113HEALTH LITERACY AND MEDICATION RECONCILIATION IN VETERANS ON CHRONIC HEMODIALYSIS Divya Jain, Elisa Gordon, Subhash Popli, Brian Bartle, Michael Fischer, Hines VA Hospital, Chicago, IL, USA. Adults with end-stage kidney disease (ESKD) generally require treatment with numerous prescribed medications for appropriate disease management. However, it is unknown if adults with ESKD requiring chronic hemodialysis (HD) can accurately recall the name and purpose of their medications. Further, little is known as to whether health literacy (HL) is related to medication reconciliation in ESKD. We conducted a cross-sectional study involving semi-structured interviews with Veterans with ESKD requiring chronic HD at a VA outpatient dialysis unit in 2011. Participants were asked to recall the name and purpose of their medications, and medication reconciliation was obtained by comparing the recalled medications with those in the electronic health record (EHR), which was considered the gold standard. HL was assessed by the Short Form Test of Functional Health Literacy Assessment (S-TOFHLA), and inadequate HL was defined by a score < 54. Bivariate analyses were used to assess the association between medication reconciliation and HL. Among a cohort of 17 HD patients, the median (interquartile range) number of prescribed medications (excluding PRNs and topicals) is 9 (8-11). Few patients (18%) could recall (even if inaccurately) the names of all their medications, 59% named at least one medication, and 23% could not name any of their medications. Patients correctly identified the purpose of most (71%) of the medications they recalled. The concordance of recalled medications with those found in the EHR was 37%. A fourth (24%) of all patients had inadequate HL. HL was significantly associated with medication reconciliation (p=0.014, t=2.84); concordance of recalled medications with those in the EHR was lower in patients with inadequate HL compared to those with adequate HL (12% vs. 45%). These findings suggest that many adults with ESKD requiring chronic HD are unable to accurately recall prescribed medications, and low HL is associated with poor medication reconciliation.

114PROBIOTICS FOR UREMIA: EXTENSIVE REVIEW OF THE LITERATURE. Koyal Jain, Andre A. Kaplan. University of Connecticut Health Care Center, Farmington, CT Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit to the host. Given the emerging data, we wanted to evaluate the benefits and safety of probiotics in chronic kidney disease (CKD) patients. We performed an extensive pubmed search using keywords: “probiotics”, “urea”, ”uremia”, “CKD”, “kidney”, “prebiotics”, “chronic kidney disease” and “safety” revealing over 6000 articles. Though over 600 articles came up with word combinations, only relevant CKD articles were included in the review. Dietary protein is broken down into amino acids and converted to ammonia (NH3) and urea by enterocytes. The NH3 exchanges with circulation such that the amount entering the lumen equals amount absorbed. The theory is that certain bacteria (probiotics) added to the intestinal flora could utilize the NH3 and urea. This would aid urea removal from blood. Animal studies on rats, post-nephrectomy mini-pigs, cats and dogs showed that these bacteria can enhance urea clearance through the gut. One such study conducted on 36, 5/6th nephrectomized rats and 6 non-nephrectomized control rats demonstrated a significant reduction in blood urea nitrogen (BUN) by 37% and creatinine by 40%. There has been only one randomized prospective study in 46 CKD III and IV patients over 4 countries (in 5 centers). Reduction in BUN levels in 29 patients (63%) and improvement of quality of life were statistically significant. The absolute reduction in BUN varied from 6.4 (US) to 26.3 (Argentina) mg/dL. Creatinine change was not significant. Though case reports of bacteremia and endocarditis exist with probiotics containing lactobacillus, the incidence is less than 1 case/million people. In conclusion, data regarding use of probiotics in CKD patients appear promising. These probiotics have been designated as “presumed safe” and do not require FDA approval. They are currently available without prescription. More data is needed regarding dosing, types of probiotics and overall benefit.

115REVIEW OF GLOMERULAR PATHOLOGY IN NYC HISPANICS COMPARING NATIVE AMERICAN AND AFRICAN ANCESTRY Sudhanshu Jain1, Salwa Rhazouani1, George Coritsidis1, Ayesha Shaikh2, Isaiarasi Gnanasekaran2, Neha Garg2, Sandra Vargas2, Elmhurst Hospital Center1, Lincoln Medical Center2. The type and incidence of different glomerular diseases vary worldwide based on race, age and sex. American Hispanics can have either Native American or African ancestry, which may influence renal pathology. Retrospective kidney biopsy data between 2001 and 2010 from 3 ethnically diverse city hospitals in New York City area (Elmhurst Hospital Center, Queens Hospital Center and Lincoln Hospital) was reviewed. 103 Hispanic patients identified by charts were separated into two groups based on ancestry: South & Central American Hispanics representing Native American ancestry (SH), and Puerto Rican, Dominican and Cuban Hispanics representing African ancestry (Caribbean Hispanics, CH). Variables studied were age, gender, proteinuria; MDRD estimated glomerular filtration rate (eGFR), and glomerular pathologies. Incidence of diabetes mellitus, focal segmental glomerulosclerosis, membrano-proliferative glomerulonephritis, and membranous nephropathy was similar. The most common diagnosis in both groups was lupus nephritis. Caribbean Hispanics had a higher male prevalence and presented with worse renal function. SH (n=68) CH(n=35) Age 41.41± 1.69 41.11 ± 2.13 Gender (Male) 38.24% 45.71% Proteinuria (g/day) 7.95± 1.2 5.48± 1.1 eGFR (ml/min) 66.4 ± 4.64 55.86 ± 6.24 IgA 7(10.3%) 1 (2.9 %) FSGS 11 (16.2%) 5 (14.3%) SLE eGFR(ml/min) Gender (Male)

17 (25%) 83.3 ± 8.4 3 (17.6%)

11 (31.43 %) 62.7±11.5 4 (36.4%)

IgA nephropathy (IgAN) was highest in our SH population possibly due to genetic predisposition related to native ancestry. The incidence of FSGS was unexpectedly similar in both populations despite African ancestry in Caribbean Hispanics. However, consistent with African ancestry, Caribbean Hispanics presented with worse renal function.

116RISK OF RENAL ALLOGRAFT FAILURE DUE TO RECURRENT GLOMERULAR DISEASES Usman Rahmat1, Laura Flisnik2, Jennifer Verbesey3 and Basit Javaid3. 1Division of Nephrology, Department of Medicine, 2Georgetown University School of Medicine and 3Department of Surgery, Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC. Objective: The primary objective of this study was to assess the risk of graft loss due to recurrent glomerular diseases compared with other causes of graft failure in the UNOS kidney transplant cohort. Methods: All patients in the UNOS database who underwent a kidney transplant were considered for analysis. Cox proportional hazards regression modeling technique was used to determine the risk of graft failure due to disease recurrence compared with other causes of graft loss, with adjustment for confounders as applicable. Results: We identified 276,089 patients who underwent a kidney transplant in the United States between 10/01/1987 and 05/22/2009. Living donation accounted for 95,479 (34.6%) of transplants, with male gender dominating the recipient cohort (n=165,983; 60.1%). Recurrent disease was responsible for a significant proportion of graft failures in patients with FSGS (493/3869; 12.7%), membranous nephropathy (144/1386; 10.4%), MPGN I (36/343; 10.5%), MPGN II (12/49; 24.5%), and IgA nephropathy (209/2159; 9.7%). Patients with FSGS (unadjusted HR=1.29, 95%CI=1.17-1.42, p<0.01; adjusted HR=1.47, 95%CI=1.31-1.65, p<0.01); membranous nephropathy (unadjusted HR=1.23, 95% CI=1.04-1.47, p=0.02; adjusted HR=1.74, 95%CI=1.43-2.13, p<0.01); and MPGN I (unadjusted HR=1.48, 95%CI=1.05-2.10, p=0.03; adjusted HR=1.92, 95%CI=1.28-2.87, p<0.01) were more likely to have graft failure due to recurrent disease compared with all other causes of graft failure. The risk of graft failure due to disease recurrence was comparable for patients with kidney failure due to MPGN II, IgA nephropathy, SLE, post-infectious glomerulonephritis, Wegener’s, and Goodpasteur’s disease. Conclusions: Recurrence of glomerular diseases remains a significant cause of kidney transplant failure. Patients with FSGS, membranous nephropathy and MPGN I are more likely to develop graft failure due to disease recurrence and should be counseled accordingly.

NKF 2012 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2012;59(4):A1-A92 A43