HYPERTENSION PREVALENCE IN CHINATOWN CLINIC Seung J. Yi, Lisa K. Wong, Vincent J. Zarro and Allan B. Schwartz. Drexel Univ College of Medicine, Philadelphia, PA, USA, 19129.

Prevalence of High Blood Pressure (HBP) among Asians at the Philadelphia Chinatown Clinic was determined by review of 1,322 charts. Pts with HBP were analyzed for systolic (S) BP, diastolic (D) BP, glucose, medications, ethnicity, gender, and years in US. Of 1,322 subjects, 288 presented to clinic with HBP (21.8%). 14/288 had Diabetes (4.9%). 174 were Indonesian with av BP of 151/91 and 55 were Chinese with an av BP of 151/91. Initial BP in 110 males was 148/92 and in 155 females was 154/91. Av BP for subsequent visits was 139/88 for males and 139/86 for females. BP increased with years of U.S. residence: <2 yrs 148/90; 2-4 yrs 150/92; >4 yrs 157/96. Mean random serum glucose of 287 pts was 150 mg/dL and of Diabetics was 253 mg/dL. BP control was categorized into 4 groups: I. No improvement or worse, 43 (33%) mean BP 145/90 at 1st visit to 158/94 at last visit. II. Improvement but not JNC7 goal (BP<140/90), 34 (26%), 171/96 to 147/91, decrease in SBP 24 mmHg, DBP 5mmHg. III. Reached goal, but did not sustain goal, 15 (12%), 150/91 to 150/93. However, mean lowest BP of III was 122/78. IV. Reached goal and sustained, 38 (29%), 152/94 decreased to 124/81. Of 288 pts, 181 were not given drugs, 60 returned for follow up: 21 pts had no improvement, 11 patients had improvement but not goal, 3 patients reached goal but did not sustain the goal BP, and 25 reached and sustained goal BP. 70 of 107 pts given drugs returned for follow up: 18 showed no improvement, 23 pts had improvement but not goal BP, 12 patients reached goal but did not sustain the goal BP, and 13 patients reached and sustained BP goals. Drugs given: HCTZ 78, Enalapril 51, ?Blocker 27 and Amlodipine 3. 158 of 288 were lost to follow up (55%). Chinese and Indonesians showed no BP difference. Initial female BP 154/91 was greater than male BP 148/92. Subsequent female BP was similar to the male BP at 139/86 vs. 139/88. Increasing BP with years in US reveals westernization affects BP in Asians, corroborating studies of risk factors of country of destination, not country of origin. High drop out rate was noted and 30% met JNC7 requirements for HBP drug therapy. Asian pts given HBP drugs were more likely to return for follow up than pts not given HBP drugs.

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REASONS FOR HEMODIALYSIS CATHETER USE & ITS COMPLICATIONS: PATIENT AND COORDINATOR PERSPECTIVES Jane Yuan, Dheeraj Rajan, Cynthia Bhola, Julia Lee, Charmaine E. Lok University of Toronto & Toronto General Hospital, Toronto, Ontario, Canada Catheters (CVC) for hemodialysis access are associated with significant morbidity and mortality, yet CVC use continues to be high. This study aims to 1) determine the reasons why patients use CVC from 2 perspectives i) the patient and ii) the vascular access coordinator (VAC) ; and 2) compare these perspectives. Additionally, the complication ofcentral venous stenosis (CS) may limit the creation of a future permanent access. Therefore, the prevalence and impact of CS is examined. 165 patients from a large, tertiary centre and their VAC were independently surveyed using a standardized questionnaire on CVC use. An interventional radiologist reviewed all venograms in patients who had at least one CVC exchange to determine the presence of CS. The resultsare summarized in the following table: MAIN REASONS FOR CVC USE PATIENT

(% of total) VAC(% of total)

BOTH(% of total)

Needle phobia 40 (24%) 0 0Prior failed fistula/graft, does not want or unable to go on to peritoneal dialysis, does not want other surgery

29 (18%) 5 (3.0%) 3 (1.8%)

Cosmetic appearance of fistula/graft 24 (15%) 0 0Patient Preference 1 (<1%) 57 (35%) 2 (1.2%) Table 1: Reasons for CVC use, as cited by patients, VAC, or both (not all data shown).

There was<15% agreement in views amongst patients and the VAC regarding the reason for CVC use. Primary reasons were needle phobia and surgical fatigue (patients’ views) and patient preference (VAC view). <5% were waiting for new access creation or maturation or had a medical contradiction to access creation. 40% had CS and may limit future access creation. Understanding specific patient concerns, and greater patient education of the risk of CVC use, its complications and consequences is required to reduce CVC use and promote optimal access care.

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EARLY AND AGGRESSIVE RECURRENCE OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN A RENAL TRANSPLANT RECIPIENTTausif Zar1,, Sein Yin See1, Fabiola Balarezo1, Nimrata Ghuman1,Rigoberto Gonzalez1, Karen McHugh2, Mathew Brown2, Anne Lally2,David Hull2, K.Vinay Ranga1,2 .University of Connecticut ,Farmington, CT1/ Hartford Hospital Hartford, CT2.Idiopathic Membranous Nephropathy (IMN) recurs in 10-30% of patients after transplantation. The mean onset time of recurrent disease is approximately 10-24 months post transplant. We report an early and aggressive recurrence within a few weeks post-transplant. Case: A 59 year old male, recipient of a pre-emptive living unrelated kidney for ESRD secondary to MGN, complained of ‘frothy urine’ 4 weeks following the transplantation, and increasing swelling of his legs. Examination showed edema, and labs revealed hypolbuminemia, hypercholesterolemia, and a normal S. Cr. Collection of 24 hour urine revealed 5 gm proteinuria. A renal biopsy was performed, showing minimal expansion of mesangial matrix on LM, immune-complex GN with pre-dominant IgG-C3-kappa-Lambda deposits in peripheral capillary walls on IF, and subepithelial deposits on EM, consistent with recurrent IMN. Secondary causes of MN were excluded (Hepatitis B and C, neoplasia, paraproteinemia). The patient was continued on his Tacrolimus, MMF and steroids, along with ACEI, ARBs and diuretics. Gradually, his serum albumin and edema worsened, with increasing need for diuretics. A repeat biopsy was done 6 months after transplant, which essentially showed the same picture of recurrent membranous GN on EM. Also, a perfusion scan showed no native perfusion or function, making native proteinuria very unlikely. It was decided to try a course of Rituximab, which was well tolerated. There was no response, and serum albumin and renal function began to decline, with repeat 24 hr proteinuria of 10 gm. Our patient presented far earlier then the reported mean time of onset with a much aggressive course. No risk factors for recurrence have been identified. The initial concerns with regards to the risk of recurrence with living related donors, presence of HLA-DR3 in the recipient, and aggressiveness of native disease have not been substantiated. Therapeutic interventions have been largely disappointing.

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PREDICTABLE REMOVAL OF ANTICARDIOLIPIN ANTIBODY (aCL AB) BY THERAPEUTIC PLASMA EXCHANGE (TPE) IN A PATIENT WITH CATASTROPHIC ANTIPHOSPHOLIPID ANTIBODY SYNDROME (CAPS) Tausif Zar, Atiq Dada and Andre A. Kaplan. University of Connecticut, Farmington, CT, USA

CAPS is a rare, life-threatening condition. Treatment consists of heparin, steroids, IVIG and/or TPE. We report predictive and effective removal of pathological aCL AB using TPE. A 33 yr old female with history of antiphospholipid antibody syndrome presents with CAPS (hemiplegia, MI and ARF). She is started on above management including TPE. She received 2 treatments of TPE on the 1st day, twelve hours apart and then daily for 4 days, using 3 liters of albumin and 1 liter of FFP. Patient completely recovered. Decline in immunoglobulin level after a single TPE can be predicted with first order kinetics by calculating the ratio of Volume exchanged (Ve)/ Expected Plasma Volume (EPV). Similar to the KT/V prescription for urea reduction, Ve/EPV ratios of 0.7, 1.0 and 1.4 are expected to yield a 50%, 63% and 75% decline in immunoglobulin level respectively. In the above case Ve/EPV was 1.0 and predicted decline would be 63%. The achieved average daily decline in aCL IgM and IgG levels was 57 % & 59 % respectively.CCL: As with KT/V for urea reduction, removal of aCL AB by TPE follows first order kinetics and can be accurately predicted.

Anticardiolipin antibody removal by TPE

0

10

20

30

40

50

60

70

TPE treatments

Imm

unog

lobu

lin C

once

ntra

tion

(mg/

dl)

IgM aCL AB IgG aCL AB

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NKF 2007 Spring Clinical Meetings Abstracts A85