Background and objectives The cytokine midkine (MK) is pathologically implicated in progressive chronic kidney disease (CKD) and its systemic consequences and has potential as both a biomarker and therapeutic target. To date, there are no published data on MK levels in patients with different stages of CKD. This study aims to quantify MK levels in patients with CKD and to identify any correlation with CKD stage, cause, progression, comorbid disease or prescribed medication. Methods In this observational, single-centre study, demographic data were collected, and serum and urine assayed from 197 patients with CKD and 19 healthy volunteers in an outpatient setting. Results The median serum and urine MK level in volunteers was 754 pg/mL (IQR: 554–1025) and 239 pg/mL (IQR: 154–568), respectively. Compared with serum MK in stage 1 CKD (660 pg/mL, IQR: 417–893), serum MK increased in stage 3 (1878 pg/mL, IQR: 1188–2756; p<0.001), 4 (2768 pg/mL, IQR: 2065–4735; p<0.001) and 5 (4816 pg/mL, IQ: 37477807; p<0.001). Urine MK levels increased from stage 1 CKD (343 pg/mL, IQR: 147–437) to stage 3 (1007 pg/mL, IQR: 465–2766; p=0.07), 4 (2961 pg/mL, IQR: 1368–5686; p=0.005) and 5 (6722 pg/mL, IQR: 3796–10 060; p=0.001). Fractional MK excretion (FeMK) increased from stage 1 CKD (0.159, IQR: 0.145–0.299) to stage 3 (1.024, IQR: 0.451–1.886, p=0.047), 4 (3.39, IQR: 2.10–5.82, p=0.004) and 5 (11.95, IQR: 5.36–24.41, p<0.001). When adjusted for estimated glomerular filtration rate, neither serum nor urine MK correlated with primary CKD diagnosis or CKD progression (small sample). There was a positive correlation between protein:creatinine ratio and FeMK (p=0.003). Angiotensin blockade (adjusted for proteinuria) was associated with lower urine MK (p=0.018) and FeMK (p=0.025). Conclusion MK levels sequentially rise with CKD stage beyond stage 2, and our data support existing animal evidence for an MK/renin angiotensin-system/proteinuria relationship. To what extent this is related to renal clearance versus pathology, or the consequences of chronically elevated MK levels requires further exploration.

AimMost clinical registries in Australia, including the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), do not audit submitted data. Inaccurate data can bias registry analysis. This study aimed to audit data submitted to ANZDATA from a single region.MethodsA retrospective audit of individual haemodialysis patient data recorded by ANZDATA at 31 December 2009 was completed by nephrologists in a blinded fashion. Original data were recorded by nursing staff. Patients received treatment at a public hospital, two affiliated satellite haemodialysis units, and three private haemodialysis units.ResultsFifty-one audits were completed of a total 175 patients (29.1%) undertaking haemodialysis in 2009. Primary renal disease was correct in 86.3% (95%CI: 74.3-93.2), although errors in type of glomerulonephritis were common. Date of first dialysis ( 1-month error margin) was correct for 93.6%. Creatinine at first dialysis (10% error margin) was correct in 74.4%. Baseline comorbidity accuracy included: peripheral vascular disease (sensitivity 36.4% (95%CI: 24.6-50.1), specificity 82.8% (95%CI: 70.2-90.7)), ischaemic heart disease (sensitivity 69.2% (95%CI: 55.6-80.2), specificity 88.0% (95%CI: 76.3-94.3)), chronic lung disease (sensitivity 25.0% (95%CI: 15.2-38.3), specificity 93.6% (95%CI: 83.4-97.7)), diabetes (sensitivity 86.4% (95%CI: 74.4-93.2), specificity 96.6% (95%CI: 87.5-99.1)), cerebrovascular disease (sensitivity 75.0% (95%CI: 61.7-84.8), specificity 95.3% (95%CI: 85.8-98.6)), and ever smoked (sensitivity 83.3% (95%CI: 70.3-91.4), specificity 71.4% (95%CI: 57.3-82.3)). Non-melanoma skin cancer was under-reported and inaccurate.ConclusionData accuracy was favourable compared with other renal registry validation studies. Data accuracy may be improved by education and training of collectors. A larger audit is necessary to validate ANZDATA.Summary at a Glance Gray etal. present a local audit of the accuracy of data captured by ANZDATA for a cohort of their haemodialysis patients. These data hope to emphasize the accuracy of data collection in the large registration programme. They provide a comprehensive renal registry protocol and data validation. Finally, they emphasize the data accuracy may be improved by education and training of collectors.

NephrologyVolume 12, Issue 4 p. 420-421 PRIMARY PRESENTATION WITH METASTATIC MERKEL CELL CARCINOMA IN A RENAL TRANSPLANT RECIPIENT MOHAMMED O KAISAR, MOHAMMED O KAISAR Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this authorKUMAR MAHADEVAN, KUMAR MAHADEVAN Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this authorRANDALL J FAULL, RANDALL J FAULL Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this author MOHAMMED O KAISAR, MOHAMMED O KAISAR Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this authorKUMAR MAHADEVAN, KUMAR MAHADEVAN Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this authorRANDALL J FAULL, RANDALL J FAULL Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, AustraliaSearch for more papers by this author First published: 17 July 2007 https://doi.org/10.1111/j.1440-1797.2007.00818.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume12, Issue4August 2007Pages 420-421 RelatedInformation

SUMMARY: Background: The biochemical, haemodynamic, clinical and nutritional benefits of nocturnal home haemodialysis (NHHD) compared with 4 h, three times per week conventional haemodialysis are well known and accrue by increasing dialysis time and frequency either for 8 h alternate night per week (NHHD 3.5 ) or for 8 h six nights per week (NHHD 6 ). However, there are little data comparing NHHD 3.5 with NHHD 6 . Method and Results: Thirteen patients on NHHD 6 were compared with 21 patients on NHHD 3.5 , all with similar demographic profiles. Pre‐ and post‐dialysis phosphate (PO 4 ) control was ideal between the groups. However, all NHHD 6 needed PO 4 supplementation compared with 4/21 (19%) NHHD 3.5 . In the present study, 8/21 (38%) NHHD 3.5 needed PO 4 binders whereas none was required with NHHD 6 . The pre‐haemoglobin (Hb) 122.8 g/L (NHHD 6 ) versus 124.9 g/L (NHHD 3.5 ) and the pre‐albumin 38.31 g/L (NHHD 6 ) versus 37.71 g/L (NHHD 3.5 ) were not significantly different. NHHD 6 had significantly lower pre‐blood urea and creatinine (10.16 vs 19.54 mmol/L and 437.0 vs 812.3 µmol/L, respectively). Less interdialytic urea and creatinine fluctuation were also noted in NHHD 6 . Of major significance was the significantly lower ultra filtration rate and intradialytic weight gains (mean ± SEM) of NHHD 6 (249 ± 76 mL/h and 2.0 ± 0.65 kg) versus NHHD 3.5 (425 ± 168 mL/h and 2.9 ± 1.2 kg). Conclusion: The authors conclude that NHHD 6 offers the optimum biochemical, volume and clinical outcome, but NHHD 3.5 has additional appeal to providers seeking home‐based therapy cost advantages and consumable expenditure control. A flexible dialysis programme should offer all the time and frequency options of NHHD but in particular, should support NHHD at a frequency sympathetic to the clinical rehabilitation and lifestyle aspirations of individual patients.

BACKGROUND:Despite the advent of two new dialysis options, nocturnal home haemodialysis and short daily haemodialysis, many units are yet to build them into the modalities on offer to end-stage renal failure patients. The reasons behind this inertia are complex but primarily include anxieties about workload, budgetary implications and outcome data.METHOD:The Geelong dialysis programme, where both nocturnal home haemodialysis and short daily haemodialysis are offered, is compared with Australian and New Zealand national profiles.RESULTS:Significant profile differences emerge when comparing sessions/week and h/week between the three groups. Most Australian (92.93%) and New Zealand (95.07%) haemodialysis patients dialyse for three sessions/week. This contrasts to Geelong where only 73.6% dialyse for three sessions/week. 18.8% of Geelong haemodialysis patients versus 1.8% (Australia) and 0.9% (New Zealand) dialyse for five or more sessions/week. Australia and New Zealand follow similar h/session patterns although more Australians (44.2%) dialyse for 4 h and fewer (24.2%) for 5 h than their New Zealand counterparts (39.6% and 29.8%, respectively), and few dialyse outside the 3.5-5 h window. In contrast, 6.7% of Geelong patients dialyse for 2-2.5 h/session versus Australia (0.9%) and New Zealand (0.2%). This represents the Geelong short daily dialysis programme. More Geelong patients (>15%) dialyse >/=8 h/week and represent the Geelong nocturnal home haemodialysis programme.CONCLUSION:The flexible Geelong programme has been supported without exceeding the budget applied to a conventional dialysis programme with the same patient numbers.

The biochemical, haemodynamic, clinical, and nutritional benefits of nocturnal haemodialysis (NHD) compared with (c/w) 4 hr, 3/week conventional haemodialysis (CHD) are well known and accrue by increasing dialysis time and frequency either for 8 hrs alternate night/week (NHD3.5) or for 8 hrs 6 nights/week NHD (NHD6). However, there is little data yet comparing NHD3.5 with NHD6. 13 NHD6(8.15 hrs/night) were c/w 14 NHD3.5(7.8 hrs/night), all with similar demographic profiles. NHD6 had unrestricted diet and fluid intake but NHD3.5 needed some restriction. Before (b) and after (a) HD phosphate (PO4) control was ideal though bPO4 levels for NHD6 were lower (1.64 mmol/l) c/w NHD3.5(1.83 mmol/l). All NHD6 needed PO4 supplementation c/w 2/14 NHD3.5 but 5/14 NHD3.5 needed PO4 binders c/w 0/13 NHD6. Both had normal blood pressures with 3/14 NHD3.5 needing anti‐hypertensives c/w 2/13 NHD6. The bHb was 122.8 g/l (NHD6) c/w 127.7 g/l (NHD3.5) and the balbumin was 38.3 g/l (NHD6) c/w 37.7 g/l (NHD3.5). NHD6 had lower b blood urea (10.2 c/w 19.5 mmol/l) and less interdialytic urea and creatinine fluctuation. NHD6 ultrafiltration rates (UFR) and intradialytic weight gains (mean ± SEM) were significantly lower (248 ± 22.7 ml/hr and 2.03 ± 0.19 kg) c/w NHD3.5(453 ± 34.6 ml/hr and 2.85 ± 0.27 kg): UFR p < 0.10. We conclude that NHD6 offers the optimum biochemical, volume, and clinical outcome but NHD3.5 still has a clear and major advantage over CHD and a dual additional appeal to providers seeking home‐based therapy cost advantages and consumable expenditure control. A flexible dialysis program should offer all the time and frequency options of NHD but, in particular, should support NHD at a frequency sympathetic to the clinical, rehabilitation, and lifestyle aspirations of individual patients.

In end‐stage renal failure, impaired renal catabolism leads to retention of beta 2 microglobulin (ß2M), identified as the major constituent of hemodialysis (HD) related amyloidosis. It has been previously shown that, while using a high flux (HF) HD membrane, nocturnal hemodialysis (NHD) with its increased time and frequency provides a much higher clearance of ß2M compared to conventional HD. We compared serum ß2M levels between low flux (LF) and HF in a group of 9 NHD patients who dialyse 8 hours 6 nights/week. Fresenius polysulfone LF membrane size F6‐F8 HPS dialyser were used for the first 15 months (mth) of NHD (SA 1.3–1.8 m2). Subsequently, polysulfone HF FX80 dialyzer were used (SA 1.8 m2). Blood flow and dialysate flow rates were unchanged throughout the study. ß2M levels were measured at 6, 12, 15 mth on LF and at 6, 12 mth on HF. Albumin, homocysteine (Hcy), and phosphate (Phos) levels were also recorded at these times. ß2M levels trended upwards during the 15 mth on LF (36.6 ± 10.57 at 6 mth vs 47.1 ± 11.7 at 15 mth). On introduction of HF, there was a significant fall in ß2M at 6 mth to 12.4 ± 3.5 (p < 0.003), while ß2M levels were unchanged at 12 mth of HF. A downward trend in Hcy levels with the use of HF was noted (12.9 ± 2.9 at 0 mth Vs 11.1 ± 3.7 at 12 mth). Plasma albumin and Phos levels remained unchanged as did the use of Phos supplementation. Levels of ß2M continued to rise on NHD with LF, indicating inadequate clearance. With the introduction of HF there was a significant fall in ß2M levels consistent with improved clearance. The implications of this are that ß2M clearance may be time and frequency dependent only if dialyser membrane flux is adequate.