357HIGHER PREVALENCE OF CV-RELATED COMORBIDITIES IN US ADULTS WITH STAGE IIIB CKD SUPPORTS A MODIFICATION TO THE EXISTING NKF/KDIGO CLASSIFICATION OF CKD Daniel Wilson, Andreas Kuznik, Jack Mardekian, Lisa Tarasenko Pfizer Inc, New York, NY, USA Some clinicians have recommended revision of the current NKF/KDIGO classification of CKD and establishing Stages IIIa and IIIb CKD because of perceived differences in CV risk profiles in Stage III. CKD is often associated with CV target organ damage and CHD risk equivalents. In this analysis of a nationally representative database, we quantified the prevalence of CVD and CHD risk equivalents in US adults by CKD stage, utilizing the suggested modification of Stage III CKD, in an attempt to determine if such a revision is warranted. Data from NHANES 2001–2008 were stratified by CKD stage; eGFR was calculated using the 4-variable MDRD Study equation. CKD staging used modified NKF criteria: Stage III CKD was subdivided into Stage IIIa (eGFR >45–<60 mL/min/1.73m2) and Stage IIIb (eGFR 30–<45 mL/min/1.73m2). CVD history was self reported; DM was identified by self report, use of diabetic medications, or fasting glucose ≥126 mg/dL. Of the NHANES participants with valid renal data, 12% had CKD. The prevalence of CV-related comorbidities increased with progressive renal impairment (Table). Prevalence of CVD, CHD and stroke increased markedly between CKD Stage IIIa and IIIb. Prevalence of DM was notably higher in Stage IV versus Stage I CKD. CKD Stage CVD* CHD Stroke DM

Normal 5.9% 4.2% 1.9% 7.8% I 10.9% 7.2% 2.8% 33.7% II 24.3% 17.6% 6.5% 30.9%

IIIa 25.6% 19.1% 7.9% 20.4% IIIb 48.7% 33.6% 23.5% 33.1% IV 60.1% 42.6% 33.2% 49.1%

*Composite of CHD, stroke and CHF Persons with CKD, especially those with advanced renal impairment, have a high prevalence of concomitant CVD. Our analysis supports the proposed revision of the current NKF/KDIGO classification of CKD, as the prevalence of specific CV comorbidities and CHD risk equivalents was substantially higher in Stage IIIb versus IIIa CKD.

358UNDERTREATMENT OF MODIFIABLE CV RISK FACTORS PERSISTS IN A VERY HIGH-RISK CKD POPULATION Daniel Wilson, Andreas Kuznik, Jack Mardekian, Lisa Tarasenko Pfizer Inc, New York, NY, USA Clinical trial data suggest that aggressive treatment of dyslipidemia and hypertension reduces CV events and may modify the progression of renal disease in CKD. However, under-treatment of these CV risk factors has consistently been reported in patients with CKD. The NKF recommend an LDL-C goal of <100 mg/dL and a BP <130/80 mmHg for those with CKD. Nearly 30% of CHD patients, and 40% of patients with DM, have concomitant CKD. In this analysis of US adults from a national database, we assessed the utilization of lipid-lowering and BP-lowering agents, and rates of LDL-C and BP goal attainment, in a very high-risk population with CHD or DM, concomitant with CKD. Data from NHANES 2001–2008 were stratified by CKD stage; eGFR was calculated using the 4-variable MDRD Study equation. CKD staging used modified NKF criteria: Stage III CKD was subdivided into Stage IIIa (eGFR >45–<60 mL/min/1.73m2) and Stage IIIb (eGFR 30–<45 mL/min/1.73m2). Disease history and drug utilization were self reported. Of the NHANES participants with valid renal data, 606 had concomitant CHD and CKD; 1,056 had concomitant DM and CKD. As renal impairment progressed, the use of lipid-lowering agents remained steady in CHD patients and increased in DM patients (Table). Attainment of an LDL-C <100 mg/dL improved with advancing CKD, with the exception of CHD patients with Stage IV CKD. BP goal attainment was unchanged in CHD patients, and decreased in DM patients between CKD Stage IIIa/IIIb and IV, despite the increased use of antihypertensives. Few patients (10–40%) attained the optional LDL-C goal of <70 mg/dL for CKD patients at very high risk. CKD Stage

Dyslipid. Tx Hyperten. Tx LDL-C <100 BP ≤130/80 CHD DM CHD DM CHD DM CHD DM

IIIa 55.2% 40.1% 62.6% 80.9% 53.5% 45.5% 47.3% 40.7%IIIb 55.8% 52.5% 73.8% 80.7% 68.4% 64.6% 49.9% 51.5%IV 54.6% 49.5% 83.8% 100% 24.3% 53.7% 48.0% 28.2%

Undertreatment of CV risk factors persists in these very high-risk populations and represents an unmet medical need in CKD. Future treatment guidelines should recommend aggressive, comprehensive CV risk factor modification to maximize CV event reduction and progression of renal disease in CKD patients at high risk for CHD.

359USE OF ELECTROLYTICALLY-PRODUCED SODIUM HYPOCHLORITE REDUCES INFECTIONS IN DIALYSIS FACILITIES Steve Wilson1; Amy Young1

1DaVita Inc., Denver, CO, USA USRDS estimates that 30% of dialysis patients receive antibiotics in

a 6-month period. We used episodes of antibiotic administration as a measure of effectiveness of topical disinfection with sodium hypochlorite (ESH) solution in preventing CVC-related infections. We surveyed 226 facilities (n >20 patients each), recorded the CVC-preparation procedure (ESH vs iodine-based solution), determined episodes of antibiotic use as a surrogate to all-cause infection rates from 5/09 through 10/09, then compared the results by use or non-use of ESH. While exit-site infections could not be identified directly, to the extent antibiotic use systematically differed between ESH- and iodine-using facilities that were otherwise similar, a difference in exit-site infections was inferred. Of the facilities, 78.4% reported use of ESH. A total of 18.1% of patients in ESH facilities and 19.2% of patients in the iodine facilities used antibiotics at least once in 6 months(p=0.09). The observed rate of antibiotic use was lower in ESH facilities for most months of the study, but differences were not significant. Expressed in terms of antibiotic use per 1000 patient days, the overall inferred infection rate among patients with CVCs did not differ between facilities that used ESH and those that used an iodine-based solution (7.21 ±0.12 episodes per 1000 patient days versus 7.57 ±0.26 per 1000 patient days). We conclude that ESH use for CVC preparation is higher than expected, and that use of antibiotics is lower than that expected from USRDS estimates. Despite observed equivalence on a number of facility characteristics, unobserved confounding may still exist in this retrospective sample. Accordingly, prospective examination of the relationship between ESH use and access related infection is planned.

360PRE-DIALYSIS FLUID STATUS IS AN IMPORTANT PREDICTOR OF RENAL RECOVERY IN PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY. Dawn Wolfgram , Mallika Kommareddi, Peter Song, Michael Heung. University of Wisconsin, Madison WI, University of Michigan, Ann Arbor, Michigan Acute kidney injury (AKI) in hospitalized patients is associated with poor short and longterm outcomes. Identifying factors that correlate with renal recovery (REC) in patients with AKI requiring renal replacement therapy (RRT) can help clinicians develop strategies to prevent non-recovery (NREC). We hypothesized that fluid status is an important factor in REC and that lesser volume overload at dialysis initiation would be associated with higher rates of REC defined as dialysis independence. To further evaluate we did a retrospective study of consecutive hospitalized patients who developed acute tubular necrosis-related AKI requiring RRT. Data included demographics, comorbidities, and treatment variables. Primary outcome was REC at 1 year following dialysis initiation. Fluid status was defined as percent change in weightat dialysis initiation compared to baseline and was analyzed as both a continuous and categorical variable (<10% versus >10%). Results showed that 170 patients met criteria and were included in analysis. Mortality was 53% in hospital and 65% at 1 year. REC occurred in 69% survivors. Patients in the REC group were found to have 6.2% +/- 11.5% increase in fluid status at dialysis initiation compared to 11.6 +/- 13.2% in NREC patients (p = 0.006). Multivariate analysis showed a 3% decline in hazard for recovery for every one unit increase in percent fluid overload (p = 0.043]). Our study showed that worse baseline Cr, higher severity of illness and >1 comorbidities were significant risk factors for NREC. We did find that lesser degree of fluid overload at initiation of RRT was associated with increased REC. While other studies have shown that fluid status is predictive of mortality our study shows that pre-dialysis fluid status is also associated with renal recovery. Based on our results further studies evaluating conservative fluid management strategies andlooking at the impact of fluid removal strategies on renal recovery would help clinicians guide therapy in AKI requiring RRT.

NKF 2011 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2011;57(4):A1-A108A106