Effect of increased convective clearance by on-line hemodiafiltration on all cause and cardiovascular mortality in chronic hemodialysis patients – the Dutch CONvective TRAnsport STudy (CONTRAST): rationale and design of a randomised controlled trial [ISRCTN38365125]

BACKGROUND: The high incidence of cardiovascular disease in patients with end stage renal disease (ESRD) is related to the accumulation of uremic toxins in the middle and large-middle molecular weight range. As online hemodiafiltration (HDF) removes these molecules more effectively than standard hemodialysis (HD), it has been suggested that online HDF improves survival and cardiovascular outcome. Thus far, no conclusive data of HDF on target organ damage and cardiovascular morbidity and mortality are available. Therefore, the CONvective TRAnsport STudy (CONTRAST) has been initiated. METHODS: CONTRAST is a Dutch multi-center randomised controlled trial. In this trial, approximately 800 chronic hemodialysis patients will be randomised between online HDF and low-flux HD, and followed for three years. The primary endpoint is all cause mortality. The main secondary outcome variables are fatal and non-fatal cardiovascular events. CONCLUSION: The study is designed to provide conclusive evidence whether online HDF leads to a lower mortality and less cardiovascular events as compared to standard HD

What is new in uremic toxicity?

Uremic syndrome results from a malfunctioning of various organ systems due to the retention of compounds which, under normal conditions, would be excreted into the urine and/or metabolized by the kidneys. If these compounds are biologically active, they are called uremic toxins. One of the more important toxic effects of such compounds is cardio-vascular damage. A convenient classification based on the physico-chemical characteristics affecting the removal of such compounds by dialysis is: (1) small water-soluble compounds; (2) protein-bound compounds; (3) the larger “middle molecules”. Recent developments include the identification of several newly detected compounds linked to toxicity or the identification of as yet unidentified toxic effects of known compounds: the dinucleotide polyphosphates, structural variants of angiotensin II, interleukin-18, p-cresylsulfate and the guanidines. Toxic effects seem to be typically exerted by molecules which are “difficult to remove by dialysis”. Therefore, dialysis strategies have been adapted by applying membranes with larger pore size (high-flux membranes) and/or convection (on-line hemodiafiltration). The results of recent studies suggest that these strategies have better outcomes, thereby clinically corroborating the importance attributed in bench studies to these “difficult to remove” molecules

An environmental (pre)history of European fishing: past and future archaeological contributions to sustainable fisheries.

This paper explores the past and potential contribution of archaeology to marine historical ecology. The primary focus is European fishing of marine and diadromous taxa, with global comparisons highlighting the wider applicability of archaeological approaches. The review illustrates how study of excavated fish bones, otoliths and shells can inform our understanding of: (a) changes in biogeography, including the previous distribution of lost species; (b) long-term fluctuations in the aquatic environment, including climate change; (c) the intensity of exploitation and other anthropogenic effects; (d) trade, commodification and globalisation. These issues are also relevant to inform fisheries conservation and management targets. Equally important, the long (pre)history of European fishing raises awareness of our ecological heritage debt, owed for centuries of wealth, sustenance and well-being, and for which we share collective responsibility. This debt represents both a loss and a reason for optimism, insofar as it is a reservoir of potential to be filled by careful stewardship of our rivers, lakes, seas and oceans

Recovery of dialysis patients with COVID-19 : health outcomes 3 months after diagnosis in ERACODA

Background. Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods. We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results. In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8-6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions. Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

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Tijdens de opgraving bij het abdijcomplex te Middelburg zijn behalve aardewerkscherven ook dierlijke resten gevonden. De resten komen van een plek tussen de noordzijde van de oostvleugel aan het Pandhof en de zuidmuur van het Abtshuis.1 De resten zijn onder te brengen in twee vondstcomplexen. Het oudste, complex 1, komt uit een 50 cm dik pakket terzijde van het Abtshuis. Het pakket bestaat uit lagen sterk humeus tot kleiige grond met veel lei- en baksteenfragmenten. De aanwezigheid van houtskool kan wijzen op herstelwerkzaamheden na een kleine brand in de vleugel aan het Pandhof. Naast bouwafval is op deze plaats blijkbaar ook ander afval gedeponeerd, waaronder etensresten. Op grond van het aardewerk dateert dit complex uit de laatste kwart van de 13e tot de 1e helft van de 14e eeuw. Complex 2 komt van dezelfde locatie, maar stamt uit de 2e helft van de 14e eeuw. Het materiaal is in een 10-20 cm dikke lemige laag gevonden waarin naast bouwafval in afwisselende concentraties dierlijke resten aanwezig zijn. Waarschijnlijk gaat het om een laag met puin van een verbouwing van het aangrenzende Pandhuis, vermengd met op dat moment ontstaan tafelafval in de vorm van gebroken vaatwerk en botresten. Het onderzoek aan de dierlijke resten is uitgevoerd om meer te weten te komen over de voeding en leefgewoonten van de abdijbewoners. Welke diersoorten zijn er bijvoorbeeld gegeten, hoe is men aan deze soorten gekomen en hoe is men ermee omgegaan en geeft het materiaal ook informatie prijs over de vermeende welstand van de abdijbewoners

Van 's heren dis : archeologisch botmateriaal uit een 10e eeuwse afvalkuil in Huize van de Kasteele te Zutphen

Met lit. opg