RESULTS: A total of 74 participants were enrolled in the study. Through RNA sequencing, we found 107 different miRNA expressions between HVs and patients without DN, and 95 different expressions between HVs and patients with DN. Among these differently expressed miRNAs, we found 7 miRNAs uniquely up-regulated in patients with DN compared to HVs, and 1 miRNA highly expressed in patients with DN when compared to those without DN. Biological pathway analysis of 8 miRNAs revealed that these are likely involved in MAPK, integrins in angiogenesis, and AP-1 transcription factor. Moreover, all these miRNAs had significant correlation with amount of albuminuria. CONCLUSIONS: Patients with DN have different profiles of serum exosomal miRNAs when compared to HVs and these miRNAs may be a promising candidates for diagnosis and treatment of DN. FP497 FACTORS PREDICTING RAPID PROGRESSION IN MEN AND WOMEN WITH DKD IN ROUTINE CLINICAL PRACTICE Sol Carriazo 1 , Jinny Sanchez 1 , Teresa Stock da Cunha 1 , Alejandro Avello 1 , Esmeralda Castillo-Rodr  ıguez 1 , Maria Dolores S anchez-Ni~ no 2 , Alberto Ortiz 1 , Beatriz Fernandez 1 1 Fundaci on Jime ´nez D  ıaz, Madrid, Spain and 2 IIS-Fundaci on Jimenez Diaz UAM, Madrid, Spain INTRODUCTION: There is recent interest and controversy on the reasons behind the lower incidence of renal replacement therapy in women, despite a higher prevalence of CKD. Diabetic kidney disease (DKD) is the most frequent cause of end-stage kidney disease. We explored DKD outcomes in men and women treated according to guidelines by nephrologists under routine clinical practice conditions. Aim: to analyze the characteristics, progression of CKD and predictive factors in men and women with DKD under nephrological care. METHODS: Prospective cohort study of patients referred to an outpatient CKD clinic and treated according to existing guidelines. RESULTS: 261 incident patients, two thirds of them men, mean age 68613 were studied. Women had lower albuminuria, were more frequently non-smokers, and had lower urinary sodium and potassium and higher folate levels. The distribution in G categories was similar in men and women but in men, proteinuria categories were skewed towards A2-A3. Over a mean follow-up of 30610 months, eGFR had changed by -1.2 [-4.6;2.3]ml/min/ 1.73m 2 /year in men and -0.8 [4.1; 3.5] ml/min/1.73m 2 /year in women, very similar to general population age-related standards. Albuminuria remained stable in men changing by 3.1 [-7.3;20.3] %/year, but decreased in women, changing by -4.8 [- 12.9;7.4] %/year. There were 48/261 (18%) rapid progressors, losing eGFR >5 ml/min/1.73m2/year. Women represented 15/48 (31%) of rapid progressors and 70/199 (35%) of non- progressors. Lower 25OH vitamin D levels and higher UACR were associated with rapid progression in both sexes, but most of the statistically significant predictors differed for men and women. The AUC for predicting rapid progression by UACR was 0.71 (95% CI 0.61 to 0.81) for men and 0.62 (95% CI 0.43 to 0.82, thus overlapping the 0.50 mark) for women, with cut-off points of 811 and 213 mg/g respectively. 36% of men and 20% of women with A3 UACR were rapid progressors. The best multivariate model to predict rapid progression in the whole cohort included UACR, FEphosphate, triglycerides, uric acid and vitamin B12 (AUC to predict rapid progression 0.81). UACR and FEphosphate were part of the multivariable model predicting rapid progression in men (AUC 0.92). The women multivariate model included systolic blood pressure, uric acid and either folate or UACR (AUC 0.90 and 0.91, respectively). CONCLUSIONS: In women with DKD, CKD progression is slower overall than in men and a reduction in albuminuria is more frequent. Those differences could be partially explained for genetic or hormonal differences, but also behavioral factors. However, the proportion of rapid progressors was similar in both sexes although factors predicting rapid progression differed. FP498 THE RELATIONSHIP OF ENDOTHELIAL DYSFUNCTION AND RENAL DYSFUNCTION IN PATIENTS WITH DIABETES MELLITUS TYPE 2 Mirakhmadjon Mirmaksudov 1 , Muzaffar Usarov 1 , Durbek Rakhmonov 1 , Marufjon Norkulov 1 1 Tashkent Medical Academy, jłreyn, Uzbekistan INTRODUCTION: Endothelial dysfunction in renal vasculature is implicated in the pathogenesis of renal failure in type 2 diabetes mellitus (DM). Endothelial dysfunction occurs in systemic vasculature of DM patients, and there may be a relationship between endothelial dysfunction in the brachial artery and renal vasculature. This study examined whether endothelial vasomotor dysfunction in the brachial artery predicts early renal dysfunction in DM patients. METHODS: Flow-mediated endothelium-dependent dilation (FMD, % increase in artery diameter from baseline) in the brachial artery was measured in 27 consecutive DM patients with normal renal function at enrollment (serum creatinine levels [sCr] <1.0 mg/dl, urinary albumin excretion [UAE] < 25 mg/day and estimated glomerular filtration rate [eGFR] 60 mL/min/1.73 m2 at baseline). They were prospectively followed for 1.5 years. The end point was development of early stage renal dysfunction, defined as occurrence of one or more of the following events: sCr 1.2 mg/dL, UAE 30 mg/day and eGFR < 60 mL/min/1.73 m2 RESULTS: During the follow-up period, early stage renal dysfunction developed in 63 (46.7%) patients with impaired FMD (< 5.2%, 50th percentile of the distribution) and in 17 (12.1 %) patients with the preserved FMD ( 5.2%) (p < 0.0001). Using multivariate logistic analysis, the impaired FMD was an independent predictor of the development of early stage renal dysfunction (OR; 5.1, 95%CI; 2.62 - 9.68, p < 0.0001) after adjustment with covariates, including hypertension, age, use of anti-diabetic drugs and CRP levels. Using a c-statistic, the predictive value of impaired FMD was significantly incremental over that of the conventional known risks including hypertension, age, use of anti-diabetic drug and CRP levels for progression of renal dysfunction (area under the ROC curve; 0.88 and 0.72, respectively, p = 0.01). Dilator response of the brachial artery to nitrates had no significant predictive value. CONCLUSIONS: Endothelial vasomotor dysfunction in the brachial artery is an independent predictor of development of early renal dysfunction in DM patients. The measurement of FMD is useful for identifying patients with type 2 DM at risk of developing future renal dysfunction. FP499 PHARMACODYNAMIC REASON WHY THE DOSE OF SGLT2 INHIBITORS SHOULD NOT BE REDUCED IN PATIENTS WITH GFR LESS THAN 45 ML/MIN Keller Frieder 1 1 Universit€ atsklinikum Ulm, Ulm, Germany INTRODUCTION: Though less glucose is cleared and half-life only slightly increases from 14 to 20 hours, the drug label recommends a reduced dose of 10 mg empagliflozin when eGFR is < 60 ml/min. METHODS: This study wants to explain why and how dapagliflozin likewise benefits patients even with an eGFR of 21 ml/min [Park HS. Kidney Res Clin Pract. 2018]. The published data were analyzed to characterize pharmacodynamics of SGLT2 inhibitors. RESULTS: Pharmacodynamics have been characterized for empagliflozin [Mondick J. Diabetes Obes Metab. 2016]: The empagliflozin plasma concentration producing 50 % of the maximum inhibitory effect is low at 4.61 nmo/l (CE50). Impaired kidney function means that the maximum effect (Emax) will decrease along with lower number of SGLT2 transporters. A high and over-ceiling concentration (C) will be needed to produce a constant effect (E) on glucose reabsorption according to the pharmacodynamic Emax model [Hartmann B. Dtsch Aerztebl Int. 2010]. CONCLUSIONS: Empagliflozin should be given with 25 mg/day to establish a glucose clearance of 45 ml/min in patients with an eGFR of 45 ml/min as demonstrated with canagliflozin [Yamout H. Am J Nephrol. 2014]. FP500 EXPLORING THE MODERATING EFFECT OF MEDICATION COMPLIANCE ON THE RELATIONSHIP BETWEEN COMORBIDITY AND MEDICAL COSTS FOR DIABETIC PATIENTS Yi-Hsin Chen 1 , Chin-Shien Lin 2 , Ming-Ju Wu 3 1 Taichung Tzuchi Hospital, Taichung, Taiwan, 2 National Chung Hsing University, Taichung, Taiwan and 3 Taichung Veterans General Hospital, Taichung 407, Taiwan INTRODUCTION: Prevalence of diabetes mellitus is increasing worldwide. Diabetes was also the fifth cause of mortality. Regularly taking medication and receiving follow- up are the main treatment besides exercise and healthy diet. Medication compliance is important in treating chronic disease such as diabetes. Diabetes with poor control will cause terrible outcomes such as amputation and blindness. Stroke and myocardial infarction are common in diabetic patients with high morbidity and mortality. Charlson comorbidity index is often used as a clinical prognostic indicator. Previous studies indicated high index is associated with more medical interventions such as admission and critical care. Medical coast will increase with high index too.Our objectives are 1. We want to investigate if Charlson comorbidity index in diabetic patients will affect medical cost 2. We want to know if the medication compliance was the moderator between Charlson comorbidity index and medical cost. doi:10.1093/ndt/gfz106 | i211 Nephrology Dialysis Transplantation Abstracts Downloaded from https://academic.oup.com/ndt/article/34/Supplement_1/gfz106.FP497/5514803 by guest on 08 December 2021