361SATISFACTION WITH PROVIDER COMMUNICATION IS ASSOCIATED WITH PERCEIVED DISEASE KNOWLEDGE INPATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) Julie Wright, Kenneth Wallston, Svetlana Eden, Ayumi Shintani, T. Alp Ikizler, Kerri Cavanaugh. Vanderbilt University Medical Center, Nashville, TN USA Effective patient-provider communication is a crucial component of high quality patient care. Data are scarce regarding patient views of physician communication skills in the setting of pre-dialysis CKD care. Adult patients with non-dialysis dependent CKD (Stages 1-5) were enrolled from April-October 2009 during nephrology clinic visits. Patient satisfaction with provider communication was assessed using the Communication Assessment Tool (CAT), a validated scale for measuring patient perception of physician interpersonal and communication skills. Perceived knowledge was assessed by asking patients to rate their CKD knowledge on a scale from 1 (no knowledge)to 4 (a lot of knowledge) in nine areas and averaged to generate an overall perceived knowledge survey (PiKS) score. Associations between CAT and patient characteristics, including PiKS and a validated measure of objective CKD knowledge, were examined. Of 399 patients enrolled, the mean (SD) age was 57 (16) years. 53% were male, 83% Caucasian, and 77% had CKD Stage 3-5. The mean (SD) CAT and PiKS scores were 4.69 (0.51) and 2.56 (0.61), respectively. CAT was associated only with PiKS (Spearman correlation 0.15, p<0.0001) in unadjusted analysis. Patients of older age (OR 1.22 CI [1.11, 1.35]; p<0.0001 per 10 years), higher eGFR (1.03 [1.02, 1.04]; p<0.0001 per 5 ml/min/1.73m2), and higher PiKS (2.15 [1.72, 2.68]; p<0.0001 per 1.0 increment increase) were likely to have higher odds of satisfaction with provider communication in adjusted analysis that also included sex, race, health literacy (REALM survey), income, number of provider visits, and objective knowledge. Adjusted analysis presented no evidence that objective knowledge was associated with CAT score. In addition to advancing age and higher eGFR, patients' perception oftheir disease specific knowledge may be an important component of their satisfaction with CKD care.

362CLINICAL RESPONSE TO PEGINTERFERON IN A CASE OF HEPATITIS B VIRUS-ASSOCIATED NEPHROTIC SYNDROME FROM IGA NEPHROPATHY Iti Yadav, Deepti D. Torri, Hitesh H. Shah. NSLIJHS/Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, USA Hepatitis B virus (HBV) is most commonly associated with membranous nephropathy but it has also been seen with membranoproliferative glomerulonephritis, minimal change disease and IgA nephropathy. We report a patient with chronic HBV infection who presented with atypical clinical features of IgA nephropathy with management. A 47-year-old Taiwanese man presented with a 1-week history of generalized body swelling. He noted “foamy urine” approximately 2 months ago. He was diagnosed with HBV infection several years ago inTaiwan. His BP was 120/80 mm Hg. He had pitting edema of his lowerextremities. At the time of presentation, serum creatinine was 0.8 mg/dl, serum albumin 2.0 g/dl, AST 36 u/l, ALT 32 u/l, alkaline phosphatase 99 u/l, and cholesterol 589 mg/dl. Urinalysis showed 3+ proteinuria and 2+ blood. Spot urine total protein to creatinine ratio was8.8. C3 and C4 were normal. HBsAb and Hep C Ab were negative. However, HBsAg was positive. HBeAg was negative and HBeAb was positive. Quantitative HBV PCR assay was greater than 200,000 DNA copies/ml. He was started on daily furosemide, ramipril and atorvastatin. Renal biopsy results were consistent with IgA nephropathy. Liver biopsy showed grade I, stage 0 chronic hepatitis. The patient was started on peginterferon alfa-2b 150 µg subcutaneous weekly for 6 months. At follow-up after 4 months of therapy, the patient had a complete clinical remission of nephrotic syndrome. Serum creatinine was 0.7 mg/dl, serum albumin 3.9 g/dl, cholesterol 138 mg/dl, random urine protein/creatinine ratio 0.1 and quantitative HBV PCR assay was less than 200 DNA copies/ml. In conclusion, treatment with peginterferon alfa-2b induced complete clinical remission of our patient’s nephrotic syndrome from HBV associated IgA nephropathy as well as a dramatic decrease in HBV viral load. Our findings suggest that hepatitis B virus antigenemia, particularly HBsAg, have a pathogenic role in the development of somecases of IgA nephropathy.

363COLLABORATIVE OUTPATIENT MANAGEMENT OF RECURRENT MERKEL CELL CARCINOMA IN A HEMODIALYSIS PATIENT Iti Yadav, Deepti D. Torri, Hitesh H Shah. NSLIJHS/Hofstra North Shore-LIJ School of Medicine, Great Neck, New York Merkel cell carcinoma is a rare but aggressive neuroendocrine skin tumor predominantly seen in Caucasians and immunocompromised patients. Being such a rarity, the therapeutic guidelines are far from defined, posing a great challenge in population subgroups such as thoseon dialysis. Local disease is usually managed by surgical resection. However, disease with extensive skin involvement is not amenable to such therapy. This has led to experimental use of platinum based chemotherapy with agents like carboplatin in combination with etoposide. These combination therapies are derived from experiences from small cell lung cancer treatment. Carboplatin is well known to cause cytotoxicity via direct DNA damage. This can be prevented by timely elimination of the drug by modality like hemodialysis. We report a 68-year-old morbidly obese Caucasian male with historyof DM, ESRD on hemodialysis who was diagnosed with Merkel cell carcinoma of left leg approximately 2 yrs ago. At that time, patient underwent surgical resection of the tumor followed by radiation. He remained in remission until recently when he presented with recurrencemanifesting as multiple coin sized skin lesions involving his left leg. This time, the carcinoma was deemed to be far too extensive for any surgical intervention (Stage IIIbT2N2M0). Patient was initiated on chemotherapy regimen with carboplatin and etoposide for a total of six cycles. Carboplatin infusion was followed by outpatient hemodialysis within 1 hour of chemotherapy administration. Following six cycles of above chemotherapy, patient remains in remission with resolution of his skin lesions. He has had no adverse cytotoxic effects following chemotherapy. Based on our experience, combination chemotherapy with platinum based drug for Merkel cell carcinoma can be safely used in patients with ESRD. However, a collaborative approach in ensuring almost immediate hemodialysis to prevent cytotoxicity without limiting therapeutic effectiveness is needed.

364HEALTH-CARE PROFESSIONALS DIALYSIS MODALITY SELECTION SURVEY.Iti Yadav, Deepti D. Torri, Kenar D. Jhaveri. Hofstra North Shore LIJ School of Medicine, NY, USA In US >93% of the patients are treated with in -center hemodialysis(HD) about 7% undergo peritoneal dialysis(PD) and less than 1% are on home HD. Above fact depicts the choice trends among patients but also reveals that home dialysis therapies are clearly underutilized. There is scarce data on what a heathcare professional would choose for themselves. We conducted an anonymous survey via link from a survey generating website accessible through the internet. The survey consisted of seven questions aimed at assessing choice a health care provider would make for themselves. We posed these questions to physicians, nephrologists,nurses,dialysis nurses and nephrology fellowsin training. Preliminary results suggest that 51.2% of health care professionals chose PD to be their choice of therapy. Among those whochose HD 87% chose one of Home HD modality with only 13% choosing in-center HD; far from evident in our current US statistics for ESRD patients. 45.7% chose Nocturnal Long HD(6-8 hr,3 times/wk) ,31.5% Daily Short Home HD(2-3 hr,5-6 times/wk), 9.8% Home HD (3hr 3times/wk).70.5 % chose a modality based on a belief of better outcomes of one over the modality.57.3% responders reported the quality of life to be the specific outcome which was better for the modality they opted for with 35.4% choosing the modality based on better morbidity, mortality and survival data. In center HD was the modality most health care providers were comfortable discussing with their patients with only 18.7 % being comfortable in discussing PD. There is an urgent need for research in this area to explore the preferences of the physicians and health care providers for themselves which might have bearing on what their patients might opt for. Health care professionals perceptions about choice of modality are surprisinglynot reflected in the choice their patients are making.

NKF 2011 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2011;57(4):A1-A108 A107