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

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

Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD

Background We explore longitudinal trajectories of clinical indicators, patient-reported outcomes, and hospitalizations, in the years preceding death in a population of older patients with advanced chronic kidney disease (CKD). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR Results We included 661 decedents with a median time to death of 2.0 years (IQR 0.9-3.2). During the years preceding death, eGFR, Subjective Global Assessment score, and blood pressure declined, with accelerations seen at 6 months preceding death. Serum hemoglobin, hematocrit, cholesterol, calcium, albumin, and sodium values declined slowly during follow-up, with accelerations observed between 6 and 12 months preceding death. Physical and mental quality of life declined linearly throughout follow-up. The number of reported symptoms was stable up to 2 years prior to death, with an acceleration observed at 1 year prior to death. The rate of hospitalization was stable at around one hospitalization per person year, increasing exponentially at 6 months preceding death. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began similar to 6 to 12 months prior to death, which are likely multifactorial in nature, but correlate with a surge in hospitalizations. Further research should focus on how to effectively use this knowledge to inform patient and family expectations, to benefit the planning of (end-of-life) care, and to establish clinical alert systems.Clinical epidemiolog

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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

Interne Rapporten van de ROB juni 1991

Onderzoek aan de visresten van Mienakker (opgraving 1990). Mienakker valt op door de grote relatieve hoeveelheid schelvis. Daarnaast vormen platvis en kabeljauw(achtigen) een belangrijk aandeel. Uit het spectrum kan worden afgeleid dat de nederzetting het kustgebied exploiteerde. De grootste activiteit heeft zich in het voorjaar afgespeeld. Schelvis en zeebaars duiden op visvangst in dieper water

Het onderzoek op het terrein van de voormalige Winston bioscoop te Hoorn

Met lit. op