Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort

Background Individuals with rare kidney diseases account for 5–10% of people with chronic kidney disease, but constitute more than 25% of patients receiving kidney replacement therapy. The National Registry of Rare Kidney Diseases (RaDaR) gathers longitudinal data from patients with these conditions, which we used to study disease progression and outcomes of death and kidney failure. Methods People aged 0–96 years living with 28 types of rare kidney diseases were recruited from 108 UK renal care facilities. The primary outcomes were cumulative incidence of mortality and kidney failure in individuals with rare kidney diseases, which were calculated and compared with that of unselected patients with chronic kidney disease. Cumulative incidence and Kaplan–Meier survival estimates were calculated for the following outcomes: median age at kidney failure; median age at death; time from start of dialysis to death; and time from diagnosis to estimated glomerular filtration rate (eGFR) thresholds, allowing calculation of time from last eGFR of 75 mL/min per 1·73 m2 or more to first eGFR of less than 30 mL/min per 1·73 m2 (the therapeutic trial window). Findings Between Jan 18, 2010, and July 25, 2022, 27 285 participants were recruited to RaDaR. Median follow-up time from diagnosis was 9·6 years (IQR 5·9–16·7). RaDaR participants had significantly higher 5-year cumulative incidence of kidney failure than 2·81 million UK patients with all-cause chronic kidney disease (28% vs 1%; p<0·0001), but better survival rates (standardised mortality ratio 0·42 [95% CI 0·32–0·52]; p<0·0001). Median age at kidney failure, median age at death, time from start of dialysis to death, time from diagnosis to eGFR thresholds, and therapeutic trial window all varied substantially between rare diseases. Interpretation Patients with rare kidney diseases differ from the general population of individuals with chronic kidney disease: they have higher 5-year rates of kidney failure but higher survival than other patients with chronic kidney disease stages 3–5, and so are over-represented in the cohort of patients requiring kidney replacement therapy. Addressing unmet therapeutic need for patients with rare kidney diseases could have a large beneficial effect on long-term kidney replacement therapy demand. Funding RaDaR is funded by the Medical Research Council, Kidney Research UK, Kidney Care UK, and the Polycystic Kidney Disease Charity

Statistical design of mass spectrometry calibration procedures

The main objective of this task was to agree on calibration procedures to estimate the system parameters (i.e., dead-time correction, ion-counting conversion efficiency, and detector efficiency factors) for SAL`s new Finnigan MAT-262 mass spectrometer. SAL will use this mass spectrometer in a clean-laboratory which was opened in December 1995 to measure uranium and plutonium isotopes on environmental samples. The Finnigan MAT-262 mass spectrometer has a multi-detector system with seven Faraday cup detectors and one ion- counter for the measurement of very small signals (e.g. 10{sup -17} Ampere range). ORNL has made preliminary estimates of the system parameters based on SAL`s experimental data measured in late 1994 when the Finnigan instrument was relatively new. SAL generated additional data in 1995 to verify the calibration procedures for estimating the dead-time correction factor, the ion-counting conversion factor and the Faraday cup detector efficiency factors. The system parameters estimated on the present data will have to be reestablished when the Finnigan MAT-262 is moved-to the new clean- laboratory. Different methods will be used to analyzed environmental samples than the current measurement methods being used. For example, the environmental samples will be electroplated on a single filament rather than using the current two filament system. An outline of the calibration standard operating procedure (SOP) is included

Differentiation of Aroclors in environmental samples using linear discrimination

Environmental samples suspected of containing polychlorinated biphenyls (PCBs) and analyzed by Environmental Protection Agency (EPA) methods frequently contain non-PCB components, such as phthalates, polynuclear aromatic hydrocarbons, or organochlorine pesticides. The presence of these interferences can often obscure the gas chromatographic (GC) patterns and cause problems in differentiating the Aroclor types by visual inspection. Because EPA methods require the identification of Aroclor types in order to determine which Aroclor standard should be used for the quantitation calibration, and possibly, to trace the source of PCB occurrences, electron capture negative ion chemical ionization (ECNICI) mass spectrometry was used to provide additional parameters for discriminating PCB congeners from the interferences. In this study, eight Aroclors (i.e., 1016, 1232, 1242, 1248, 1254, 1260, 1262, and 1268) were analyzed by ECNICI for a range of concentration levels. Using selective ion display, the ion abundances of the prominent peaks in the isotopic clusters of molecular ions were measured for eight PCB homologs (Cl{sub 2}-Cl{sub 9}) within their GC retention time windows for each sample. Corresponding relative ion abundances from eight Aroclor standards were used as classification training sets. These training sets were used to develop a classification algorithm using standard linear discriminant analysis to classify the PCBs present in an unknown sample(s) as a specific Aroclor. This technique employed a sequential application of two sets of linear discriminant functions to successfully identify known EPA quality control and environmental samples. However, classifications of Aroclor mixtures were less successful

Detecting isotopic ratio outliers

An alternative method is proposed for improving isotopic ratio estimates. This method mathematically models pulse-count data and uses iterative reweighted Poisson regression to estimate model parameters to calculate the isotopic ratios. This computer-oriented approach provides theoretically better methods than conventional techniques to establish error limits and to identify outliers. 6 refs., 3 figs., 3 tabs

Differeniation of Aroclors in environmental samples using negative ion chemical ionization (NICI) mass spectrometry

Environmental samples suspected of containing polychlorinated biphenyls (PCB) and analyzed by EPA Method 8080 frequently contain non-PCB components, such as phthalates, PAH's, or organochlorine pesticides. The presence of these interferences can often obscure the GC/ECD patterns and cause problems in differentiating the Aroclor types by visual inspection. Since Method 8080 requires the identification of Aroclor types in order to trace the sources of PCB occurrences, NICI detection was used to provide additional parameters for discriminating PCB congeners from interferences. In this study, a pattern recognition method has been developed to classify the types of Aroclors for environmental samples. A computer program written in BASIC has been implemented to facilitate Aroclor classification using the NICI ion abundance measurement for PCB congeners. NICI measurements on Aroclor standards were used as training data set to develop classification methods for environmental samples. PCB contaminated oil or soil samples were either extracted of diluted with hexane and analyzed in the same manner as the standards. This sequential classification method classified all Aroclors in the training set correctly. A set of 15 environmental samples with known Aroclor types were also correctly classified

The Hydrolysis of Di-Isopropyl Methylphosphonate in Ground Water

Di-isopropyl methylphosphonate (DIMP) is a byproduct from the manufacture of the nerve agent Sarin. The persistence of DIMP in the ground water is an important question in evaluating the potential environmental impacts of DIMP contamination. The half-life of DIMP in ground water at 10 deg C was estimated to be 500 years with a 95% confidence interval of 447 to 559 years from measurements of the hydrolysis rates at temperatures between 70 to 98 deg C.Extrapolation of the kinetics to 10 deg C used the Arrhenius equation, and calculation of the half-life assumed first-order kinetics. Inorganic phosphate was not detected

Resin bead U and PU analysis of WAK input solutions: a statistical summary of experiment No. 1

A statistical analysis of the resin bead experimental data was made to identify sources of variations among the measurements of isotopic atom ratios and elemental concentrations of plutonium and uranium. Comparisons among treatment means of the analytical laboratory and the resin bead preparation methods are tabulated using Duncan's multiple range test

Comparative Testing of Slurry Monitors

The US Department of Energy (DOE) has millions of gallons of radioactive liquid and sludge wastes that must be retrieved from underground storage tanks, transferred to treatment facilities, and processed to a final waste form. The wastes will be removed from the current storage tanks by mobilizing the sludge wastes and mixing them with the liquid wastes to create slurries. Each slurry would then be transferred by pipeline to the desired destination. To reduce the risk of plugging a pipeline, the transport properties (e.g., density, suspended solids concentration, viscosity, particle size range) of the slurry should be determined to be within acceptable limits prior to transfer. These properties should also be monitored and controlled within specified limits while the slurry transfer is in progress. The DOE issued a call for proposals for developing on-line instrumentation to measure the transport properties of slurries. In response to the call for proposals, several researchers submitted proposals and were funded to develop slurry monitoring instruments. These newly developed DOE instruments are currently in the prototype stage. Before the instruments were installed in a radioactive application, the DOE wanted to evaluate them under nonradioactive conditions to determine if they were accurate, reliable, and dependable. The goal of this project was to test the performance of the newly developed DOE instruments along with several commercially available instruments. The baseline method for comparison utilized the results from grab-sample analyses. Document type: Repor

Stability of purgeable VOCs in water samples during pre-analytical holding. Part 2: Analyses by an EPA regional laboratory

This study was undertaken to examine the hypothesis that prevalent and priority purgeable VOCs in properly preserved water samples are stable for at least 28 days. For the purposes of this study, VOCs were considered functionally stable if concentrations measured after 28 days did not change by more than 10% from the initial values. An extensive stability experiment was performed on freshly-collected surface water spiked with a suite of 44 purgeable VOCs. The spiked water was then distributed into multiple 40-mL VOC vials with 0.010-in Teflon-lined silicone septum caps prefilled with 250 mg of NaHSO{sub 4} (resulting pH of the water {approximately}2). The samples were sent to a commercial [Analytical Resources, Inc. (ARI)] and EPA (Region IV) laboratory where they were stored at 4 C. On 1, 8, 15, 22, 29, 36, and 71 days after sample preparation, analysts from ARI took 4 replicate samples out of storage and analyzed these samples for purgeable VOCs following EPA/SW846 8260A. A similar analysis schedule was followed by analysts at the EPA laboratory. This document contains the results from the EPA analyses; the ARI results are described in a separate report