P1039BARIATRIC SURGERY AND RISKS OF RENAL DISEASES, CARDIOVASCULAR DISEASES AND MORTALITY AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Background and Aims To measure and compare the risks of end-stage renal diseases (ESRD), cardiovascular diseases (CVD), all-cause mortality between obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery. Method A retrospective population-based cohort of 1,690 obese T2DM patients who were free of ESRD and CVD were assembled based on 2006-2017 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IR) of stage 4/5 chronic renal diseases, ESRD, CVD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for stage 4/5 chronic renal diseases, ESRD, CVD events were assessed using Cox proportional hazard models. Changes in estimated glomerular filtration rate (eGFR), and urine albumin-creatinine ratio (UACR) were measured up to 60 months. Results Over a mean follow-up period of 34 months with 863 person-years, cumulative incidences of mortality, stage 4/5 chronic kidney diseases, ESRD and CVD for surgical patients were 0, 0.050, 0.017, and 0.036, respectively. Surgical patients had reduced IR of all-cause mortality, stage 4/5 chronic kidney diseases, ESRD and CVD (IR=0, 1.784, 0.587 and 1.321 per 100 person-years, respectively) than control patients (IR=1.954, 2.028, 0.914 and 2.814 per 100 person-years, respectively). Surgery group had a significant reduction in risk of CVD events (HR=0.464, P=0.015), and no occurrence of mortality events. However, the IR of stage 4/5 chronic kidney diseases and ESRD of the two groups were not significantly different. Surgical patients had significantly higher eGFR within 12 months, and had significantly lower until 48 months. Conclusion Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes of eGFR up to 36 months.

Comparison of serum iron, TIBC, transferrin saturation and serum ferritin in anemia of chronic renal diseases

Background: In patients with CKD and diabetes combined, anemia may be relative or absolute. If the serum ferritin is more than or equal to 100ng/ml associated with reduced iron saturation, then it is defined as functional iron deficiency anemia. This type of anemia is very common in patients with CKD. To compare serum iron, TIBC, transferrin saturation and serum ferritin in anemia of chronic renal diseases with healthy controls.Methods: A hospital based comparative study was carried out among 30 known cases of chronic kidney disease with anemia. They were compared with 20 age and sex matched healthy control who were free from chronic kidney disease and anemia. The parameters like serum iron, TIBC, transferrin saturation and serum ferritin were compared between the two groups. Student’s t test and a two tailed p value were calculated and if the p value was less than 0.05, it was taken as statistically significant.Results: It was seen that the mean hemoglobin value was significantly less among CKD patients compared to healthy controls (p<0.05). Serum iron was also significantly less among CKD patients compared to healthy controls (p<0.05). TIBC as significantly high among CKD patients compared to healthy controls (p<0.05). This is because of low hemoglobin and low serum iron in CKD patients but again the transferrin saturation was significantly low among CKD patients compared to healthy controls (p<0.05).Conclusions: Anemia prevalence was very high in CKD patients. Hemoglobin, serum iron and transferrin saturation were significantly low and TIBC was significantly high.

Pulse-Spray Pharmacomechanical Thrombolysis of Native Arteriovenous Fistulas and Grafts under Ultrasound Guidance: Our Initial Experience

Chronic renal diseases have been on rise with most patients requiring renal transplantation. With advances in treatment, patients undergo hemodialysis through arteriovenous (AV) fistulas and grafts. Thrombosis in these fistulas and grafts are more common and may result in failure. Interventional radiology plays an important role in managing these thromboses through catheter-directed thrombolysis. With success rate of more than 80%, catheter-directed thrombolysis has become the treatment of choice. However, the need of trained personnel, well-equipped catheter laboratories, and expensiveness are its disadvantages. We share our initial experience in two patients in whom we have performed ultrasound-guided percutaneous pulse-spray pharmacomechanical thrombolysis as a day-care procedure. This technique is less expensive, can have a wider outreach, and patients can be benefitted early to avoid new access.