Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.

Background and objectives The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older ($65 years, n=1005) and younger (,65 years, n=2878) patients.Design, setting, participants, & measurements Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified.Results Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rates of kidney transplantation and parathyroidectomy were .3-fold higher in younger relative to older patients and were more frequent in patients randomized to placebo. In older patients, the adjusted relative hazard (95% confidence interval) for the primary composite (CV) end point (cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients, the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to 1.13). Reduction in the risk of severe unremitting HPT was similar in both groups. ConclusionsIn the EVOLVE trial, cinacalcet decreased the risk of death and of major CV events in older, but not younger, patients with moderate to severe HPT who were receiving hemodialysis. Effect modification by age may be partly explained by differences in underlying CV risk and differential application of cointerventions that reduce parathyroid hormone.

Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early access failure (EAF) as well as ischemic heart disease (IHD) (Am J Kidney Dis. 2003; 41: 422-428). Objective: This study was designed to determine the impact of IHD on the EAF in nondiabetic HD patients. Methods: This study enrolled 125 nondiabetic HD patients who received radiocephalic arteriovenous fistula operation for the first time. We evaluated IHD before the operation through clinical symptoms and electrocardiography and then investigated EAF within 1 year after the operation. We analyzed the access patency rates between the patients with and without IHD, using Kaplan-Meier method and log-rank test. Multiple regression analysis was performed to identify independent risk factors of the EAF. Results: The mean age of the patients was 48 AE 14 years, and the number of females was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the operation. The EAF developed in 23 patients (18.4%) within 1 years after the operation. The access patency rate in the patients with IHD was lower than that in the patients without IHD (39.7 vs. 88.3%, p < 0.001). IHD and old age were independent risk factors of the EAF in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the EAF. Conclusion: This study suggests that IHD is closely associated with EAF in nondiabetic HD patients. Dialysis Staff Time and SupplyCost for the LifeSite System vs. Hemodialysis Catheters D. Shore, S. Vega. West Palm Dialysis --Preferred Medical Group, West Palm Beach, FL, U.S.A.The LifeSite System is a new subcutaneous vascular access option for hemodialysis patients. As the procedure for accessing the Life-Site differs from hemodialysis catheters, we prospectively studied the differences in time required to initiate and discontinue treatments for LifeSite patients compared to patients with hemodialysis catheters. We also collected data on the cost of supplies and the number of alarms during dialysis for both groups. 5 LifeSite and 5 catheter patients were chosen at random for participation in the study. The time required for the ON and OFF procedures was recorded for 3 consecutive dialysis sessions for each patient for a total of 15 observations/group. The average staff time required per session for supply preparation, ON/OFF procedure, dressing changes, and responding to alarms was 15.9 min for the LifeSite and 16.9 min for catheters. Catheter patients experienced 4.5Background: Hemodialysis is often complicated by cardiovascular instability (CVI). We studied factors contributing to

Abstract.Background: Human paraoxonase-1 (PON1) inhibits LDL-oxidation and atherogenesis, and possesses lactonase activity. Decreased PON1 activity was found in hemodialyzed and renal transplanted patients. Cystatin C plays a protective role in atherosclerosis, and is a new, sensitive marker of renal function. The relationship between these two markers in renal failure has not been investigated. Aims: The goal of this study was to clarify the relationship between PON1 activity, cystatin C and homocysteine in chronic renal failure. We also determined the levels of oxidatively modified LDL (oxLDL) and thiobarbituric acid reactive substances (TBARS) to characterize lipid peroxidation. Patients and methods: 74 hemodialized (HD), 171 renal transplanted patients (TRX), and 110 healthy controls (C) were involved in the study. PON1 activity and TBARS levels were measured spectrophotometrically. OxLDL level was determined with sandwich ELISA. Results: There was a negative correlation between PON1 activity and cystatin C level. Homocysteine level correlated negatively with PON1 activity, and positively with cystatin C level. OxLDL and TBARS levels were significantly higher in the HD and TRX groups compared to C. Conclusions: Cystatin C may be a good predictive factor not only for homocysteine levels but for the antioxidant status in patients with renal failure and renal transplantation.

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