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NKF 2014 Spring Clinical Meetings Abstracts A19 Am J Kidney Dis. 2014;63(5):A1-A121 ASSOCIATION OF HIGH AND LOW DENSITY LIPOPROTEINS (HDL AND LDL) WITH ALL-CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS Pouya Abhari 1 ; Hamid Moradi 1 ; Vanessa Ravel 1 ; Elani Streja 1 ; Connie M. Rhee 1 ; Csaba P. Kovesdy 2 ; Rajnish Mehrotra 3 , Kamyar Kalantar-Zadeh 1 . 1 Harold Simmons Center, UC Irvine, Orange, CA; 2 Nephrology, Univ. Tennessee, Memphis, TN; 3 Univ. Washington, Seattle, WA; Previous studies have reported on a “lipid paradox” for hemodialysis (HD) patients, where associations of lipids with mortality are reverse or non- significant compared to what is found in the general population. The lipoprotein profile and patho-physi-ology of dyslipidemia in peritoneal dialysis (PD) are different from HD and the general population. The data on the associations of LDL and HDL with mortality in PD patients are limited. We examined the association of LDL and HDL separately with all-cause mortality among 1,440 PD only patients followed for up to 2 years (2004-2006). We use restricted cubic splines of Cox proportional hazard models with case- mix multivariable adjustment to illustrate the associations. Patients were 58±15 years old and included 46% women, 18% blacks, and 50% diabetics. Using 3 degrees of freedom, plots demonstrate non-significant associations of both increasing levels of HDL or LDL with all-cause mortality. Patients with HDL>100 mg/dL demonstrated a non-significant trend of increased death risk, while patients with LDL>160 m/dL showed a non- significant trend of higher mortality. In conclusion, in PD patients, the association of LDL and HDL levels with mortality appears different from the general population, similar to that described in HD patients in spite of the potential differences in pathophysiology between the two conditions. POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) MASQUERADING AS ACUTE REJECTION: Ameer Abdulrazzak M.D, FACP, David B. Butcher M.D, Keith A. Bellovich D.O, FASN. St. John Hospital and Medical Center, Detroit, MI, USA PTLD involving a kidney allograft is diagnosed pathologically by a diffuse lymphocytic infiltrate of such severity that is difficult to visualize tubular architecture. These findings can easily be confused with severe acute cellular rejection. We present a 27 year old male patient with a history of ESRD due to Aloport syndrome, status post living donor renal transplant. He presented 2 months post transplant, dehydrated with worsening level of creatinine and complaints of sore throat, and odynophagia. He had tender cervical lymphadenopathy. EBV serology was initially negative. BKV PCR and CMV DNA were all negative. Transplanted kidney biopsy was reported as acute T cell mediated rejection, Banff Type 1B. The patient received methylprednisolone, IVIG, and antithymocyte globulin. Despite therapy, his graft function continued to deteriorate requiring hemodialysis. In conjunction with above, worsening hyperbilirubinemia was also noted. Hepatitis panel was negative. CT of abdomen-pelvis showed a splenomegaly and retroperitoneal lymphadenopathy. Subsequent repeat EBV PCR showed 1,020,000 copy/ml. Two days later upper GI bleeding prompted EGD, which showed multiple ulcerated gastric lesions. Biopsies revealed EBV associated monomorphic type B cell PTLD. Donor specific antibodies came back negative. In light of these new findings the original graft biopsy pathology was reexamined and revised the diagnosis to EBV associated PTLD. The patient was started on R-CHOP chemotherapy, however the course had to be interrupted due to another bout of GI bleeding. PTLD can be mistakenly diagnosed as acute allograft rejection. This is critically important in EBV D+/R- presenting with acute mononucleosis symptoms. Since the treatment is markedly different, additional studies must be performed including stains for T and B cells, EBV antigens with PCR, and serum and urine protein electrophoresis. 1 3 2 4

ASSOCIATION OF HIGH AND LOW DENSITY LIPOPROTEINS (HDL AND LDL) WITH ALL-CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS

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NKF 2014 Spring Clinical Meetings Abstracts

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Am J Kidney Dis. 2014;63(5):A1-A121

ASSOCIATION OF HIGH AND LOW DENSITY LIPOPROTEINS (HDL AND LDL) WITH ALL-CAUSE MORTALITY IN PERITONEAL DIALYSIS PATIENTS Pouya Abhari1; Hamid Moradi1; Vanessa Ravel1; Elani Streja1; Connie M. Rhee1; Csaba P. Kovesdy2; Rajnish Mehrotra3, Kamyar Kalantar-Zadeh1. 1Harold Simmons Center, UC Irvine, Orange, CA; 2Nephrology, Univ. Tennessee, Memphis, TN; 3Univ. Washington, Seattle, WA; Previous studies have reported on a “lipid paradox” for hemodialysis (HD)

patients, where associations of lipids with mortality are reverse or non-significant compared to what is found in the general population. The lipoprotein profile and patho-physi-ology of dyslipidemia in peritoneal dialysis (PD) are different from HD and the general population. The data on the associations of LDL and HDL with mortality in PD patients are limited. We examined the association of LDL and HDL separately with all-cause

mortality among 1,440 PD only patients followed for up to 2 years (2004-2006). We use restricted cubic splines of Cox proportional hazard models with case-mix multivariable adjustment to illustrate the associations. Patients were 58±15 years old and included 46% women, 18% blacks, and

50% diabetics. Using 3 degrees of freedom, plots demonstrate non-significant associations of both increasing levels of HDL or LDL with all-cause mortality. Patients with HDL>100 mg/dL demonstrated a non-significant trend of increased death risk, while patients with LDL>160 m/dL showed a non-significant trend of higher mortality.

In conclusion, in PD patients, the association of LDL and HDL levels with mortality appears different from the general population, similar to that described in HD patients in spite of the potential differences in pathophysiology between the two conditions.

POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) MASQUERADING AS ACUTE REJECTION: Ameer Abdulrazzak M.D, FACP, David B. Butcher M.D, Keith A. Bellovich D.O, FASN. St. John Hospital and Medical Center, Detroit, MI, USA PTLD involving a kidney allograft is diagnosed pathologically by a diffuse lymphocytic infiltrate of such severity that is difficult to visualize tubular architecture. These findings can easily be confused with severe acute cellular rejection. We present a 27 year old male patient with a history of ESRD due to Aloport syndrome, status post living donor renal transplant. He presented 2 months post transplant, dehydrated with worsening level of creatinine and complaints of sore throat, and odynophagia. He had tender cervical lymphadenopathy. EBV serology was initially negative. BKV PCR and CMV DNA were all negative. Transplanted kidney biopsy was reported as acute T cell mediated rejection, Banff Type 1B. The patient received methylprednisolone, IVIG, and antithymocyte globulin. Despite therapy, his graft function continued to deteriorate requiring hemodialysis. In conjunction with above, worsening hyperbilirubinemia was also noted. Hepatitis panel was negative. CT of abdomen-pelvis showed a splenomegaly and retroperitoneal lymphadenopathy. Subsequent repeat EBV PCR showed 1,020,000 copy/ml. Two days later upper GI bleeding prompted EGD, which showed multiple ulcerated gastric lesions. Biopsies revealed EBV associated monomorphic type B cell PTLD. Donor specific antibodies came back negative. In light of these new findings the original graft biopsy pathology was reexamined and revised the diagnosis to EBV associated PTLD. The patient was started on R-CHOP chemotherapy, however the course had to be interrupted due to another bout of GI bleeding. PTLD can be mistakenly diagnosed as acute allograft rejection. This is critically important in EBV D+/R- presenting with acute mononucleosis symptoms. Since the treatment is markedly different, additional studies must be performed including stains for T and B cells, EBV antigens with PCR, and serum and urine protein electrophoresis.

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A19