CARNITINE EFFEVTIVENESS ON INTRADIALYTIC HYPOTENSION Joel M. Topf, and Genevieve Alumit. St. John Hospital & Medical Center, Detroit, Michigan Intradialytic hypotension (IDH) in end-stage renal disease patients is a common complication of hemodialysis (HD). In some patients IDH is refractory to standard interventions including reduced ultrafiltration, sodium modeling and cold dialysate. In two small, randomized, controlled trials L-carnitine was shown to reduce IDH. The objective of our study was to confirm that L-carnitine is effective in reducing IDH. We retrospectively reviewed the charts of 9 patients at a single dialysis center who received L-carnitine for IDH. All had IDH and L-carnitine levels < 40 mmol/L. IDH was defined as a sudden drop in systolic blood pressure (SBP) <90mmHg, a more than 30mmHg drop mean arterial pressure (MAP), or a more than 30mmHg drop in SBP from baseline. Every blood pressure from every HD session was recorded for the 4 weeks prior to the L-carnitine order and for 24 weeks of L-carnitine administration. To account for a possibility that duration of treatment was important we divided the treatment period into three: first 20 doses, second 20 doses, and thereafter. We found significant improvement following the initiation of L-carnitine in multiple measures of IDH. Sudden drops in SBP > 30mmHg fell 22% from the control period to the 3rd period (p=0.015). Drops in SBP from baseline fell 24% (p=0.001). SBP falling below 90 mmHg fell 55% (p=0.039). During the treatment period there was no change in ultrafiltration, dry weight, or pre-dialysis SBP. Pre-dialysis MAP and a modest increase in post-HD MAP from 88.7 to 90.7 were also found to be significant (p=0.017). In this retrospective analysis L-carnitine use was associated with significant improvement in IDH. This improvement increased with longer duration of administration. This data further highlights the need for a large randomized placebo controlled trial to confirm the utility of L-carnitine for IHD.

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COMBINATION USE OF ACE/ARB IN THE INITIAL TREATMENT OF LOIN PAIN HEMATURIA SYNDROME. KateTretyakov, Adam Dratch, Richard Snyder, Easton Hospital/Drexel University College of Medicine, Easton, PA. Loin-pain hematuria syndrome is a poorly understood condition usually consisting of the triad of flank pain, hematuria, and low grade fever. The pathogenesis remains obscure, with theories ranging from increased intraglomerular pressure to increased sympathetic tone, and/or increased neuronal sensitivity. As such, no standard treatment or initial approach to a patient with LPHS has ever been promoted. We present the case of a patient diagnosed with loin-pain hematuria syndrome (LPHS) who was initially treated with an ACE/ARB combination with some relief from her pain. A 35-year-old female presented with the triad of flank pain, hematuria, and low grade fever. Recurrent CT scans failed to identify a stone or filling defect. A urologic examination and CT angiogram were nondiagnostic. Creatinine of 0.9 mg/dl and no protein was seen on a p/c ratio. There was no significant proteinuria, and a renal biopsy demonstrated thin basement membrane disease. We postulated a diagnosis of LPHS. The patient was initially started on valsartan 80 mg, and a week later lisinopril 5 mg was added. The patient still complained of some mild flank discomfort, but noted a significant decrease in her pain level compared to when she was not on those medications. The patient’s pain gradually increased and pain medication was added. She was subsequently referred to a tertiary referral center and surgery was performed, which dramatically helped her symptoms. We feel that combination ACE/ARB therapy in conjunction with pain management may be an effective initial therapy in this condition. Further studies are needed in this area.

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EFFICACY OF ERGOCALCIFEROL IN THE TREATMENT OF SECONDARY HYPERPARATHYROIDISM: RESULTS OF PROSPECTIVE, OPEN LABELED TRIAL IN PATIENTS WITH STAGE III CHRONIC KIDNEY DISEASE J.A. Tumlin, Southeast Renal Research Institute, University of North Carolina Charlotte NC, Claude Galphin and Mandeep Grewal , Nephrology Associates of Chattanooga, Chattanooga TN., USA Introduction: Previous studies in patients with CKD, find that 80% of patients with GFR < 30 mls/min have 25OH cholecalciferol levels below 30 ng/ml. We speculated that oral supplementation of 25OH cholecalciferol could normalize 1,25-OH2-Vit-D levels and reduce serum PTH levels in patients with stage III CKD. To investigate this hypothesis, we performed a prospective open-labeled trial of 6 months of oral ergocalciferol (25OH vit D2) (50,000 units) in 147 patients with stage III CKD. Patients were screened from a large out-patient CKD clinic and were considered for enrollment if 1) patients had a stable GFR (<40 ml/min); 2) 25OH vit D2 less than 35 ng/ml; Of the enrolled patients, 58 completed 6 months of therapy and a documented 50% rise in (25OH vit D2) levels. Stat-Signif:*=P<0.005; ^=P<0.0001________________Table 1: GFR#1 VitD2#1 PTH#1 GFR#2 VitD2#2 PTH#2 Total 35+2.8 15+0.9 125+9 32+1.9 25+1.6 109+8.6Non-Resp 30+2.7 12+1.4 90+11 27+2.8 30+3.4 118+15* Respond 35+2.9 13+1.1 163+20* 32+3.3 30+2.5 89+12^Results: PTH levels in the total population fell from 125+9 to 109+9pg/ml, but this value did not reach statistical significance (P<0.08). Of the 58 patients, 27 (47%) failed to reduce PTH levels despite a significant (P<0.03) rise in 25OH-vit D2 levels. In contrast, ergocalciferol decreased PTH levels among responders from 163+20 to 89+12 pg/ml (P<0.001). There were no differences in baseline GFR or 25OH-vit D2 among responsive and non-responsive patients, but basal PTH levels were significantly (P<0.03) higher among the responsive group. In conclusion, 6 months of oral supplementation with ergocalciferol decreased PTH levels in over 50% patients with stage III CKD. The increased number of patients with undetectable levels of 5OH-vit-D2 suggests that higher doses may required to reverse secondary hyperparathyroidism.

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EFFECT OF SIROLIMUS VERSUS MYCOPHENOLATE MOFETIL ON THE EFFICACY OF DARBEPOETIN ALFA ON ANEMIA IN RENAL TRANSPLANT RECIPIENTS Shamin Vania, Sandeep Jaglan, Karthik Ranganna, Ziauddin Ahmed, Sandra Levison, Drexel University College of Medicine, Philadelphia Anemia is a well known complication in renal transplant recipients. Although the primary presumption is impaired erythropoiesis, other factors such as immunosuppressive drugs have been suggested to have a negative impact on anemia. We attempt to determine whether there is a difference between sirolimus(SIR) and mycophenolate mofetil (MMF) on the efficacy of darbepoetin alfa(DA) in treating anemia. We examined 78 pts who received DA consistently over a 3 month interval. Of these pts, 24 were excluded based on one of the following: they did not have consistent hemoglobin(Hgb) monitoring, were hospitalized, transfused, or HIV+. The following table demonstrates the characteristics of the pts as well as our findings.

SIR MMF p-value Age 52.8 55.7 0.503 Gender 17 M, 14 W 14 M, 9 W 0.656 Race 21 AA, 10 W 13 AA, 10 W 0.399Iron 50 53.5 0.287 TIBC* 225.5 220.5 0.945 Tsat* 0.24 0.29 0.251 Ferritin* 768 574 0.154 CrCl(MDRD)* 30.75 24.99 0.902 Avg DA 119.2 116 0.768 Avg Hgb 10.34 10.84 0.07 Two-sample t-tests as well as Mann-Whitney tests(for non normally distributed data labeled with *) were used to analyze the data. The pts were similar in terms of age, creatinine clearance, and iron studies. The avg DA dose for SIR pts was 119.2+/-40.9 and for MMF pts was 116+/-39.4. The avg Hgb for SIR pts was 10.34+/-1.01 and avg Hgb for MMF pts was 10.84+/-0.949(p-value=0.07). Our study showed that there was no statistically significant difference in average Hgb between the two groups.

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NKF 2007 Spring Clinical Meetings Abstracts A81