcet plus intravenous calcitriol (Group CC) for at least one year.

RESULTS: In group CP mean PTH values in 1st and 12th month were 1257.6 ± 668.4 pg/ml and 929.8 ± 497.3 pg/ml whereas in CC group, mean PTH values in 1st and 12th month were 1226.9 ± 595.6 pg/ml and 1210.9 ± 574.8 pg/ml (p<0.003). At baseline both groups' alkaline phosphatase levels were similar however at the end of the study ALP levels were significantly lower in group CP than in the group CC (p<0.002). Although the mean dose of vitamin D administration was significantly higher in paricalcitol group than the calcitriol group we observed less hyperphosphatemia and lower CaxP in group CP (p<0.01, p<0.05 respectively).

CONCLUSION: This observational study showed that combination therapy with paricalcitol and cinacalcet is superior in terms of PTH response to treatment. There was less hyperphosphatemia and a decrease in alkaline phosphatase levels in response to the combination of paricalcitol and cinacalcet in dialysis patients with severe SHPT compared to the combination with cinacalcet and calcitriol. We suggest that paricalcitol and cinacalcet combination should be preferred in resistant cases.

OP 11 DIFFERENTIAL EFFECTS OF VITAMIN D RECEPTOR ACTIVATORS ON PULSE WAVE VELOCITY IN MAINTENANCE HEMODIALYSIS (MHD) PATIENTS

SİREN SEZER, ZEYNEP BAL, EMRE TUTAL, ORHAN GULİYEV, MEHTAP ERKMEN UYAR, BAHAR GÜRLEK DEMİRCİ, NURHAN ÖZDEMİR ACAR

Başkent University Faculty of Medicine, Department of Nephrology, Ankara, Turkey

BACKGROUND: In MHD patients, vascular calcification (VC) is closely related to the control of secondary hyperparathyroidism (SHPT). The present study investigates the differential effects of two vitamin D receptor activators, calcitriol and paricalcitol, on control of SHPT and measures of VC.

METHODS: Eligible 80 patients were included. Patients with parathyroid hormone (PTH) levels above >300 pg/mL were randomized and treated according to one of 4 groups: a) total serum calcium <10.5 mg/dL, serum Ca × P <75 and PTH level between 300-800 pg/ml were randomized to receive either paricalcitol (group 1) or calcitriol (group 2), b) normalized total serum calcium < 10.5 mg/dL, serum Ca × P<75 and PTH level >800 pg/ml were randomized to receive either paricalcitol plus cinacalcet (group 3) or calcitriol plus cinacalcet (group 4).

RESULTS: After 12 months of treatment, PTH levels were assessed and compared to basal values. We observed significant increases in group 2 and group 4 at the end of the study (p< 0.002, 0.006). PWV significantly increased in Group 2, compared to the other groups at the end of the study (p<0.013). Additionally, we found that in calcitriol based treatment groups (Group 2 and 4) PWV significantly increased during the follow-up period while there was no significant change in PWV in paricalcitol based treatment groups (p<0.047).

CONCLUSION: In MHD patients with established SHPT, we demonstrated differential effects of calcitirol and paricalcitol on parathyroid hormone control and vascular calcification. We suggest that in clinical practice, the use of paricalcitol may allow for a wider therapeutic window with effects beyond SHPT management and may explain the increased survival advantage with paricalcitol treatment.

OP 12 A RELATIONSHIP BETWEEN CARDIAC VALVULAR CALCIFICATION AND PERIAORTIC FAT TISSUE, 25 HYDROXY VITAMIN D, AND MALNUTRITION-INFLAMMATION-ATHEROSCLEROSIS (MIA) COMPONENTS IN HEMODIALYSIS PATIENTS

OLCAY ELDEM¹, GÜLTEKİN GENÇTOY², CEVAHİR HABERAL³, TARKAN ERGÜN⁴, TONGUÇ SABA³, ERCAN BALCI⁵, SERAP ARIKAN⁶, SİREN SEZER²

Başkent University Faculty of Medicine, ¹Department of Cardiology; ²Department of Nephrology; ³Department of Cardiovascular Surgery; ⁴Department of Radiology; ⁵Hemodialysis Unit and ⁶Department of Biochemistry

BACKGROUND: Valvular calcification (VC) in ESRD was shown to be an important determinant of mortality. A negative correlation between vascular calcification and vitamin D has been reported in hemodialysis (HD) patients. VC is also a component of malnutrition, inflammation and atherosclerosis/calcification (MIAC). The amount of periaortic fat tissue (PAFT) is increased in patients with ESRD, and was found to have positive correlation with MIAC components, calcification of the aorta and coronary arteries. In this study we investigated a relationship between MIA components, 25-hydroxy vitamin D levels, and PAFT and heart VC in HD patients.

METHODS: 76 patients (49 M, 27 F) who were on HD for at least six months were included. VC was defined as bright echoes of >1 mm on one or more cusps of aortic, mitral valve or mitral annulus on echocardiography (HP Sonos 4500) evaluation. Results were expressed as the number of regions with calcified valve (0, 1, 2). Midweek predialysis blood samples were collected to determine Ca, P, PTH, CRP, albumin and 25-hydroxy vitamin D levels (Architect I, Abbott). The amount of PAFT was calculated using a method based on manual definition of borders on images derived from multislice CT.

RESULTS: 65.8% of the patients had one or more of valve calcification. Patients with valvular calcification (VC) were older (63.5±14.6; 55±17, p=0.02). PAFT (cm³) (1599±596, 739.7±179, p=0.001) and CRP (mg/dl) (15.8±11; 11.1±13.2 p=0.04) were higher in the group with VC. The logistic regression analysis revealed that the only significant predictor of VC was the amount of PAFT (p=0.04, Exp (B):1.006).

CONCLUSION: In this study we showed PAFT was positively correlated with inflammation and VC in HD patients. Accordingly, an important determinant of mortality in HD patients may be PAFT.

OP 13 PROGNOSTIC MARKERS IN AA AMYLOIDOSIS PATIENTS WITH KIDNEY INVOLVEMENT

MAHMUT ALTİNDAL, MUSTAFA ARICI, ERCAN TURKMEN, TOLGA YILDIRIM, MUCAHIT UNAL, SEREF RAHMI YILMAZ, BULENT ALTUN, YUNUS ERDEM

Hacettepe University Medical Faculty, Department Nephrology, Ankara, Turkey

BACKGROUND: Kidney disease is the most serious cause of morbidity and mortality in patients with AA amyloidosis. Data are scarce regarding outcome in AA amyloidosis with kidney involvement and response to therapy in populations with familial Mediterranean fever (FMF) as the primary cause of AA amyloidosis.

METHODS: One hundred and eleven patients were diagnosed with AA amyloidosis and kidney involvement in our unit between January 2000 and June 2012. Eighty patients with estimated glomerular filtration rate over 20 ml/min/1.73m² were followed for a median of 39 months. We evaluated clinical and laboratory data at the time of diagnosis and at the end of follow up to investigate factors affecting kidney survival and mortality.

RESULTS: Primary disease underlying AA amyloidosis was FMF in 55 (68.8%) patients. Median kidney survival was 86 months. Baseline serum creatinine (HR=3.81 [95% CI: 2.28–6.37] p<0.001) and serum albumin levels (HR=0.45 [95% CI: 0.28–0.74] p=0.001) were independent prognostic factors for kidney survival. Renin-angiotensin-aldosterone system (RAAS) blockers did not significantly change the kidney outcome (HR= 0.54 [% 95 CI: 0.25–1.14] p=0.107]. Serum creatinine (HR=4.38 [95% CI: 2.01–9.51] p<0.001) and serum albumin levels (HR=0.72 [95% CI: 0.57-0.90)] p=0.018) were also independent predictors of survival with hemoglobin (HR=0.39 [95% CI: 0.18–0.85] p=0.005).

CONCLUSION: Our results showed that in AA amyloidosis patients with kidney involvement, baseline serum creatinine and albumin at the time of diagnosis were the most important predictors of both renal survival and mortality.

OP 14 KIDNEY INVOLVEMENT IN LEUKOCYTOCLASTIC VASCULITIS

MAHMUT ALTINDAL, TOLGA YILDIRIM, RAHMI YILMAZ, ERCAN TURKMEN, AYMAN ABUDALAL, MUSTAFA ARICI, BULENT ALTUN, YUNUS ERDEM

Hacettepe University Medical Faculty, Department of Nephrology, Ankara, Turkey

BACKGROUND: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis, which may be an isolated entity or a manifestation of a systemic disorder. Data regarding renal involvement in LCV are scarce. The aim of this study is to investigate the prevalence and nature of renal disease in LCV.

METHODS: Two hundred and four patients diagnosed as LCV with skin biopsy between January 2000 and January 2013 were included in this study. The demographic characteristics, kidney function tests, associated systemic diseases and renal biopsy reports were retrospectively recorded. Renal involvement was defined as greater than 300-mg/day urinary protein excretion and/or estimated GFR calculated by CKD-EPI formula less than 60 ml/min/1.73 m².

RESULTS: One hundred and nine patients were male (53.4%). Median age of study population was 48 (17–84). Median serum creatinine and eGFR were 0.83 (0.38–11.91) mg/dL and 96.5 (4–152) ml/min/1.73 m2 respectively. Renal involvement was present in 69 patients (33.8%). Seven patients had nephrotic range proteinuria. Kidney biopsy had been performed in seventeen patients. The histological findings were as follows: HSP nephritis (n=6), pauci-immune glomerulonephritis (n=4), AA amyloidosis (n=2), AL amyloidosis (n=1), postinfectious glomerulonephritis (n=1), IgA nephropathy (n=1), acute tubulointerstitial nephritis (n=1) and immune complex glomerulonephritis (n=1).

CONCLUSION: LCV is an entity with frequent renal involvement and diverse clinical presentation. Kidney disease should be actively sought in patients with LCV.

OP 15 pH ESTIMATION CAN BE MADE EASILY THROUGH MEASUREMENTS OF THE TOTAL BLOOD CARBONDIOXIDE CONTENT AND BICARBONATE LEVELS

MUSTAFA ÇAKAR¹, FATİH BULUCU¹, ÖMER KURT¹, FATİH YEŞİLDAL², HAKAN ŞARLAK³

Gülhane Medical Faculty, ¹Department of Internal Medicine, ²Department of Clinical Biochemistry, and ³Department of Internal Medicine, Ankara, Turkey

BACKGROUND: The blood pH (bpH), electrolytes, blood oxygen and carbon dioxide (CO₂) levels are very useful markers representing the degree of proper functioning of vital organs, primarily the kidneys and lungs. The associations between pH, CO₂, bicarbonate (HCO₃) and other components have largely been investigated before. We aimed to investigate the associations between pH, HCO3 and total CO2 content (ctCO₂) measurements.

METHODS: We recruited 21811 separate arterial blood gas (ABG) analysis reports in the study, obtained at different time points and mainly from different patients. Reports were taken in a raw digital format from the ABG analyzer devices.

RESULTS: 4941 (22.65%) reports were from biochemistry, 4430 (20.3%) from internal medicine intensive care unit (ICU), 4952 (22.7%)from anesthesia ICU, 2540 (11.6%) from chest diseases and 4948 (22.68%) from cardiovascular surgery ICU. bpH values were between 6.600-7.599 (7.391±0.109). 5619(25.8%) of the results reported acidemia (pH<7.35; 7.249±0.103), 6614 (30.3%) had alkalemia (pH>7.35; 7.493±0.032) and 9578(43.9%) had a normal bpH (7.405±0.028). Based on the non-linear regression analysis of the data from the whole group by HCO3 and ctCO2 to reach pH, the following formula was generated: Estimated pH (pHe)=9-LOG10(-620.133+621.224^*((ctCO2/HCO3)^1.223)). The real pH and pHe values had a very significant correlation(r=0.989, p<0.001).

CONCLUSION: Using this formula, bpH can be estimated accurately from blood HCO₃ and ctCO₂ values. Though the formula resembles the Henderson-Hasselbalch equation, we think that it may be used for other ABG analyses aimed to estimate blood pH, even in venous samples.

OP 16 CLINICAL AND HISTOPATHOLOGICAL EVALUATION OF PATIENTS WITH NEPHROTIC SYNDROME IN OUR CLINIC IN THE LAST 5 YEARS

ISMAIL YILDIZ¹, DILEK TORUN¹, HASAN MICOZKADIOGLU¹, TUBA CANPOLAT², RUYA OZELSANCAK¹, AYSEGUL ZUMRUTDAL¹, ERTUGRUL ERKEN¹

Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center; ¹Department of Nephrology and ²Department of Pathology, Adana, Turkey

BACKGROUND: Renal biopsy is an invasive method for diagnosis of kidney diseases. In our study we evaluated both clinical and pathological findings and the response to treatment in cases that underwent native kidney biopsy in our institution.

METHODS: Kidney biopsies performed in adults who presented to the Baskent University Adana Practice and Research Hospital, Nephrology Department between years 2006 and 2011 were analyzed. All biopsies were performed with the guidance of ultrasonography, and a pair of core samples was taken. At least seven glomeruli and one medium sized artery were accepted as adequate biopsy for diagnosis.

RESULTS: 182 patients are included in the study. The mean age of patients was 41.8 ±15.9 (16-81) years. 57% of patients were male and 43 % female. The most frequent indication for kidney biopsy was nephrotic range proteinuria in % 63 of patients. The most common primary and secondary glomerulonephritides were membranoproliferative glomerulonephritis (n=31, % 17) and amyloidosis (n=18, % 9.9). Only one complication (% 0.05%), a case of gross hemorrhage, was encountered. Before treatment the mean proteinuria of patients included in the study was 5179.8 ± 3906.4 mg/day. After treatment, proteinuria decreased to 1844.5± 2201.2 mg/day (p<0.05).

CONCLUSION: The most frequent indication of the kidney biopsy was nephrotic range proteinuria in our department. Membranoproliferative glomerulonephritis and amyloidosis were the most common primary and secondary glomerulonephritides respectively. Kidney biopsy, the gold standard method, could be performed safely for diagnosis and to guide the treatment of kidney diseases with a very low major complication rate.

OP 17 PROTEINURIA MAY PREDICT POSTOPERATIVE ACUTE RENAL FAILURE IN PATIENTS THAT UNDERGO HIP AND KNEE ARTHROPLASTY

AYSUN ÇALIŞKAN, İHSAN ERGÜN, BERK GÜÇLÜ, PERİHAN EKMEKÇİ, BURAK AKAN, TUĞRUL YILDIRIM, ALPER KAYA

Ufuk University School of Medicine, Ankara, Turkey

BACKGROUND: The incidence of the reported acute renal failure (ARF) risk reached to %9.1 after orthopedic surgical operations. Patients that undergo total joint arthroplasty are generally older and obese, and more likely to have comorbid conditions like diabetes, hypertension, chronic renal failure and they are on multiple medications.

METHODS: The aim of this prospective study was to describe ARF incidence and to identify risk factors for ARF after joint arthroplasty. We analyzed 124 consecutive patients who underwent joint arthroplasty in our center between January to July 2012. The cohort consisted of 29 men and 95 women, knee/hip arthroplasty: 85(%68.5)/39(%31.5), timing of the operation, elective/urgent: 113 (%91.1)/11 (%8.9). All patients in the study group had a GFR>30 ml/min/1.73 m².

RESULTS: Nine of 124 patients developed ARF (%7.2). Four of the 9 patients underwent urgent surgery (4/11, % 36), and 5 underwent elective operation (5/113, %4). The demographic parameters, laboratory values and data on the type of surgery are given in Table 1. Length of hospital stay (ARF vs. nonARF group: 12.5 vs, 6.5 days) and mortality (ARF vs. nonARF group: %55.6 vs. %0.9) was significantly higher in the ARF group. In regression analyses, proteinuria, congestive heart failure (CHF) and timing of the operation were determined as independent risk factors.

Table 1. Demographic parameters, laboratory values, and data depending on the operation given.

Parameters	ARF (n=9)	non-ARF (n=115)	p-values
Sex, M/F, n (%)	5/4 (55.6/44.4)	24/91 (20.9/79.1)	0.032
Age (years)	73.5±7.9	67.8±10.8	0.125
BMI (kg/m2)	28.2±3.3	29.9±5.2	0.415
CHF, n (%)	5 (55.6)	15 (13)	0.006
CRF, n (%)	4 (44.4)	15 (13)	0.031
BUN (mg/dl)	27±17	16±5	<0.001
Creatinine (mg/dl)	1.04±0.44	0.70±0.21	<0.001
GFR (ml/sec/1.73m2)	67±27	89±20	0.03
Proteinuria, n (%)	6 (66.7)	11 (9.6)	<0.001
Plasma albumin (g/dl)	3.6±0.9	4.2±0.4	0.003
Infection, n (%)	2 (22.2)	2 (1.7)	0.026
Lower SBP during surgery (mmHg)	93±30	110±20	0.051
Urgent operation, n (%)	4 (44.4)	7 (6.1)	0.003
Hospitalization (days)	12.5±6.6	6.5±2.8	<0.001
Mortality, n (%)	5 (55.6)	15 (13)	<0.001

ARF, Acute renal failure. CHF, Congestive heart failure. BMI, Body mass index. CKD, Chronic kidney disease. BUN, Blood urea nitrogen. GFR, Glomerular filtration rate. SBP, Systolic blood pressure

CONCLUSION: ARF was a frequent after joint arthroplasty operations. ARF risk was higher for patients with CHF and those who underwent urgent operations. Dipstick proteinuria may predict ARF better in patients with GFR>30 ml/min/1.73 m2 after joint arthroplasty operations.

OP 18 THE ROLE OF RESISTIN AND ADIPONECTIN LEVELS IN PROTEIN ENERGY WASTING IN PATIENTS WITH CHRONIC KIDNEY DISEASE

KUBRA KAYNAR¹, BİRGUL VANİZOR KURAL², SUKRU ULUSOY¹, MUAMMER CANSİZ¹, BUKET AKÇAN², NURAY MISIR³, NUH KAYA⁴, ASİYE AYDIN⁵, MERYEM BAKKALOĞLU⁶

Karadeniz Technical University School of Medicine, ¹Department of Nephrology and ²Department of Biochemistry Karadeniz Technical University School of Forestry; ³Department of Forest Management Karadeniz Technical University School of Medicine; ⁴Department of Internal Medicine; ⁵Hemodialysis Unit and ⁶Peritoneal Dialysis Unit, Trabzon, Turkey

BACKGROUND: The aim of this study was to evaluate the effects of adipocytokines including adiponectin, leptin, resistin, neuropeptide Y, and gastric hormone ghrelin, acyl ghrelin, on the development of Protein Energy Wasting (PEW) in chronic kidney disease patients with different renal replacement modalities.

METHODS: 150 patients without active infections or chronic inflammatory conditions were recruited to the study. Study groups were control group, hemodialysis group, predialysis group, peritoneal dialysis group and kidney transplant group. Fasting morning serum leptin, ghrelin, acylated ghrelin, neuropeptide Y, adiponectin, and resistin levels were measured in all patients using ELISA (Sandwich) method. Diagnosis of PEW was made according to definition recommended by ISRNM.

RESULTS: Presence of PEW in hemodialysis (23.3%) and peritoneal dialysis (26.7%) groups were significantly higher than those of predialysis (3.3%), and transplantation (0%) groups. Average protein intake of hemodialysis, predialysis, peritoneal dialysis and kidney transplant patients were 0.96 ± 0.21, 0.82 ± 0.21, 0.95 ± 0.3 and 1.01 ± 0.24 g/kg/day respectively. Adiponectin and resistin levels in predialysis, peritoneal dialysis and hemodialysis patients were higher than control group. There were significant positive correlations between the presence of PEW and serum resistin (r = 0.267, p=0.001), and serum adiponectin levels (r=0.349, p=0.0001).

CONCLUSION: CKD patients except transplant patients had higher adiponectin and resistin levels than controls. PEW was linearly correlated with resistin and adiponectin levels. High serum resistin and adiponectin levels might have a role in development of PEW among dialysis patients.

OP 19 NEUTROPHIL GELATINASE ASSOCIATED LIPOCALIN (NGAL) IN PREDICTION OF LONG-TERM CARDIOVASCULAR MORBIDITY AND MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE

YALCIN SOLAK¹, MAHMUT ILKER YILMAZ², MUTLU SAGLAM³, HALIL YAMAN⁴, HILMI UMUT UNAL⁵, MAHMUT GOK⁵, HAKKI CETINKAYA⁵, ABDUZHAPPAR GAIPOV⁶, TAYFUN EYILETEN⁵, SEBAHATTIN SARI³, ALİ OSMAN YILDIRIM⁷, ZEKI TONBUL⁸, SULEYMAN TURK⁸

Karaman State Hospital, ¹Nephrology Unit, Karaman, Turkey; Gulhane School of Medicine, ²Department of Nephrology; ³Department of Radiology; ⁴Department of Biochemistry and ⁵Department of Nephrology, Ankara, Turkey; National Scientific Medical Research Center; ⁶Department of Extracorporeal Hemocorrection, Astana; Kazakhstan Gulhane Military School of Medicine; ⁷Department of Emergency, Ankara, Turkey; Necmettin Erbakan University Meram School of Medicine, ⁸Department of Nephrology, Konya, Turkey

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker of acute kidney injury. NGAL has been used to predict survival in patients with myocardial infarction. We aimed to evaluate the prognostic role of NGAL regarding development of cardiovascular (CV) events in patients with CKD.

METHODS: 298 infjects with stage 1-5 (predialytic) CKD were followed for a median of 41 months. Fatal and nonfatal CV events were recorded during follow-up period. Plasma NGAL, high-sensitivity C-reactive protein (hsCRP), and pentraxin3 (PTX3) at baseline were determined in addition to routine biochemistry. Endothelial function (flow mediated dilation, FMD) was also determined.

RESULTS: A total of 104 composite (35 fatal and 69 nonfatal) CV events occurred during the follow-up period. NGAL as well as PTX-3 and CRP particularly showed significant increase from stage-1 CKD to stage-5 CKD (Table 1). Univariate and multivariate Cox analyses showed that NGAL was a significant independent predictor of composite CV events. Univariate analysis demonstrated that NGAL predicts composite CV events independent of FMD, hemoglobin and history of diabetes (hazard ratio 1.05; 95% CI; p<0.001). NGAL was inversely correlated with FMD (r=−0.67; CI 95% p<0.001). Kaplan-Meier analysis showed that NGAL ⩾50 ng/ml was related to a significantly decreased survival time. The survival rate was 96% in the group with NGAL ⩽ 50 ng/ml compared to 84% in the group with NGAL > 50 ng/ml (p=0.001 by log-rank test).

Table 1. Biochemical assessment according to CKD stages.

Parameter	Stage 1 CKD (n=60)	Stage 2 CKD (n=62)	Stage 3 CKD (n=59)	Stage 4 CKD (n=59)	Stage 5 CKD (n=58)	p value
eGFR (ml/min)	95.5 (91–107)	68 (61–89)	43 (30–58)	20 (15–29)	9 (3–14)	<0.001
hsCRP (mg/l)	7.0 (2–17)	10 (2–24)	16 (5–35)	23 (4.7–46)	26.7 (4–48)	<0.001
Pentraxin-3 (ng/ml)	2.73±2.97	5.5±6.2	7.22±7.45	8.91±8.13	11.47±12.15	<0.001
Hb (g/dl)	13.29±2.53	12.32±2.07	12.28±1.99	12.02±1.91	10.90±1.81	<0.001
NGAL (ng/ml)	47.28 (15.9–54)	49.23 (16.8–56.3)	50.27 (17.11–80.7)	53.14 (17.5–83.5)	62.50 (27.6–91)	<0.001

CONCLUSION: This is the first study in the literature showing that NGAL is independently related to endothelial dysfunction and can independently predict composite CV endpoints in patients with CKD. NGAL >50 ng/ml may be used as a complementary prognostic marker for predicting CV events in patients with CKD.

OP 20 SERUM MALONDIALDEHYDE LEVELS AND MYELOPEROXIDASE AND CATALASE ACTIVITIES IN PATIENTS WITH NEPHROTIC SYNDROME

HÜSEYİN BEĞENİK¹, YASEMİN USUL SOYORAL¹, REHA ERKOC², HABİB EMRE¹, ABDULLAH TAŞKIN³, MEHMET TAŞDEMİR⁴, MEHMET ASLAN⁴

¹Yüzüncü Yil University School of Medicine, Department of Nephrology, Van, Turkey; ²Bezmialem University School of Medicine, Department of Nephrology, Istanbul, Turkey; ³Harran University School of Medicine, Department of Biochemistry, ^a. Urfa, Turkey; ⁴Yüzüncü Yil University School of Medicine, Department of Internal Medicine, Van, Turkey

BACKGROUND: Some studies have indicated the pathophysiological importance of reactive oxygen species in patients with nephrotic syndrome. The aim of this study was to investigate the serum malondialdehyde levels, myeloperoxidase and catalase activities in patients with adult nephrotic syndrome.

Methods: Twenty-four patients with nephrotic syndrome (12 females) and 24 healthy controls (11 females) were enrolled. Serum myeloperoxidase activity, catalase activity and malondialdehyde levels were assessed. A renal biopsy was performed in all patients with NS. The etiologies of the NS patients were as follows: membranous glomerulonephritis (n=10), focal segmental glomerulosclerosis (n=7) and membranoproliferative glomerulonephritis (n=7). The average follow-up period for the NS patients was 23.3±13.3 months. All patients were receiving immunosuppressive treatment.

Results: Serum myeloperoxidase activity and malondialdehyde levels were signicantly higher in patients with nephrotic syndrome than controls (both, p<0.001), while catalase activity was signicantly lower (p<0.001). Serum catalase activity was significantly correlated with myeloperoxidase activity (r=−0.417, p=0.003) and malondialdehyde levels (r=−0.532, p=0.007). Serum malondialdehyde levels were significantly correlated with myeloperoxidase activity (r=0.419, p=0.003).

CONCLUSION: These results indicate that increased myeloperoxidase activity is associated with an oxidant-antioxidant imbalance that may contribute to atherosclerosis in patients with adult nephrotic syndrome.

OP 21 ASSOCIATION OF ENDOTHELIAL DYSFUNCTION, PLASMA ADMA LEVELS, CARDIAC FUNCTIONS, AND METABOLIC PARAMETERS IN PERITONEAL DIALYSIS PATIENTS

SAMİ UZUN¹, SERHAT KARADAв, METİN YEĞEN³, MELTEM GÜRSU⁴, SAVAŞ ÖZTÜRK⁴, ZEKİ AYDIN⁴, ABDULLAH ŞUMNU⁴, EGEMEN CEBECİ⁴, OKTAY ÖZKAN⁴, BARIŞ DÖNER⁴, RÜMEYZA KAZANCIOĞLU⁵

Ordu State Hospital, ¹Division of Nephrology, Ordu, Turkey; Kafkas University School of Medicine, ²Division of Nephrology, Kars, Turkey; Haseki Education and Research Hospital, ³Division of Internal Medicine; ⁴Division of Nephrology, Istanbul, Turkey Bezmialem University School of Medicine; ⁵Department of Nephrology, Istanbul, Turkey

BACKGROUND: Chronic kidney disease (CKD) is associated with endothelial dysfunction and increased cardiovascular events. Asymmetric dimethylarginine (ADMA) is accepted as a risk factor for coronary artery disease by causing endothelial dysfunction and vasospasm. We aimed in the present study to investigate the relationship between flow-mediated dilatation (FMD) as an indicator of endothelial dysfunction and ADMA levels, echocardiographic and metabolic parameters in PD patients.

METHODS: This is a cross-sectional study in which PD patients aged 18-80; with at least three-month duration of dialysis and without active cardiac, infectious or malignant diseases, and clinically evident hypervolemia were included. FMD measurement, ADMA levels and echocardiographic parameters were recorded.

RESULTS: Fifty-five patients were included in the study. Their mean age was 53±15 years. Mean FMD level was 10.7±6.5 %, and the mean ADMA level was 81.9±48.0 μmol/L. There was no statistically significant relationship between ADMA levels and FMD (p=0.873). We detected negative correlation of FMD with systolic and diastolic blood pressures (p=0.001 and p<0.001, respectively). Patients with hypertension had lower FMD values (p=0.012). Hypertension was the main determinant of FMD among all parameters (p=0.037). FMD was not correlated with echocardiographic findings, laboratory results and parameters of dialysis adequacy.

CONCLUSION: The major risk determinant for cardiovascular disease in peritoneal dialysis patients is the presence of hypertension.

OP 22 RED BLOOD CELL DISTRIBITION WIDTH AND RELATED FACTORS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

KENAN TURGUTALP¹, TOLGA KÖŞECݹ, TÜRKAY ÖZCAN², YAVUZ GÖZÜKARA³, AHMET KIYKIM¹

Mersin University School of Medicine, ¹Division of Nephrology and ²Department of Cardiology, Mersin, Turkey Mersin State Hospital; ³Department of Internal Medicine, Mersin, Turkey

BACKGROUND: Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus and the leading cause of end-stage renal disease. Recent data demonstrated that elevated red blood cell distribution width (RDW) was associated with the incidence of both micro and macrovascular complications in diabetic patients. However, no studies have investigated the relationship between RDW and diabetic nephropathy in a defined diabetes population. We aimed to investigate the RDW measurements in patients with type 2 diabetes mellitus (DM), in patients with DN, and in healthy volunteers.

METHODS: Group 1 consisted of healthy control participants. Group 2 consisted of patients with uncomplicated DM. Group 3 consisted of patients with DN and normal GFR values (>90 mL/min). Fasting blood glucose, HbA1c, proteinuria level, serum albumin, creatinine, uric acid, lipid parameters, and RDW values were measured.

RESULTS: A total of 563 patients composed of 3 different groups were recruited to the study. The mean age of group 1 patient (n=157, 76 male, 81 female) was 42.41±16.8, group 2 patients (n=210, 106 male, 114 female) was 52.12±10.8, and group 3 patients (n=196, 99 male, 97 female) was 52.02±11.1 years. The RDW values in group 1 participants were significantly lower than those in group 2 and group 3 (p<0.05). The RDW values of group 3 patients were higher than in group 2 and group 1 patients (p<0.05). There was statistically significant positive correlation between RDW value and proteinuria level in group 3 patients (p<0.05).

CONCLUSION: The RDW values were higher in diabetic groups, particularly in patients with DN than in normal participants. Proteinuria was the most powerful determinant of RDW.

OP 23 IS RED BLOOD CELL DISTRIBUTION WIDTH A PREDICTOR OF RESPONSE TO TREATMENT IN ADULT PATIENTS WITH NEPHROTIC SYDNROME?

KENAN TURGUTALP¹, ÜMİT KARABULUT¹, TÜRKAY ÖZCAN², İLTER HELVACI³, YAVUZ GÖZÜKARA⁴, AHMET KIYKIM¹

Mersin University School of Medicine, ¹Division of Nephrology; ²Department of Cardiology, Mersin, Turkey; Silifke School of Applied Technology and Management, ³Department of Business Information Management, and Mersin State Hospital, ⁴Department of Internal Medicine, Mersin, Turkey

BACKGROUND: Novel biomarkers for predicting the treatment response (TR) in patients with nephrotic syndrome (NS) are needed. Documentation of noninvasive biomarkers that exactly distinguish between treatment sensitive NS and treatment resistance NS is essential to preventing their exposure to high-dose or ineffective immunosuppressive drugs. We aimed to investigate the relationship between red cell distribution width (RDW) values and TR in patients with NS.

METHODS: We conducted a retrospective study of adult patients with NS due to primary glomerulonephritis. Patients were divided into three groups on the basis of their TR. Group 1 was composed of patients with complete remission. Group 2 was composed of patients with partial remission. Group 3 was composed of patients resistant to treatment.

RESULTS: A total of 173 patients were recruited to the study. The highest baseline mean RDW value was found in group 3 patients (17.8 ± 1.8) (p<0.05), and the lowest mean RDW value was found in group 1 patients (13.4 ± 0.7) before treatment (p<0.05). We found significant decrease in RDW value after successful treatment in group 1 and group 2 (p<0.05). In group 3 patients, there was no change in RDW value after treatment (p>0.05). Most of the patients with remission (n=49, 89%) have baseline RDW values under 14% (p<0.001, Kendal Tau= −0.86). The highest resistance to treatment was seen in patients who have RDW levels > 15 % at diagnosis (86.1 %) (p<0.001, Kendal Tau= −0.87).

CONCLUSION: Our results suggest that pretreatment RDW value is a promising novel biomarker for treatment responsiveness in adult patients with NS due to primary glomerulonephritis.

OP 24 THE RELATIONSHIP BETWEEN SERUM CYSTATIN-C LEVELS AND MICROALBUMINURIA IN PATIENTS WITH METABOLIC SYNDROME

MERAL GÜLAY KOÇAK¹, BÜLENT HUDDAM¹, ALPER AZAK¹, NİLÜFER BAYRAKTAR², SİREN SEZER³

Ankara Education and Research Hospital, ¹Division of Nephrology Başkent University, Faculty of Medicine, ²Department of Biochemistry and ³Department of Nephrology, Ankara, Turkey

BACKGROUND: Metabolic syndrome (MS) is a group of metabolic disorders in which insulin resistance plays a pivotal role. Microalbuminuria (MA) is a strong indicator of morbidity related to cardiovascular disorders, and is currently considered a novel diagnostic criterion for MS. Cystatin C is a useful marker in measuring glomerular filtration rate. Moreover, recently it has been suggested that cystatin C may be a potential biomarker for detecting MA. In this study, we attempted to investigate the relationship between serum cystatin C levels and MA in patients with MS.

METHODS: A total of 50 patients with MS and 25 control patients were included in this study. We defined MS by the NCEP criteria among nondiabetic outpatients. Patients with MS were further divided into two groups based on MA status. Overall 25 of the participants with MS did not have MA (group I), while the remaining 25 had MA (group II). Serum cystatin C levels were measured by ELISA.

RESULTS: Age, distributions of sex, BP and LDL cholesterol levels were similar among all groups. BMI, waist/hip ratio, fasting blood glucose, homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, triglyceride, and C-reactive protein levels were significantly higher in group I and II patients compared to controls. In group II, the cystatin-C levels were higher than controls and group I (Table 1). Moreover, cystatin-C concentrations were positively correlated with microalbuminuria (r=0.50, p=0.0001).

Table 1. Comparison of the groups according to microalbuminuria and cystatin levels.

Parameter	Group 1 mean±SD	Group 2 mean±SD	Control (mean±SD)	p
Microalbuminuria (mg/day)	6.56±5.66	146.68±157.24	3.3±2.2a,b	0.0001
Cystatin-C (ng/ml)	1067.61±217.7	1501.28±494.08	1032±233b	0.0001

^ap>0.05 as compared with group 1,

^bp<0.05 as compared with group 2.

CONCLUSION: In our study, we found that MS patients with MA had high levels of cystatin-C. In conclusion, we suggest that determination of cystatin C levels could be a useful marker as an early indicator of renal injury in patients with MS.

OP 25 IS URINE PROTEIN TO URINE CREATININE RATIO FOR ESTIMATION OF DAILY PROTEINURIA VALID IN DIFFERENT PATIENT GROUPS?

EDA ALTUN, BÜLENT KAYA, SAİME PAYDAŞ, MUSTAFA BALAL

Çukurova University School of Medicine, Department of Nephrology, Adana, Turkey

BACKGROUND: Measurement of protein excretion in a 24-hour urinary collection is the gold standard for the quantitative evaluation of proteinuria. However urine collection is cumbersome. The spot urine protein (Upr) to creatinine (Ucr) ratio (Upr/ Ucr) has been shown to correlate with 24-hour estimation. Our aim was to evaluate the spot Upr/ Ucr ratio against 24-hour urinary protein excretion in infjects with diabetic nephropathy (DN), renal transplant recipients (RTrs) and chronic glomerulonephritis (CGN).

METHODS: A total of 190 patients (90 female, 100 male, mean age 41.8±12.9 years) were included. Patients were grouped into DN, RTrs and CGN. Upr and Ucr concentrations were measured in spot morning urine samples and Upr/ Ucr ratios were calculated. Urinary protein measurement in 24-hour timed collected urine samples were used to determine daily urinary protein excretion rate.

RESULTS: The spot morning Upr/ Ucr was significantly correlated with 24 hours Upr excretion rate in groups with DN, RTrs and CGN (p= 0.92, p= 0.97 and p= 0.96 respectively). Blood urea nitrogen, creatinine and glomerular filtration rate were similar in three groups. We found that daily proteinuria can be calculated as y= 1,09x + 0,095 (y= daily proteinuria, x= Spot Upr to Ucr ratio) in all patients. Table 1

Table 1. Comparisons in groups.

Parameter	RTrs Mean±SD Med (Min-Max)	DN Mean±SD Med (Min-Max)	CGN Mean±SD Med (Min-Max)	P	Total Mean±SD Med (Min-Max)
Age	40.5±10.6 38 (21-66)	49.8±12.9 56(21–70)	40.7±14.9 35 (18-83)	0.003	41.8±12.9 42 (18-83)
Creatinine clearance (ml/min)	76.4±28.8 74.8 (26.7–203.5)	78.5±54.5 56.4 (16.9-219)	90.1±45.6 90.9(14.7–204.3)	0.096	81.7±40.0 79.5 (14.7-219)
24 h proteinuria	0.67±1.1 0.29 (0.02-6.1)	1.9±2.1 1.1 (0.06-8.3)	2.5±3.0 1.1 (0.06-11.3)	0.001	1.5±2.3 0.47 (0.02-11.3)
Upr/Ucr	0.59±1.1 0.21 (0.05-6.6)	1.5±1.6 0.72 (0.04-5.8)	2.1±2.5 0.99 (0.08-8.9)	0.001	1.3±1.9 0.37 (0.04-8.9)

CONCLUSION: For estimation of daily urinary protein, spot Upr/ Ucr was validated in all groups. Significant correlations were found between spot Upr/ Ucr and daily urine protein in all three groups of patients. Upr/ Ucr can be used for screening test for daily proteinuria in renal transplant recipients as in diabetic nephropathy and chronic glomerulonephritis.

OP 26 CLINICAL OUTCOME OF ANCA-ASSOCIATED GLOMERULONEPHRITIS: SINGLE CENTER EXPERIENCE

ARZU VELİOĞLU¹, SERDAR NALCACݹ, GURDAL BİRDAL¹, DERYA GULER¹, HAKKİ ARİKAN¹, MEHMET KOC¹, HANER DİRESKENELݲ, SERHAN TUGLULAR¹, CETİN OZENER¹

Marmara University School of Medicine, ¹Department of Nephrology and ²Department of Rheumatology, Istanbul, Turkey

BACKGROUND: Standard therapeutic regimens for ANCA related nephritis have not been established. Treatment is usually planned individually depending on disease status. In patients requiring hemodialysis at presentation, response to treatment may vary according to the intensity of the treatment.

METHODS: We evaluated 28 patients with ANCA-associated glomerulonephritis (mean age: 54.8±13.8 years, F/M: 9/19). Clinical characteristics and outcomes of patients were investigated.

RESULTS: We diagnosed Wegener′s Granulomatosis in 14 patients, and microscopic polyangiitis in 14. Baseline creatinine level was 3.8±3.5 mg/dl. 21 patients (75%) had active urinary sediment. 15 patients (53%) required HD upon presentation. Crescentic GN was found in 21 patients. All patients received steroid treatment. 23 patients received intravenous cyclophosphamide, and 13 patients underwent plasmapheresis. The mean follow-up time was 40.7±44.8 months. End-stage renal disease (ESRD) developed in 6 (21%) patients. 5 patients (17%) died due to infectious complications (pneumonia in 4, cytomegalovirus disease in 1). ESRD and death were significantly higher in patients who required HD compared to the patients who did not require HD (6/15 vs. 0/13, p=0.013; 5/15 vs. 0/13, p=0.031). Nine (60%) of the 15 patients who required HD initially recovered sufficient kidney function to come off dialysis. After treatment, the mean creatinine level was 2.4±2.2 mg/dl.

CONCLUSION: Initial HD requirement is the most important factor for ESRD and death in ANCA-associated glomerulonephritis. Plasmapheresis in addition to steroid and cyclophosphamide improves the renal outcome in these patients. However, infectious complications, especially pneumonia, should be closely followed.

OP 27 SERUM URIC ACID IS CORRELATED WITH PULSE WAVE VELOCITY IN STAGE 1-4 CHRONIC KIDNEY DISEASE PATIENTS

RENGİN ELSÜRER AFŞAR¹, BARIŞ AFŞAR²

Selçuk University, Faculty of Medicine, ¹Department of Nephrology and Konya Numune Hospital, ²Department of Nephrology, Konya, Turkey

BACKGROUND: Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Both increased arterial stiffness and hyperuricemia are associated with elevated cardiovascular risks. Our aim was to investigate the relationship between serum uric acid and arterial stiffness in CKD patients.

METHODS: 96 patients (male/female= 32/64, age = 54.5±13.5 years, body mass index= 29.7±5.7 kg/m2) were included. Patients underwent biochemical testing and glomerular filtration rate (GFR) was calculated by Modification of Diet in Renal Disease (MDRD) formula. CKD stage was determined according to NKF KDOQI guidelines. All patients underwent ambulatory blood pressure measurement (Mobil-O-Graph® CE0044, I.E.M., GmbH, Stolberg, Germany). PWV was determined by oscillometric method.

RESULTS: Mean GFR was 76.3±26.7 ml/min/1.73m². Distribution of patients according to CKD stages was as follows; Stage 1 (n=27, 28.1%), stage 2 (n=46, 47.9%), stage 3 (n=18, 18.8%), stage 4 (n=5, 5.2%). Mean systolic and diastolic blood pressures (BP) were 125.3±17.6 mmHg and 79.3±12.6 mmHg, respectively. Mean arterial BP was 100.3±14.2 mmHg. PWV was positively correlated with age(r=0.856,p. 856,p<0.0001), mean systolic and diastolic BP (r=0.378,p. 378,p<0.0001 and r:0.295. 295, p:0.004. 004, respectively), mean arterial BP (r = 0.355, p<0.0001), pulse pressure (r = 0.302, p = 0.003) and peripheral resistance (r= 0.323, p = 0.002.). There was a positive correlation between PWV and blood urea nitrogen (r= 0.687, p < 0.0001), serum creatinine (r = 0.430, p<0.0001) and fasting blood glucose (r = 0.267, p = 0.012). GFR was negatively correlated with PWV (r = −0.532, p<0.0001). CONCLUSION: In stage 1-4 CKD patients, elevated serum uric acid level is correlated with increased arterial stiffness.

OP 28 DIFFERENTIAL EFFECT OF VITAMIN D RECEPTOR ACTIVATORS AND PHOSPHATE BINDERS ON QT DISPERSION IN MAINTENANCE HEMODIALYSIS PATIENTS

SİREN SEZER¹, ZEYNEP BAL¹, EMRE TUTAL¹, UGUR BAL², MEHTAP ERKMEN UYAR¹, NURHAN ÖZDEMİR ACAR¹

Başkent University Faculty of Medicine, ¹Nephrology and ²Cardiology, Ankara, Turkey

BACKGROUND: Cardiovascular diseases are common cause of mortality in maintenance hemodialysis (MHD) patients. Prolongation of corrected maximal QT interval (QTcmax) and QTc dispersion (QTcd) are risk factors for cardiac arrhythmias and mortality. The aim of this study was to examine the differential effects of vitamin D receptor activators (VDRAs) and phosphate-binding agents on QT parameters in MHD patients.

METHODS: Patients were grouped according to type of VDRA and phosphate-binding treatment. The correlation between QT parameter changes and serum electrolytes and acid-base alterations was analyzed at the end of one year.

RESULTS: When sevelamer based therapy was compared to calcium acetate based therapy QTcmax did not change but QTcd was significantly decreased in sevelamer group (p <0.03) whereas in calcium acetate group, QTcmax was significantly increased while there was no significant change in QTcd (p<0.05) at the end of one year. In paricalcitol group there were no significant changes in QT parameters while in calcitriol group QTcmax significantly increased (p< 0.004). When combined with cinacalcet QTcd was significantly decreased in paricalcitol group (p<0.05) while QTcmax were significantly increased in calcitriol group (p< 0.013). Multiple logistic regression analysis revealed that mean serum bicarbonate level was an independent risk factor for QT dispersion (r² = 0.045; p = 0.009).

CONCLUSION: We suggest paricalcitol and sevelamer based treatment could be a good choice in MHD patients who are known to have a high risk of cardiovascular disease. Additionally management of uremic acidosis could play a role in cardiovascular stability in MHD patients.

OP 29 THE EFFECT OF SERUM MANNOSE BINDING LECTIN LEVELS ON DIALYSIS-ASSOCIATED PERITONITIS AND CATHETER RELATED BACTEREMIA

ERTUGRUL ERKEN¹, DİLEK TORUN¹, NURZEN SEZGİN², HASAN MİCOZKADİOGLU¹, AYSEGUL ZUMRUTDAL¹, RUYA OZELSANCAK¹, ISMAİL YİLDİZ¹

Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, ¹Department of Nephrology and ²Department of Biochemistry, Adana, Turkey

BACKGROUND: Mannose binding lectin (MBL) takes part in innate immunity through opsonization and complement activation. MBL deficiency is associated with some infections. This study focused on functional MBL deficiency and its effect on risk of dialysis related peritonitis and tunneled catheter related bacteremia in patients with end stage renal disease.

METHODS: 51 patients on peritoneal dialysis (PD) and 31 patients under maintenance hemodialysis (HD) who had tunneled/cuffed hemodialysis catheters as vascular access (total 82) were included in this study. Serum MBL level measurements were performed by ELISA.

RESULTS: The mean value for serum MBL level in patient groups PD and HD and healthy controls were 2536.5 ng/ml, 2088.7 ng/ml, and 1924 ng/ml respectively. Differences between serum MBL levels were not significant among groups. Serum MBL value was negatively correlated to the number of peritonitis episodes in PD group (p=0.019). MBL deficiency was not associated with increased incidence of peritonitis (>0.67 episodes/year) in peritoneal dialysis patients. The surveillance of catheter associated blood stream infections for tunneled/cuffed hemodialysis catheters in our center was 2.07 episodes/1000 catheter days. An association with functional MBL deficiency and incidence of catheter related bacteremia was not observed.

CONCLUSION: MBL deficiency was not associated with an increased incidence of dialysis related peritonitis or catheter related bacteremia in patients at our center. On the other hand serum MBL value was negatively correlated to the number of peritonitis episodes in the PD group. Further studies with larger sample size might indicate the potential effect of MBL deficiency on dialysis related peritonitis.

OP 30 THE EFFECTS OF CINACALCET TREATMENT ON ANEMIA PARAMETERS, BONE MINERAL MATEBOLISM, LEFT VENTRICULAR MASS INDEX, AND PARATHYROID GLAND VOLUME IN HEMODIALYSIS PATIENTS WITH SEVERE SECONDARY HYPERPARATHYROIDISM

DİLEK TORUN¹, ISMAİL YİLDİZ¹, HASAN MİCOZKADİOGLU¹, GUL NİHAL NURSAL², FATMA YİGİT³, RUYA OZELSANCAK¹

Baskent University Faculty of Medicine Adana Teaching and Medical Research Center, ¹Department of Nephrology, ²Department of Nuclear Medicine and ³Department of Cardiology, Adana, Turkey

BACKGROUND: In this study we investigated the effects of cinacalcet therapy on anemia parameters, bone mineral metabolism, left ventricular mass index (LVMI) and parathyroid gland volume in hemodialysis (HD) patients.

METHODS: Twenty-four HD patients (M/F = 11/14, mean age = 45.2 ± 17.9 years, mean HD duration of 96.4 ± 32.7 months) were included in this study. The indication for calcimimetic therapy was persistent serum levels of iPTH >1000 pg/mL, which were refractory to IV vitamin D therapy. Initial and 1-year results of adjusted serum Ca+2, phosphate, CaXP product, iPTH, anemia parameters, median weekly EPO dose, LVMI and parathyroid volume were determined.

RESULTS: After one year of treatment Hb levels (10.4±1.2 and 11.2±1.7 g/dl, p=0.048) increased significantly compared to baseline levels. After the treatment weekly EPO dose (5800±3041 and 4416.6±3775.3 IU /week, p=0.304) decreased but this was not statistically significant. There were no differences between pre and post treatment levels of serum Ca+2 (9.3±0.6 vs. 9.1±0.8 mg/dl, p=0.853), phosphate (6.7±1.5 vs. 6.5±2.0 mg/dl, p=0.447), CaXP product (62.7±15.6 vs. 59.9±18.9, p=0.587), iPTH (1505.6±444.4 vs. 1237.1±581.3 pg/ml, p=0.273), TS (%29.6±14.8 vs. 37.1±17.7 p=0.104), and ferritin (712.0±320.9 vs. 844.9±441.1 ng/ml p= 0.153). The dose of cinacalcet increased from 32.4±12.0 to 60.0±24.4 mg/day (p=0.01). After the treatment we did not find a difference in LVMI and parathyroid volume.

CONCLUSION: The management of sHPT with cinacalcet achieved higher hemoglobin levels with lower EPO dose in vitamin D unresponsive HD patients. We suggest that cinacalcet therapy might have additional benefits to control anemia in these patients.

OP 32 FREQUENCY, RISK FACTORS, CLINICAL COURSE, AND EFFECT ON MORTALITY OF ACUTE KIDNEY INJURY IN NEWBORNS IN A TERTIARY NEONATAL INTENSIVE CARE UNIT

GAZİ ARSLAN¹, DERYA ÖZMEN¹, ALİ HAYDAR SEVER¹, MELTEM KOYUNCU ARSLAN¹, HÜLYA ELLİDOKUZ², ALPER SOYLU¹

Dokuz Eylül University Medical Faculty, ¹Department of Pediatrics and ²Department of Biostatistics, Izmir, Turkey

BACKGROUND: Improved perinatal care increased not only the survival rate but also the frequency of acute kidney injury (AKI) in newborns. We aimed to determine the frequency, etiology, clinical course and mortality of AKI in a third level neonatal intensive care unit (NICU).

METHODS: Medical records of all patients admitted to a NICU in Western Turkey during 2007–2011 were evaluated and those having AKI within 0-30 days of life were determined. Birth weight, gestational age, mode of delivery, gender, maternal morbidity, hospitalization period, accompanying morbidities and mortality of all patients, and the primary disease causing AKI, highest serum creatinine and prognosis of patients with AKI were recorded.

RESULTS: There were 677 patients (M/F = 392/285) and 94 (13.9%) had AKI of which 80% developed during 0-7 days of life mostly due to birth asphyxia, hypovolemia, cardiac disease, sepsis and urinary system anomalies. AKI incidence and total mortality rate were higher in patients with birth weight ⩽1000 g and with gestational age <28 week. However, mortality in patients with AKI was increased independent of birth weight (42.1% in ⩽1000 g vs 32.1% in >1000 g; p=0.324) and gestational age (44.1% in <28 week vs 31.7% in ⩾28 week; p=0.227). Mortality tended to increase in the presence of AKI independent of the underlying cause, but this was significant only for sepsis (33.3% vs 5.9%, p<0,001; OR 7.9) and cardiac diseases (50.0 %vs 15.0%, p=0.001; OR 5.6). Hospitalization period was increased if AKI was present (39.1 vs 20.5 days, p<0,001). Serum creatinine in deceased patients with AKI was higher than those who survived (2.0 vs 1.6 mg/dL, p<0.05). Chronic kidney disease developed in 6 (10%) patients of whom 3 had urinary tract anomalies and 3 had birth asphyxia.

CONCLUSION: AKI incidence in NICU was 14%, and 80% of AKI developed during the first week of life. AKI is associated with low birth weight, prematurity, birth asphyxia, sepsis, hypovolemia, cardiac diseases and urinary tract anomalies. Mortality in patients with AKI is increased independent of birth weight, gestational age and underlying etiology.

OP 33 ARE MIDDLE AND LARGE MOLECULES RESPONSIBLE FOR CARDIOVASCULAR INVOLVEMENT IN CHILDREN ON CHRONIC HEMODIALYSIS?

KADRIYE OZDEMIR, SEVGI MIR, BETUL SOZERI, NIDA DINCEL, SUKRIYE APAYDIN

Ege University School of Medicine, Department of Pediatric Nephrology, Izmir, Turkey

BACKGROUND: Cardiovascular diseases (CVD) are important cause of mortality in pediatric hemodialysis (HD) cases. Primary aim was to investigate CV system involvement in patients with HD. Secondary aim was to evaluate relationship between clearance of middle-large molecules and CVD.

METHODS: Ten patients (6 female; 4 male, mean age was 11.8 years) and 10 healthy controls were included. Serum were obtained from 10 HD patients before (HD0) and after HD (120 min). Serum concentrations of small molecules such as urea ,creatinine ,sodium, potassium, phosphorus, uric acid, glucose ;middle molecules such as parathormone (PTH), vitamin B12 and β2 microglobulin and large ones such as serum amyloid A (SAA) and homocysteine were measured and calculated clearance level (HD0-HD2/HD0). Arterial stiffness was assessed by pulse wave velocity (PWV) and augmentation index (AIx). Carotid intima-media thickness (cIMT) and the left ventricular mass index (LVMi) were also determined.

RESULTS: Patients with HD presented a higher mean PWV and AIx than controls (5.9±0.9 vs. 5.12±0.67 m/s, P =0.04 and 14.3±2.1 vs. 7.36±3.59 %, P = 0.03, respectively). The patients had greater values of cIMT and LVMi than controls (0.51±0.11 vs. 0.35±0.12 mm, P=0.04 and 32.4±10.8 vs 27.8±1.5, P=0.02, respectively). Four patients (4/10, 40%) had highest cardiovascular parameters (PWV, AugI, cIMT, and LVMI). In 4 cases with cardiac involvement B2 microglobulin and homocysteine clearance decreased (p<0.05). The clearance of small moleculs were found same all patients (p>0.05).

CONCLUSION: Middle and large molecules can not be completely cleared with conventional dialysis thus lead to increased parameters of cardiovascular involvement. It was thought, online hemodiafiltration is a better choice to decrease cardiovascular mortality of these patients.

OP 34 IMPORTANCE OF GENETIC DIAGNOSIS IN EARLY DIAGNOSIS OF ALPORT SYNDROME

KADRİYE ÖZDEMİR¹, NİDA DİNÇEL¹, BETÜL SÖZERݹ, AFİG BERDELݲ, SEVGİ MİR¹

Ege University School of Medicine, ¹Department of Pediatric Nephrology and ²Department of Molecular Genetics, Izmir, Turkey

BACKGROUND: Alport Syndrome (AS) is an inherited disorder, caused by mutations in COL4A3 and COL4A4 or COL4A5.The aim of this study was to evaluate the importance of genetic analysis in the diagnosis of AS.

METHODS: We analyzed molecular diagnosis and renal biopsy of 26 patients. Diagnosis was considered with genetic testing, clinical findings and/or electron microscopic (EM) evaluation. Genetic testing was performed in all cases; EM was performed only in 15 patients.

RESULTS: The mutational distribution of 5 cases with nephrotic range proteinuria was homozygous mutation of COL4A3 in 3 and compound heterozygous COL4A3 and COL4A4 mutation in 2 cases. There were 2 cases with hearing loss; both of these 2 had also mothers with hearing loss. There was no ocular pathology in any of the patients. Six of the probands′ parents had hematuria. Family history of chronic renal failure was found in 7. Six cases had ESRD, 1 in stage 2 and 2 were in stage 3. We identified mutations in whole, mutation rate of (17/26) 65.5 % in COL4A3 gene, (3/26) 11.5% in COL4A4 and (6/26) 23% in both COL4A3 and COL4A4 gene. LM showed non-specific changes (foam cells in 2, tubular microcalcifications in 4 and vacuolization in 3) whereas all IF exams were negative. Lamellation, thickening and thinning of GBM were observed in 13 EM exams. Diffuse thinning with segmental thickening of GBM and splitting of the lamina densa occurred in 2 patients.

CONCLUSION: We found mutations in all patients yielding a 100% of mutation rate. EM revealed pathological findings in all specimens of fifteen cases. We recommend screening for COL4A4 and 3 mutations in persistent microscopic hematuria. We also highlight early diagnosis and treatment options for young patients with this disorder.

OP 35 CHILDREN WITH STABLE PRE-TRANSPLANT SYSTOLIC CARDIAC FUNCTION ARE MORE LIKELY TO SHOW IMPROVEMENT IN SHORT-TERM SYSTOLIC CARDIAC FUNCTION AFTER KIDNEY TRANSPLANTATION

CENGİZHAN ELMAS¹, CANER ALPARSLAN¹, ONDER YAVASCAN¹, SAİT MURAT DOĞAN², SELÇUK KILINDz, CEZMİ KARACA², NEJAT AKSU¹

İzmir Tepecik Education and Research Hospital, ¹Department of Pediatrics and ²Transplantation Unit , Izmir, Turkey

BACKGROUND: Cardiovascular disease is the most important risk factor for morbidity and mortality in chronic kidney disease (CKD), even after kidney transplantation. Left ventricular hypertrophy (LVH) is one of the most significant risk factors for the development of cardiovascular morbidity. We wanted to assess the systolic cardiac parameters and related risk factors in children within 6 months after kidney transplantation.

METHODS: Twenty-four children who underwent kidney transplantation between 2005 and 2012 in our unit were evaluated retrospectively. Pre-and post-transplant parameters regarding echocardiographic features, hypertension, anemia, antihypertensive drugs, hyperlipidemia, and cumulative steroid dose were recorded.

RESULTS: After transplantation, ejection fraction (63.35±5.38 vs 66.95±5.52; p< 0.005), increased, left ventricular mass index (32.63±17.21 vs 30.9±15.42; p<0.005) decreased whereas fractional shortening (52.16±15.32 vs 50.44±13.04; p=0.43) did not change. Pre-and post-transplant systolic and diastolic blood pressure values were not statistically different (p>0.05). In patients, although insignificant, the number of anti-hypertensives use decreased after transplantation (p>0.05). Five patients (%20.83) had biopsy-proven acute allograft rejection, managed by pulse-steroid therapy or plasmapheresis.

CONCLUSION: Patients with stable cardiac function in pre-transplant period showed further improvement within 6 months after transplantation. Therefore, strictly controlled dialysis program in children before transplantation seems to play an important role in achieving better cardiac systolic function after kidney transplantation.

OP 36 THE RELATIONSHIP BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO AND VASCULAR CALCIFICATION IN END-STAGE RENAL DISEASE PATIENTS

KULTİGİN TURKMEN¹, FATİH OZCİCEK¹, ADALET OZCİCEK¹, EMİN MURAT AKBAS¹, FATİH MEHMET ERDUR², HALİL ZEKİ TONBUL²

Erzincan University Mengucek Gazi Training and Research Hospital, ¹Division of Nephrology, Erzincan, Turkey Necmettin Erbakan University Meram School of Medicine, ²Department of Nephrology, Konya, Turkey

BACKGROUND: Chronic inflammation correlates with coronary (CAC) and thoracic peri-aortic calcification (TAC) in end-stage renal disease (ESRD) patients. Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and non-cardiac disorders. Data regarding NLR and its association with TAC and CAC are lacking. We aimed to determine the relationship between NLR and vascular calcification in ESRD patients.

METHODS: This was a cross-sectional study involving 56 ESRD patients receiving PD or HD for ⩾6 months. TAC and CAC scores were measured by using an electrocardiogram-gated 64- Multidetector Computed Tomography (MDCT). NLR was calculated as the ratio of the neutrophils and lymphocytes.

RESULTS: The baseline characteristics of 56 ESRD patients are shown in Table 1. The etiology of ESRD patients was diabetic nephropathy (n=18), chronic glomerulonephritis (n=10), hypertensive nephropathy (n=20), polycystic kidney disease (n=2), nephrolithiasis (n=1) and unknown (n=5). There were no differences with respect to the following variables between PD and HD patients: age, gender, BMI, dialysis vintage, DBP, serum cholesterol, triglyceride, PTH, hs-CRP, uric acid, TACS and CACS. There were statistically significant correlations between NLR, TACS and CACS in ESRD patients (r=0.43, p=0.001 and r= 0.30, p=0.02, respectively). The stepwise linear regression analysis revealed that age, as well as NLR were independent predictors of TACS. However, increased age was the only independent predictor of CACS according to linear regression analysis.

Table 1. Results.

Parameters	ESRD patients (n:56)	PD patients (n:29)	HD patients (n:27)	p
Age (years)	49.9±14.2	51.3±16.2	48.5±11.9	0.45
Female/Male	22/34	12/17	10/17	0.74
BMI (kg/m2)	26.2±5.4	26.5±5.5	26.0±5.3	0.62
SBP (mmHg)	138±29	130±28	146±28	0.05
DBP (mmHg)	86±17	83±18	89±14	0.15
Hemoglobin (mg/dl)	11.5±1.7	11.0±1.9	12.0±1.1	0.01
Albumin (g/dl)	3.8±0.5	3.5±0.4	4.2±0.3	<0.001
Total Cholesterol (mg/dL)	190±50	184±51	198±49	0.32
Triglyceride (mg/dL)	172±96	163±103	181±88	0.28
Uric Acid (mg/dl)	4.9±1.2	5.0±1.2	4.8±1.3	0.33
hs-CRP (mg/dL)	12.7±13.9	14.3±17.2	11.0±9.3	0.36
Calcium (mg/dL)	9.3±0.9	8.9±0.9	9.6±0.8	0.006
Phosphorus (mg/dL)	4.6±1.2	4.2±0.9	5.0±1.4	0.008
Parathormone (pg/mL)	339±334	297±187	384±440	0.86
NLR	2.7±1.2	3.0±1.1	2.3±1.1	0.006
TACS	172±480	192±451	151±518	0.45
CACS	150±271	194±330	102±183	0.38

CONCLUSION: NLR can predict vascular calcification in ESRD patients.

OP 37 THE RELATIONSHIP BETWEEN ATHEROGENIC INDEX OF PLASMA AND EPICARDIAL ADIPOSE TISSUE IN END-STAGE RENAL DISEASE PATIENTS

KULTİGİN TURKMEN¹, ADALET OZCİCEK², FATİH OZCİCEK², EMİN MURAT AKBAS³, HALİL ZEKİ TONBUL⁴

Erzincan University Mengucek Gazi Training and Research Hospital, Division of Nephrology¹, Division of Internal Medicine², Division of Endocrinology³, Erzincan, Turkey Necmettin Erbakan University Meram School of Medicine⁴, Konya, Turkey

BACKGROUND: Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in end-stage renal disease (ESRD) patients. One of the established risk factors in this population is dyslipidemia. We aimed to determine the relationship between atherogenic index of plasma (AIP) and EAT in ESRD patients.

METHODS: This was a cross-sectional study involving 76 ESRD patients receiving PD or HD for ⩾6 months and 27 healthy infjects. EAT was measured by using an electrocardiogram-gated 64-multidetector computed tomography (MDCT). Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum triglyceride to HDL-cholesterol.

RESULTS: The baseline characteristics of ESRD patients and healthy infjects are shown in Table 1. The etiology of ESRD patients was diabetic nephropathy (n=16), chronic glomerulonephritis (n=10), hypertensive nephropathy (n=23), polycystic kidney disease (n=7), nephrolithiasis (n=5) and unknown (n=15). There were no differences with respect to the following variables between ESRD patients and healthy infjects: age, sex;, BMI, predialysis levels of DBP, serum levels of albumin, HDL-cholesterol and hemoglobin. However, ESRD patients had higher serum levels of triglyceride, hs-CRP and AIP when compared to healthy infjects (Table 1). There was a statistically significant relationship between EAT, BMI and AIP in ESRD patients (r=0.42, p<0.001 and r=0.25, p=0.028, respectively).

Table 1. Results.

Parameters	Healthy subjects (n=27) (mean±SD)	ESRD patients (n=76) (mean±SD)	p value
Age (years)	54±12	49.5±14	0.10
Male/female	14/13	46/30	0.43
BMI (kg/m2)	26.2±5.5	26.7±5.3	0.65
SBP (mmHg)	131±8	138±28	0.05
DBP (mmHg)	82±7	86±16	0.07
Hemoglobin (g/dL)	12.5±2.1	11.5±1.6	0.06
Albumin (g/dL)	3.7±0.52	3.8±0.49	0.39
Calcium (mg/dL)	—	9.1±0.9	—
Phosphorus (mg/dL)	—	4.6±1.3	—
Parathormone (pg/mL)	—	386±403	—
HDL cholesterol (mg/dL)	37±12	36±13	0.84
Triglyceride (mg/dL)	122±86	167±91	0.03
hs-CRP (mg/dL)	9.8±2.7	14.5±16	0.015
AIP	0.40±0.24	0.62±0.26	<0.001
Epicardial adipose tissue (cm3)	121.5±37.5	160±76	0.04

CONCLUSION: We found a relationship between EAT as defined by MDCT and AIP in ESRD patients. Further clinical and experimental studies are needed.

OP 38 HEPCIDIN IS A SIGNIFICANT PREDICTOR OF CAROTID INTIMA MEDIA THICKNESS IN PATIENTS ON MAINTENANCE HEMODIALYSIS

ALAADDİN KALİ, ÖZLEM YAYAR, BULENT ERDOGAN, OZGUR MERHAMETSİZ, AYHAN HASPULAT, ZAFER ERCAN, MEHMET BUYUKBAKKAL, BARİS ESER, S.IBRAHİM AKDAG, M.DENİZ AYLİ

Diskapi Yildirim Beyazit Training and Research Hospital, Nephrology Department, Ankara, Turkey

BACKGROUND: Dysregulated iron metabolism has been linked to anemia of chronic disease and to cardiovascular disease (CVD). CVD is one of the major causes of mortality and morbidity in dialysis patients. A recently discovered iron regulatory peptide, hepcidin, has been suspected to be one of the culprits for endothelial dysfunction via iron sequestration. In order to clarify the factors affecting atherosclerosis we evaluated the relationship between iron metabolism, carotid intima media thickness (CIMT) and risk factors for CVD in maintenance hemodialysis (MHD) patients.

METHODS: A total of 82 MHD patients were recruited and the levels of iron parameters, hepcidin, CVD risk factors and CIMT were evaluated. Carotid IMT was evaluated by using high-resolution B-mode ultrasonography. The level of serum hepcidin -25 was evaluated by using human hepcidin-25 ELISA kit.

RESULTS: CIMT was significantly correlated with age (P<0.01, R=0.33), alkaline phosphatase (P<0.01, R= 0.30) and hepcidin (P<0.01, R=0.46) but not with other iron parameters and CVD risk factors. According to multiple regression analysis age (β=0.34), alkaline phosphatase (β=0.30) and hepcidin (0.36) emerged as the significant predictors of CIMT in MHD patients.

CONCLUSION: Serum level of hepcidin is associated with CIMT in MHD patients. Iron metabolism and accumulation may be associated with the development and/or progression of atherosclerosis.

OP 39 THE PROTECTIVE EFFECT OF CURCUMIN IN RATS WITH CISPLATIN INDUCED NEPHROTOXICITY

OZGUR ARSLAN¹, AYHAN DOGUKAN², ALİ GUREL¹, RAMAZAN ULU¹, MEHMET TUZCU², KAZIM SAHIN³

Firat University School of Medicine, ¹Department of Nephrology, ² Department of Biology and ³Department of Animal Nutrition, Elaziǧ, Turkey

BACKGROUND: The major side effect that restricts cisplatin usage in solid tumor therapy is nephrotoxicity. The role of oxidative stress in cisplatin nephrotoxicity is evident. The kidney uptake of chemicals such as cisplatin into occurs via organic cation transporters (OCT) and excretion to the urine of these molecules is via multidrug resistance associated proteins (MRP). In this study, we investigated the preventive effect of curcumin on OCT and MRP in rats with cisplatin-induced nephrotoxicity.

METHODS: We used 28 female Wistar Albino rats, age 6 weeks. We separated the rats into groups as control, curcumin (100 mg/kg/day), cisplatin (7 mg/kg-single dose, ip), and curcumin+cisplatin. We determined serum urea, creatinine and malondialdehyde (MDA) levels. We analyzed Oct and MRP expressions with western blot method. Renal histopathological sections were evaluated semi-quantitatively.

RESULTS: Serum urea, creatinine and MDA levels were lower in curcumin+cisplatin group than cisplatin group. However, OCT1 and OCT2 expression were higher in curcumin+cisplatin group (p<0.001). MRP2 and MRP4 expressions in this group were significantly low (Figure 1). The histopathological changes due to cisplatin were significantly less in curcumin+cisplatin group.

Figure 1.

Effects of curcumin on cisplatin induced expression of organic cation transporters (OCT) and multidrug resistance associated proteins (MRP).

CONCLUSION: Cisplatin causes oxidative stress and renal injury. Curcumin prevents cisplatin-induced nephrotoxicity by lowering the oxidative stress and through its effects on OCT and MRP expressions.

OP 40 EFFECTS OF RESVERATROL ON OXIDATIVE STRESS AND ON ORGANIC ANION AND CATION TRANSPORTERS IN KIDNEYS OF STREPTOZOTOCIN-INDUCED DIABETIC RATS

OGUZHAN OZDEMIR¹, ALİ GUREL², MEHMET TUZCU¹, AYHAN DOGUKAN², BİLGE AYGEN², RAMAZAN ULU², KAZİM SAHIN³

Firat University School of Medicine, ¹Department of Biology, ²Department of Nephrology and ³Department of Animal Nutrition, Elaziǧ, Turkey

BACKGROUND: Polyphenols available in herbal drugs are considered as major nutrients responsible for improving general health and certain pathological conditions. We investigated the effects of resveratrol (RES), a polyphenol with antioxidant properties, on malondialdehyde (MDA), organic anion (OAT) and cation transporters (OCT), and kidney histology of streptozotocin (STZ)-induced diabetic rats. OCT and OAT are necessary for the renal clearance of a broad range of exogenous infstrates, including drugs.

METHODS: Male Wistar rats were divided into four groups. (i) The group which received a standard diet was assigned as Control group (C); (ii) Resveratrol (RES 20 mg/kg/day i.p.) treated group as (RES); (iii) Streptozotocin (single dose, 55 mg/kg i.p) treated group as (STZ); (iv) After the injection of STZ, RES 20 mg/kg i.p) treated group as (STZ/RES). The research was completed in 8 weeks.

RESULTS: At the end of the study MDA levels were significantly increased in the diabetic group and the treatment with RES prevented this increase in the diabetic/RES group (p<0.001). Urea and creatinine levels were also increased in the diabetic group and decreased significantly after the administration of RES (p<0.001). Serum OAT and OCT levels were decreased in diabetic group and tended to increase after RES therapy. Histopathologic findings such as diffuse mesangial sclerosis were reversed after RES.

CONCLUSION: The results of our study suggest that RES has protective effect against kidney damage induced by oxidative stress in diabetes. RES also increases OAT, OCT levels and decreases urea and creatinine levels. All these effects of RES constitute its nephroprotective property in diabetic state.

OP 41 PROTECTIVE EFFECT OF PALOSURAN ON GENTAMICIN-INDUCED ACUTE RENAL FAILURE IN RATS

HATİCE ÇALIŞKAN BURGUCU¹, DENİZ ÇOŞKUNSEVE², MURAT OLUKMAN², SAİT ŞEN³, ESER SÖZMEN⁴, SENA TUNA¹, SONER DUMAN¹

Ege University Faculty of Medicine, ¹Department of Internal Medicine, ²Department of Pharmacology, ³Department of Pathology and ⁴Department of Biochemistry, Izmir, Turkey

BACKGROUND: Aminoglycosides are still widely used to treat serious gram-negative infections. The main side effect is nephrotoxicity, manifested by non-oliguric renal failure. It mainly affects proximal convoluted tubules causing tubulointerstitial inflammation. Urotensin II (U-II) is a potent vasoconstrictor. Palosuran (PS) is a potent antagonist of the human UT receptor. The purpose of this study is to investigate the effect of palosuran treatment on experimental gentamicin (GM) induced acute renal failure in rats.

METHODS: 24 Wistar-albino rats were randomized into three groups. Control group was given saline intramuscular (im) for eight days. GM group was given GM 100 mg/kg/day im for eight days. GM +PS group was given GM 100 mg/kg/day im and PS 300 mg/kg/day po twice a day for eight days. Then rats were sacrificed. Histological assessment was carried out by the same pathologist blinded to the treatment protocol. Renal tissues were semi-quantitatively scored and total histological score was calculated according to recent literature. Nonparametric tests (Kruskal Wallis, Man Whitney U) were used in statistical evaluation. P<0.05 was considered as significant.

RESULTS: Results are summarized as mean ± SEM in the Table 1.

Table 1. Results.

	TD	TN	TR	TIN	MC	THS
Control	0±0	0±0	0.2±0.4	0.5±0.4	0.1±0	0.6±0
GM	2±0.14a	2.5±0.3a	1.7±0.3a	1.1±0.2a	0.5±0.3	6.4±0.6a
GM+PS	1.8±0.3a	1.3±0.4ab	1.8±0.3a	0.4±0.3	0.4±0.3	4.6±0.7ab

p<0.05, a = group v control; b = group v GM. TD=Tubular degeneration, TN=Tubular necrosis, TR=Tubular regeneration, TIN=Tubulointerstitial nephritis, MC=Microcalcification, THS=Total histological score.

CONCLUSION: Palosuran was found effective in reducing tubular necrosis and total histological score (p<0,05). Tubular injury was reduced and regeneration was increased, but both ratios were statistically insignificant (p>0.05). UT II may play a role in GM-induced acute renal failure. Palosuran as an UT II receptor antagonist might be effective in reversing this process.

OP 42 ^*THE EFFECT OF OCTREOTIDE IN EXPERIMENTAL NEPHROTIC SYNDROME

ASUMAN ÇAMYAR¹, KANİ MASAROĞULLARI ², ÖZGE TİMUR³, SENA TUNA¹, ENDER HÜR⁴, ESER SÖZMEN⁵, SAİT ŞEN⁶, SONER DUMAN¹

Ege University Faculty of Medicine, ¹Department of Internal Medicine, Izmir, Turkey; Near East University Faculty of Medicine, ²Department of Nephrology, Northern Cyprus; Erzurum Education and Research Hospital, ³Division of Internal Medicine, Erzurum, Turkey; Bülent Ecevit University Faculty of Medicine, ⁴Department of Nephrology, Zonguldak, Turkey; Ege University Faculty of Medicine, ⁵Department of Biochemistry and ⁶Department of Pathology, Izmir, Turkey

BACKGROUND: Somatostatins are naturally occurring peptides, which are responsible for regulation of various physiologic functions. Studies have shown that somatostatins have immune and inflammatory modulatory properties. The aim of this study is to investigate the effects of a somatostatin analogue, octreotide, on clinical and laboratory findings in a rat model of adriamycin induced nephrotic syndrome (NS)

METHODS: 21 Wistar albino male rats were randomized into 3 groups. Control group had received 2 ml of saline intravenously (i.v), NS Group had received 5 mg/kg ADR (Doxorubicin) iv at day zero. OCT Group had received 5 mg/kg ADR iv and 10mcg/kg octreotide (Sandostatin LAR) intramuscularly at day zero. 24 h urine samples were collected at 0, 14, and 21th days. Then all groups were scarified. Serum samples and kidney tissues were used in laboratory analysis. Total protein (prt), triglyceride (TG), cholesterol (Chol) in serum and 24-hour proteinuria were measured. The same pathologist assessed renal tissues blindly. Glomerular sclerosis, tubular fibrosis and interstitial inflammation were semi-quantitatively scored. Nonparametric tests (Kruskal Wallis, Man Whitney U) were used in statistical evaluation. P <0.05 was considered as significant.

RESULTS: Results are summarized in Table 1. NS model has established at 3 weeks after ADR administration. There were positive effects on serum protein, glomerular sclerosis and proteinuria by OCT treatment (p<0.05) but there has been no benefit observed on serum TG and serum Chol.

Table 1. The effects of octreotide on study parameters.

Parameters	Control group	NS group	NS+OCT
Proteinuria (mg/24 h)	30±4	278±68a	118±26ab
Creatinine (mg/dL)	0.60±0.06	0.40±0.07a	0.48±0.04
Serum Total Protein (g/dL)	5.8±0.02	3.7±0.6a	5.9±0.05b
Serum TG (mg/dL)	91±5	138±13a	135±24
Serum Total Chol (mg/dL)	188±5	248±19	222±28
Glomerular sclerosis	0±0	1.08±0.28a	0±0b
Tubular fibrosis	0.55±0.3	0.66±0.3	1.07±0.37
Interstitial inflammation	0.05±0.26	0.33±0.22	0.21±0.15

p< 0.05, a= group vs control, b= group vs NS (nephrotic syndrome).

CONCLUSION: OCT might be effective in reduction of proteinuria and protection of renal tissues from injury in experimental NS model. OCT seems to be a promising new agent in the treatment of NS.

*THIRD BEST ORAL PRESENTATION AWARD

P 43 ^*HOW DOES COLISTIN-INDUCED NEPHROPATHY DEVELOP AND CAN IT BE TREATED?

GÜLSÜM ÖZKAN¹, ŞÜKRÜ ULUSOY¹, ASIM OREM², MEHMET ALKANAT³, SEVDEGÜL MUNGAN⁴, ESİN YULUĞ⁵, FULYA BALABAN YÜCESAN²

Karadeniz Technical University School of Medicine, ¹Department of Nephrology, ²Department of Biochemistry, ³Department of Physiology, ⁴Department of Pathology and ⁵Department of Histology and Embryology, Trabzon, Turkey

BACKGROUND: Colistin is an old antibiotic used in the treatment of gram-negative infections. It was once suspended because of its nephrotoxic effect, but has since been reintroduced due to multidrug-resistant bacterial infections. The pathogenesis of colistin-associated nephropathy has not been clarified, and no currently effective therapeutic agent has been found. The aim of this study was to investigate the role of caspase-associated apoptosis, caspase 1, calpain 1, iNOS and eNOS expression in the pathogenesis of colistin-associated nephrotoxicity

METHODS: Twenty-four rats were divided into three groups; control, colistin and colistin+ Grape Seed Proanthocyanidin Extract (GSPE). Colistin-associated nephropathy was induced by the administration of 300,000 IU/kg/day colistin intraperitoneally for seven days. The experiment was discontinued on the seventh day. Blood was collected for BUN and creatinine measurements. Histopathological examination of kidney tissue, and caspase 1 and 3, iNOS, eNOS, TUNEL and calpain 1 staining were also performed.

RESULTS: A significant increase in BUN, creatinine, renal histopathological score, TUNEL, caspase 1, 3, calpain 1, iNOS and eNOS was observed in the colistin group compared to the control group. A significant decrease in BUN, creatinine, renal histopathological score, TUNEL, caspase 1, 3, calpain 1, iNOS and eNOS was observed in the colistin+GSPE group compared to the colistin group Table 1.

Table 1. Comparisons of study parameters between groups.

	Control (G1)	Colistin (G2)	Colistin+GSPE (G3)	P1 (G1 vs G2)	P2 (G1 vs G3)	P3 (G2 vs G3)
BUN	14.40±1.80	25.78±7.90	15.48±2.84	<0.05	NS	<0.05
Creatinine	0.36±0.02	0.56±0.15	0.40±0.04	<0.05	NS	<0.05
TOS	0.31±0.45	0.41±0.10	0.36±0.42	<0.05	<0.05	NS
TAS	24.23±4.57	21.21±3.41	23.32±3.39	NS	NS	NS
OSI	1.30±0.19	1.98±0.43	1.56±0.16	<0.05	<0.05	<0.05
MDA	78.48±15.11	95.16±13.82	70.84±13.15	<0.05	NS	<0.05
HE	0.00±0.00	1.85±0.37	0.28±0.48	<0.001	NS	<0.001
TUNEL	8.89±2.66	32.58±4.38	17.67±2.29	<0.001	<0.001	<0.001
eNOS	9.75±12.32	26.85±3.93	11.14±3.38	<0.05	NS	<0.001
iNOS	6.00±9.82	22.28±7.49	10.85±2.34	<0.05	NS	<0.05
Caspase 1	6.12±2.74	48.14±13.13	28.42±12.60	<0.001	<0.05	<0.05
Caspase 3	5.87±2.47	29.42±6.16	15.71±4.64	<0.001	<0.05	<0.05
Calpain 1	25.37±6.92	54.85±10.66	38.00±6.60	<0.001	<0.05	<0.05

Data are given as mean ± SD and p < 0.05 was regarded as significant. Abbreviations: G1: Group 1; G2: Group 2; G3: Group 3: G4; Group 4; GSPE: Grape Seed Proanthocyanidin Extract; Cr: creatinine (mg/dL); TOS: Total oxidant system: μmol H2O2 Equiv./g wet tissue TAS: Total antioxidant system: μmol T.

CONCLUSION: Our study showed, for the first time in the literature, that caspase mediated apoptosis, iNOS, caspase 1 and calpain 1 are involved in the pathogenesis of colistin-associated nephropathy. GSPE had a renoprotective effect via these lowered mediators.

*FIRST BEST ORAL PRESENTATION AWARD

OP 44 UNEXPECTED RELATIONSHIP BETWEEN CAROTID INTIMA-MEDIA THICKNESS AND MEAN PLATELET VOLUME, SERUM MAGNESIUM, AND 25-OH VITAMIN D3 LEVEL

REFİKA KARAER¹, SAİME PAYDA޹, ESİN DAMLA ZİYANOĞLU KARAÇOR², KAİRGELDY AİKİMBAEV³, MUSTAFA BALAL¹, NURTEN DİKMEN²

Çukurova University Medical Faculty, ¹Department of Nephrology, ²Department of Biochemistry and ³Department of Radiology, Adana, Turkey

BACKGROUND: Cardiovascular diseases are the most important reasons of mortality and morbidity in chronic renal disease. The purpose of this study is to determine the possible factors that effect on carotid intima-media thickness (CIMT), which is the indicator of cardiovascular diseases, in chronic renal patients and healthy individuals.

METHODS: Twenty-seven healthy individuals [(control group (CG)] and 53 patients with chronic kidney disease (GFR<60 ml/min) [study group (SG)] were included in the study. All participants' age, gender, body mass index (BMI), primary renal disease, blood pressure (BP), biochemical and hematological parameters were recorded. The same radiologist measured right and left CIMT by using color Doppler ultrasonography.

RESULT: There was no difference in age or gender in either group. CIMT was higher in SG than in CG (p = 0.002). The parameters that correlated with CIMT in both groups are shown in Table 1.

Table 1. Parameters correlated with carotid intima-media thickness in study group and control group.

Parameter	Study group (r)	Study group (p)	Parameters	Control group (r)	Control group (p)
Systolic BP	0.323	0.018	Systolic BP	0.442	0.021
Platelet	0.278	0.044	BMI	0.571	0.002
Magnesium	0.359	0.008	Albumin	−0.464	0.015
ALP	0.329	0.016	Glucose	0.462	0.015
Parathormone	0.281	0.042	ALP	0.464	0.015
Vitamin-D3	−0.282	0.042	MPV	-0.638	0.000
HDL	−0.330	0.016

In contrast to some studies, lower mean platelet volume (MPV) in CG and higher magnesium level in SG were found to be correlated with CIMT. It could be speculated that magnesium can affect CIMT through signaling associated with secondary hyperparathyroidism. 25-OH vitamin D3 deficiency was also correlated with CIMT as previously reported in some studies in chronic renal disease patients. An interesting point of our study is determination of correlation between MPV, magnesium and 25-OH vitamin D3 with CIMT. CONCLUSION: As an indicator of cardiovascular disease CIMT is associated with serum magnesium levels, MPV and 25-OH vitamin D3 in patients with chronic kidney disease.

OP 45 HLA INCOMPATIBILITY: WHICH LOCUS HAS DOMINANCE ON GRAFT FUNCTION?

PINAR ATA, SEVİNC IBİSOGLU, ALİ MURAT GOKCE, LEYLA OZEL, BULENT UYANIK, MELİH KARA, M. IZZET TİTİZ

Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey

BACKGROUND: Alloantigen response is determined by how foreign antigens on HLA are presented. Graft survival is intimately related with HLA compatibility between the donor and the recipient depending on how antigenic the mismatched HLA molecules are. Here we had investigated our patients' mismatched HLA loci retrospectively to identify factors influencing their sensitization status.

METHODS: One hundred eleven renal transplant patients who had live and cadaveric donors admitted between January 2009 through July 2012 were retrospectively analyzed. HLA A, B and DR incompatible antigens, post-transplant first month, 3rd, 6th months, first year, 15 months and last visit creatinine levels were determined. HLA typing was performed with sequence-specific primer (SSP) technique and analyzed with HLA Fusion program.

RESULTS: Sixty-eight male and 43 female patients had a mean age of 43+/-12 years and mean follow-up period of 17+/−15 months. Twenty-seven patients had cadaveric, 84 had live donors. Patients who had HLA-A incompatibility had higher serum creatinine levels than those with other loci incompatibilities (p=0.04). Table 1

Table 1. Patient data according to donor type.

	Pts with live donor n=84	Pts with cadaveric donor (n=27)	P value
Gender F/M	33/51	10/17	0.081
Mean age	34±16	46±21	0.078
HLA A mismatch	66/84	23/27	0.318
HLA B mismatch	60/84	24/27	0.214
HLA DR mismatch	17/84	21/27	0.021*
Three HLA loci mismatch	48/84	20/27	0.043*
Pretransplant high PRA	9/84	6/27	0.062
Posttransplant 3RD month mean PRA	12.4±2.8	8.4±3.2	0.368
Single Ag PRA DSA number	1.2±0.8	3.6±0.5	0.021*
Post-op 1st month mean creatinine	3.56±1.65	4.9±2.07	0.046*
Post-op 6th month mean creatinine	1.86±1.45	2.68±1.8	0.093
Post-op 1st year mean creatinine	2.82±0.8	1.89±0.6	0.345

CONCLUSION: Our study revealed that patients with HLA-A incompatibility with their cadaveric or live donors had higher first and third month creatinine levels and had delayed graft function. Patients with cadaveric donors had more donor specific antibodies that may be due to long waiting time and failed previous graft histories.

OP 46 COMPARISON OF CARDIOVASCULAR AND RENAL FUNCTION IN RENAL TRANSPLANT PATIENTS WHO CONVERTED FROM CALCINEURIN INHIBITORS TO EVEROLIMUS

NADİR ALPAY¹, ABDULLAH OZKOK², YASAR CALISKAN¹, TULIN AKAGUN³, SUZAN ADIN CINAR ⁴, GUNNUR DENIZ⁴, MUZAFFER SARIYAR⁵, ALAATTIN YILDIZ¹

Istanbul University Istanbul Medical Faculty, ¹Department of Nephrology, Istanbul, Turkey; Medeniyet University Medical Faculty, ²Department of Nephrology, Istanbul, Turkey; Giresun University School of Medicine, ³Division of Nephrology, Giresun, Turkey; Istanbul University Experimental Medicine and Research Institute⁴, Istanbul, Turkey; Medicana International Hospital, ⁵Division of General Surgery, Istanbul, Turkey

BACKGROUND: Calcineurin inhibitor (CNI) therapy is known to increase cardiovascular risk and lead to nehrotoxicity characterized especially by tubulointerstitial fibrosis. Here we aimed to investigate the effects of switching from CNI to everolimus therapy on serum/urinary markers of renal fibrosis and inflammation and pulse wave velocity (PWV).

METHODS: A total of 15 stable renal transplant recipients were enrolled. Fifteen patients were switched from CNI to everolimus. Baseline and 3rd-month follow-up measurements of serum TGF-beta, ADMA, NGAL, FGF-23 and urinary TGF-beta, NGAL, MCP-1 were performed. PWV was measured with the device SphygmoCor (Weastmead, Sydney, NSW, Australia).

RESULTS: In the analysis of the switch group, serum creatinine (1.70 ± 0.22 vs 1.60 ± 0.29 mg/dL, p=0.002) , uric acid (6.21 ± 1.21 vs 5.55 ± 1.39 mg/dL, p=0.01), serum TGF-beta (8727 ± 11222 vs 1942 ± 1415 pg/mL, p=0.03) and urinary NGAL/urinary creatinine ratio (0.26 ± 0.40 vs 0.12 ± 0.07, p=0.05) were found to be significantly decreased in the 3rd month of follow-up. In contrast, serum total cholesterol levels increased (213 ± 46 vs 235 ±64 mg/dL, p=0.01). However, serum ADMA, FGF-23, NGAL, urinary MCP-1 levels and also PWV did not change significantly with conversion to everolimus.

CONCLUSION: Conversion from CNI to everolimus in renal transplant recipients resulted in significant decrease of serum TGF-beta and urinary NGAL levels, however there was no change in PWV. Switching to everolimus may have beneficial effects on graft survival due to decrease of serum TGF-beta levels.

OP 47 A RARE CAUSE OF ILEUS IN RENAL TRANSPLANT PATIENTS WITH PERITONEAL DIALYSIS HISTORY: ENCAPSULATING PERITONEAL SCLEROSIS

ALİ MURAT GÖKÇE¹, LEYLA ÖZEL¹, PINAR ATA², GÜLİZAR ŞAHİN³, MURAT GÜCÜN³, EBRU ÖZDEMİR¹, SEVİNÇ İBİŞOĞLU¹, M. İZZET TİTİZ¹

Haydarpasa Numune Research and Training Hospital, ¹General Surgery and Transplantation, ²Medical Genetics and Tissue Typing and ³Nephrology, Istanbul, Turkey

BACKGROUND: Peritoneal fibrosis is a complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosis leading to encapsulating peritoneal sclerosis (EPS). We aimed to review encapsulating peritoneal sclerosis of three renal transplant patients.

METHODS: We had evaluated three renal transplant patients admitted with ileus between 2012 -2013. Renal insufficiency etiologies, past peritoneal dialysis histories were recorded.

RESULTS: Two patients were male and one was female. Due to ultrafiltration insufficiency short-term hemodialysis was used till transplantation. Mean peritoneal dialysis period was 5-7 years. Long-term conservative management was provided to the patients because of ileus. Surgical treatment was preferred in cases that did not respond to conservative management. The parietal peritoneum was thickened and visceral peritoneum was solid, as a fibrotic capsule covering the intestines and allowing no room for safe dissection between the intestines and the peritoneum due to adhesions. Partial surgical adhesiolysis was performed for two patients who later died on the post-operative 7th day. For the third patient conservative medical therapy was continued in order not to risk surgical complications. She is still on follow-up with medical therapy. CONCLUSION: EPS occurs with the use of incompatible biological solutions, and frequent peritonitis attacks. It presents with hemorrhagic peritoneal effluent, abdominal pain and findings of intermittent intestinal obstruction. Patients should be searched carefully before renal transplantation for intermittent intestinal obstruction.

OP 48 PREDICTIVE ROLE OF URINARY PROCOLLAGEN IN DETERMINATION OF RENAL FIBROSIS IN RENAL TRANSPLANT RECIPIENTS

TOLGA YILDIRIM¹, RAHMİ YILMAZ¹, MAHMUT ALTİNDAL¹, ERCAN TURKMEN¹, AYMAN ABUDALAL¹, DİLEK ERTOY BAYDAR², MUSTAFA ARİCݹ, BULENT ALTUN¹, YUNUS ERDEM¹

Hacettepe University Medical Faculty, ¹Department of Nephrology and ²Department of Pathology, Ankara, Turkey

BACKGROUND: Urinary procollagen is associated with the extent of renal fibrosis detected by biopsies performed on patients with CKD and renal transplant protocol biopsies. The aim of this study was to determine the predictive role of urinary procollagen in determining the amount of fibrosis in renal transplant recipients with a presumed clinical diagnosis of chronic allograft injury.

METHODS: Adult renal transplant recipients that underwent graft biopsy with a presumed diagnosis of chronic allograft injury in Hacettepe University Medical Faculty in a 12-month period were included in this study. Renal fibrosis was quantified by using Banff classification (no fibrosis, grade 1<25%, grade 2 = 25% to 50% and grade 3 = >50% fibrosis). Urine samples were collected from all patients on the same day with biopsy to determine procollagen levels. Procollagen/creatinine ratio was used in analyses to eliminate the effect of urine volume. The relation between fibrosis score and urinary procollagen/creatinine ratios were investigated.

RESULTS: Seventy patients were included in the study. Biopsy specimens of 64 patients were adequate for fibrosis assessment. Mean urinary procollagen/creatinine ratios of the patients in each group according to Banff classification score were tabulated. Mean urinary procollagen/creatinine ratios were lower in patients with no fibrosis and highest in the grade 3 group. Urine procollagen/creatinine ratio was significantly correlated with the degree of fibrosis (r=0.251, p=0.04).

CONCLUSION: Urine procollagen measurements can be a reliable predictor of the degree of interstitial fibrosis in renal transplant recipients that underwent renal biopsy with a presumed diagnosis of chronic allograft injury.

OP 49 ARTERIAL STIFFNESS AND METABOLIC SYNDROME INDICES IN RENAL TRANSPLANTATION PATIENTS

ORHAN GULİYEV, MEHTAP ERKMEN UYAR, EMRE TUTAL, ZEYNEP BAL, TURAN COLAK, SİREN SEZER

Baskent University School of Medicine, Department of Nephrology, Ankara, Turkey

BACKGROUND: In end stage renal disease, metabolic cardiovascular risk factors such as hyperuricemia, obesity and diabetes mellitus have been confirmed to be positively correlated with arterial stiffness. Although renal transplantation improves survival, cardiovascular morbidity and mortality still remain a significant problem compared with nonrenal populations. The aim of this study is to evaluate the risk factors for arterial stiffness in kidney transplant recipients.

METHODS: One hundred and forty nine kidney transplant recipients were enrolled into the study. All patients were evaluated for clinical and biochemical parameters. PWv was determined from pressure tracings over carotid and femoral arteries.

RESULTS: The frequency of patients with PWv ⩾7 m/s was higher in patients with new onset diabetes (55.9%), hyperuricemia (uric acid level > 7 mg/dl) (p = 0.029, 0.05). Higher carotid-femoral PWv was significantly related with systolic (p = 0.003) and diastolic blood pressure (p = 0.002), uric acid (p = 0.0001) and glucose (p = 0.02) levels. Muscle mass, visceral fat ratio and body weight were significantly higher in patients with PWv ⩾7 m/s (p = 0.005). In patients with high PWv, sagittal abdominal diameters and waist circumferences were significantly higher than patients with PWv < 7 m/s.

CONCLUSION: In post transplantation period metabolic syndrome indices like high blood pressure, hyperuricemia, hyperglycemia and increased waist and hip circumferences are closely related with arterial stiffness. For cardiovascular risk reduction after renal transplantation, blood pressure, serum glucose and uric acid levels should be under strict control.

OP 50 ARTERIAL STIFFNESS AND CHANGES IN QTC INTERVAL IN RENAL TRANSPLANTATION PATIENTS

MEHTAP ERKMEN UYAR¹, UGUR BAL², ZEYNEP BAL¹, EMRE TUTAL¹, CİHAT BURAK SAYİN¹, BEGUM ERDEMİR³, TURAN COLAK¹, SİREN SEZER¹

Başkent University School of Medicine, ¹Department of Nephrology, ²Department of Cardiology and ³Department of Internal Medicine, Ankara, Turkey

BACKGROUND: Arterial stiffness plays an important role in cardiovascular diseases and is an independent predictor for cardiovascular mortality. The QTc interval has been reported to be increased and to be associated with high-risk ventricular arrhythmias and sudden death. Although renal transplantation improves survival, cardiovascular morbidity and mortality still remain a significant problem compared with nonrenal populations. The aim of this study is to evaluate the association between the QTc interval changes and arterial stiffness in kidney transplant recipients.

METHODS: One hundred kidney transplant recipients from our renal transplant outpatient clinic were enrolled into the study. All patients were evaluated for their clinical, biochemical parameters. PWv was determined from pressure tracings over carotid and femoral arteries using the SphygmoCor system. Each QT interval was corrected for the patient's heart rate using Bazett's Formula. A QTc interval greater than 440 ms was considered abnormally prolonged.

RESULTS: After renal transplantation maxQTc intervals (456.7 ms to 414 ms) and QTdc (54 ms to 34 ms) of all patients were significantly decreased. In post transplantation period, patients with high QTc intervals had significantly higher PWv (p = 0.009) and higher serum CRP levels (p =0.001) than patients with QTc<440 ms. Patients with PWv⩾7 m/s had significantly higher maxQTc interval decline than patients with PWv<7 m/s (p = 0.05, r =−0.206).

CONCLUSION: High QTc interval after renal transplantation could be a predictor of arterial stiffness in renal transplant recipients. Electrocardiographic evaluation appears to be an inexpensive and reliable way to detect arterial stiffness.