13PSEUDOHYPERKALEMIA IN EXTREME LEUKOCYTOSIS Mohini Alexander, Hitesh Patni, Michael Gitman, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States. Pseudohyperkalemia occurs occasionally in patients with extreme leukocytosis. We present a rare case of extreme pseudohyperkalemia of 13.8mmol/L in a patient with chronic lymphocytic leukemia who was managed with emergent hemodialysis. An 81year-old male with known chronic lymphocytic leukemia presented with dyspnea on exertion and lower extremity edema.He was admitted for his first cycle of chemotherapy with rituximab. On presentation he was found to have an elevated WBC count of 525K/microL, potassium of 5.5mmol/L, serum bicarbonate of 22mmol/l and serum creatinine of 1.48mg/dL.Overnight his WBC count trended up to 710K/microL, potassium was extremely high at 13.8mmol/L, serum bicarbonate was 31mmol/l and serum creatinine was 1.57mg/dL. The blood sample was confirmed to be non-hemolyzed. Tumour lysis syndrome causing hyperkalemia was unlikely given that serum uric acid and serum phosphorus were not elevated at 5mg/dL and 4.4mg/dL respectively and serum calcium was only slightly low at 7.9mg/dL. A repeat blood gas potassium was sent for a suspicion of pseudohyperkalemia which also came back elevated at 9.8mmol/L. EKG showed first degree AV block and prolonged QTc of 450ms without peaked T waves. The patient was placed on telemetry and treated with intravenous calcium gluconate, dextrose 50%, insulin and kayexalate.The patient remained asymptomatic throughout. Given this degree of hyperkalemia on repeat blood gas analysis we dialyzed the patient against a 2K dialysate bath for 3 hours. Repeat serum potassium drawn after hemodialysis treatment was further elevated at 14mmol/L. Our suspicion for pseudohyperkalemia was further strengthened and we decided to draw a blood gas potassium and requested the laboratory to analyze the sample right away with minimal storage at room temperature.The repeat potassium came back at 4.4mmol/L.This case represents the importance of having a high suspicion of pseudohyperkalemia in patients with extreme leukocytosis and to repeat the potassium level using blood gas analysis which is a quick and reliable test so as to avoid inappropriate management and untoward complications of potentially even making patients hypokalemic.

14AKI WITH USE OF SITAGLIPTIN – DO WE NEED TO BE CONCERNED? Anushayanthan Alfred*, Dana V. Rizk* *University of Alabama at Birmingham, Birmingham AL USA Diabetic nephropathy is the leading cause of CKD worldwide. Newer agents like Sitagliptin (a dipeptidyl peptidase-4 [DPP-4] inhibitor) has been shown to improve glycemic control when used as adjunctive therapy. Its use in the setting of worsening glomerular filtration rate (GFR) requires dose adjustment, but is not contraindicated. We present here a case of acute kidney injury related to Sitagliptin use in CKD. L.N is a 57 year old female with uncontrolled diabetes on Glipizide and CKD stage III with a baseline creatinine 1.8 to 2 mg/dl. She was started on Sitagliptin 100mg daily. Within two months of the drug initiation, her creatinine increased from 2 to 2.5 and then to 3.4 mg/dl (eGFR=17 ml/min/1.73m2) at 5 months. She was hemodynamically stable and denied any concomitant use of NSAIDS or exposure to any nephrotoxins. Her HgbA1C improved from 9.1 to 7.4% during the same period. Due to her worsening renal failure that coincided with the initiation of Sitagliptin, the drug was stopped. Repeat creatinine 3 weeks and 3 months later was 2.1 and 2 mg/dl respectively with eGFR 31ml/min/1.73m2. Gliptins are a relatively novel class of oral anti-diabetic agents much needed in the fight against the diabetes epidemic. The package insert of Sitagliptin recommends dose adjustment in patients with moderate to severe renal insufficiency due to a decrease in drug excretion. This was not followed in our patient. More importantly, the occurrence of acute kidney injury from Sitaglitpin has not been documented to this date. Our case highlights a potentially unrecognized side effect that warrants further evaluation.

15PEER MENTORING TO INCREASE DECEASED ORGAN DONATION AMONG ESRD PATIENTS Ann Andrews1, Holly Jenkins-Riley3, Allyce Haney1, Remonia Chapman4, Jerry Yee2, 3, Ken Resnicow5 NKF of Michigan1, Ann Arbor , MI, USA, Henry Ford Health System2, Detroit, MI, USA, Greenfield Health Systems3, Bingham Farms, MI USA, Gift of Life Michigan4, Ann Arbor, MI, USA, School of Public Health, University of Michigan5, Ann Arbor, MI, USA The organ donor waiting list continues to expand. Patients with End Stage Renal Disease (ESRD) are not typically viewed, by themselves or their health care team, as potential donors after death. However, ESRD patients are eligible to donate and may obtain a sense of empowerment in knowing they can give back. The objective of this study is to evaluate if peer mentoring will increase enrollment on the Michigan Organ Donor Registry among ESRD patients. This cluster randomized design controlled intervention study is conducted in collaboration with the National Kidney Foundation of Michigan (NKFM), Greenfield Health Systems (GHS), Henry Ford Health System, Gift of Life Michigan, and the University of Michigan. Staff at twelve GHS dialysis units in Southeast Michigan will receive training in organ donation. Dialysis units will then be randomized to an intervention or control group. ESRD patients in intervention units will be assigned peer mentors and meet 7 times over a 4 month period utilizing a mix of in-person and phone contacts. Peer mentor-patient meetings will cover coping with chronic illness and leaving a legacy in relation to deceased organ donation and signing up on the Donor Registry. Patients in comparison units receive mailings about donation and the Donor Registry. The primary outcome is registrations on the Donor Registry via mail and internet. In addition, surveys will be used to evaluate feasibility, change in organ donation knowledge and attitudes, self-reported donation status, hope (Hope Scale) and quality of life (KDQOL). To date, over 60 Greenfield staff and 11 peer mentors have been trained in donation, and 92 patients have been recruited in 3 units.

16IMPORTANCE OF AMBULATORY BLOOD PRESSURE MONITORING IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS Elizabeth Anyaegbu, Paul Hmiel, Michael Seifert. Washington University in St Louis, Missouri, USA Hypertension (HTN) is a well known complication following renal transplantation (tx) and an important risk factor for allograft dysfunction (AD) and cardiovascular morbidity (CVM). ABPM is superior to casual blood pressure measurement (CBPM) in the assessment of HTN. It has the advantage of documenting circadian variability of blood pressure (BP) over a 24-hour period and calculating the blood pressure load (BPL), both of which correlate to cardiovascular risk in the general hypertensive population. To define the role of ABPM in PRTRs and determine if ambulatory HTN, elevated BPL and abnormal nocturnal dipping (ND) are associated with chronic allograft injury. ABPM data is being systematically collected from 40 PRTRs aged between 3 years and 18 years (yrs) who have completed at least 6 months follow-up. Patients had iothalamate GFR (iGFR) at 1 and 3 yrs post transplant. Data is available from 6 patients at this time. The mean age was 12 ± 5.7 (3- 18) years and 67% were male. 33% received a living donor transplant. 50% were receiving antihypertensives at the time of ABPM. 33% had HTN based on CBPM and ABPM criteria of elevated systolic and diastolic means and BP loads. There was good correlation between CBPM and daytime ABPM (SBP: r= 0.69; DBP: r= 0.73). 3/6 patients had BP loads greater than 50% and 83% were nocturnal nondippers. ABPM identified abnormal BP parameters in all patients. ABPM is shown to be a better assessment of actual BP variability and would ensure adequate BP control and reduce CVM.

NKF 2012 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2012;59(4):A1-A92A18