Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores

© 2018 International Society for HemodialysisIntroduction: Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression. Methods: In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea. Findings: Seven hundred and one HD patients were studied; 63.6% male, mean age 64.1 ± 16.6 years, 33.5% diabetic. About 24.1% recovered in 1 hour were more likely to be female, have high self-reported Beck depression inventory-II scores, a past medical history of depression, and be living without a partner. Longer recovery times were also associated with very low postdialysis systolic blood pressures (<100 mmHg), and higher body weight. However, the model predicted only 18% of the variation in recovery times. We found no association between recovery times and short-term mortality risk. Discussion: Prolonged postdialysis recovery times are associated with higher self-reported depression scores, and very low postdialysis blood pressure. Future studies investigating changes in dialysis practice and recovery times will need to target strategies to prevent intradialytic hypotension and adjust for patient psychological status.Peer reviewedFinal Accepted Versio

A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all

Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5%]; 54 diabetic [36.5%]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight 80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient.Peer reviewedFinal Accepted Versio

Comparison of resting and total energy expenditure in peritoneal dialysis patients and body composition measured by dual-energy X-ray absorptiometry

Under basal resting conditions muscle metabolism is reduced, whereas metabolism increases with physical activity. We wished to determine whether there was an association between resting energy expenditure (REE) and total energy expenditure (TEE) in peritoneal dialysis (PD) patients and lean body mass (LBM). We determined REE and TEE by recently validated equations, using doubly labelled isotopic water, and LBM by dual-energy X-ray absorptiometry (DXA) scanning. We studied 87 patients, 50 male (57.4%), 25 diabetic (28.7%), mean age 60.3±17.6 years, with a median PD treatment of 11.4 (4.7-29.5) months. The mean weight was 70.1±17.7 kg with a REE of 1509±245 kcal/day and TEE 1947±378 kcal/day. REE was associated with body size (weight r=0.78 and body mass index (BMI) r=0.72) and body composition (LBM r=0.77, lean body mass index (LBMI) r=0.76, r=0.62), all P<0.001). For TEE, there was an association with weight r=0.58, BMI r=0.49 and body composition (LBM r=0.64, LBMI (r=0.54), all P<0.001). We compared LBMI measured by DXA and that estimated by the Boer equation using anthropomorphic measurements, which overestimated and underestimated LBM for smaller patients and heavier patients, respectively. Muscle metabolism is reduced at rest and increases with physical activity. Whereas previous reports based on REE did not show any association with LBM, we found an association between both REE and TEE, using a recently validated equation derived from dialysis patients, and LBM measured by DXA scanning. Estimation of muscle mass from anthropomorphic measurements systematically overestimated LBM for small patients and conversely underestimated for heavier patients

Outcome of Patients With Small Vessel Vasculitis After Renal Transplantation: National Database Analysis

Background. Small vessel vasculitis commonly affects the kidney and can progress to end-stage renal disease. The goal of this study is to compare outcomes of patients who received a renal transplant as a result of small vessel vasculitis (group A) with those who received kidney transplants because of other causes (group B). Methods. This is a retrospective analysis of United Network for Organ Sharing registry data for adult primary kidney transplants from January 2000 to December 2014. Group A patients (N = 2196) were compared with a group B (N = 6588); groups were case matched for age, race, sex, donor type, and year of transplant in a 1:3 ratio. Results. Renal and patient survivals were better in the group A (P \u3c 0.001). New-onset diabetes after transplant developed in 8.3% of the group A and 11.3% of group B (P \u3c 0.001). Seventeen (0.8%) patients in group A developed recurrent disease. Of these, 7 patients had graft failure, 3 of which were due to disease recurrence. Group A patients had significantly higher risk of developing posttransplant solid organ malignancies (11.3% vs 9.3%, P = 0.006) and lymphoproliferative disorder (1.3% vs 0.8%, P = 0.026). Independent predictors of graft failure and patient mortality were recipients\u27 morbid obesity, diabetes, age, and dialysis duration (hazard ratio of 1.7, 1.4, 1.1/10 years, and 1.1/year for graft failure, and 1.7, 1.7, 1.6/10 years and 1.1/year for patient mortality, respectively). Conclusions. Renal transplantation in patients with has favorable long-term graft and patient outcomes with a low disease recurrence rate. However, they may have a higher risk of developing posttransplant malignancies

A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all

Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5%]; 54 diabetic [36.5%]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight 80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient

Comparison of equations of resting and total energy expenditure in peritoneal dialysis patients using body composition measurements determined by multi-frequency bioimpedance

Background & aims: Waste products of metabolism accumulate in patients with kidney failure and it has been proposed that the amount of dialysis treatment patients require be adjusted for energy expenditure. This requires validation of methods to estimate energy expenditure in dialysis patients. Methods: We compared values of resting energy expenditure (REE) estimated in peritoneal dialysis (PD) patients using a selection of available equations with estimates derived using a novel equation recently validated in chronic kidney disease patients (CKD equation). We also determined the relationship of these estimates of REE and of total energy expenditure (TEE – which is REE plus physical activity associated energy expenditure (PAEE) estimated using the Recent Physical Activity Questionnaire) – to bioimpedance-derived parameters of body composition. Results: We studied 118 adult PD patients; 75 male (63.6%), 33 diabetic (28.5%), Caucasoid (42.4%), mean age 59.3 ± 18.2 years and weight 73.1 ± 16.6 kg. REE with the CKD equation was 1532 ± 237 kcal/day, which was more than that for Mifflin–St. Joer 1425 ± 254, Harris–Benedict 1489 ± 267, Katch–McArdle 1492 ± 243, but less than Cunningham 1648 ± 248 kcal/day. Bland Altman mean bias ranged from −107 to 111 kcal/day. TEE was 1924 (1700–2262) kcal/day, and on multi-variate analysis was associated with appendicular muscle mass and nitrogen appearance rate (β 34.3, p < 0.001 and β 5.6, p = 0.002, respectively). Conclusion: With reference to the CKD equation, the majority of standard equations underestimate REE in PD patients. Whereas the Cunningham equation overestimates REE. TEE was associated with appendicular muscle mass and estimated dietary protein intake

Understanding Behavioral Sources of Process Variation Following Enterprise System Deployment

This paper extends the current understanding of the time-sensitivity of intent and usage following large-scale IT implementation. Our study focuses on perceived system misfit with organizational processes in tandem with the availability of system circumvention opportunities. Case study comparisons and controlled experiments are used to support the theoretical unpacking of organizational and technical contingencies and their relationship to shifts in user intentions and variation in work-processing tactics over time. Findings suggest that managers and users may retain strong intentions to circumvent systems in the presence of perceived task-technology misfit. The perceived ease with which this circumvention is attainable factors significantly into the timeframe within which it is attempted, and subsequently impacts the onset of deviation from prescribed practice and anticipated dynamics

Enhanced rock-slope failure following ice-sheet deglaciation : timing and causes

This research was supported by NERC Cosmogenic Isotope Analysis Facility [Grant Number: 9046.0308]The temporal pattern of rock-slope failures (RSFs) following Late Pleistocene deglaciation on tectonically stable terrains is controversial: previous studies variously suggest (1) a rapid response due to removal of supporting ice (‘debuttressing’), (2) a progressive decline in RSF frequency, and (3) a millennial-scale delay before peak RSF activity. We test these competing models through beryllium-10 (10Be) exposure dating of five closely-spaced quartzite RSFs on the Isle of Jura, Scotland, to establish the relationship between timing of failure and those of deglaciation, episodes of rapid warming and periods of rapid glacio-isostatic uplift. All five dated RSFs occurred at least 720–2240 years after deglaciation, with the probability of failure peaking ~2 ka after deglaciation, consistent with millennial-scale delay model (3). This excludes debuttressing as an immediate cause of failure, though it is likely that time-dependent stress release due to deglacial unloading resulted in progressive development of failure planes within the rock. Thaw of permafrost ice in joints is unlikely to have been a prime trigger of failure as some RSFs occurred several centuries after the onset of interstadial warming. Conversely, the timespan of the RSFs coincides with the period of maximum glacio-isostatic crustal uplift, suggesting that failure was triggered by uplift-driven seismic events acting on fractured rock masses. Implications of this and related research are: (1) that retreat of the last Pleistocene ice sheets across tectonically-stable mountainous terrains was succeeded by a period of enhanced rock-slope failure due to deglacial unloading and probably uplift-driven seismicity; (2) that the great majority of RSFs in the British Isles outside the limits of Loch Lomond Stadial (= Younger Dryas) glaciation are of Lateglacial (pre-Holocene) age; and (3) numerous RSFs must also have occurred inside Loch Lomond Stadial (LLS) glacial limits, but that runout debris was removed by LLS glaciers.PostprintPeer reviewe

Co-evolution of segregation guide DNA motifs and the FtsK translocase in bacteria: identification of the atypical Lactococcus lactis KOPS motif

Bacteria use the global bipolarization of their chromosomes into replichores to control the dynamics and segregation of their genome during the cell cycle. This involves the control of protein activities by recognition of specific short DNA motifs whose orientation along the chromosome is highly skewed. The KOPS motifs act in chromosome segregation by orienting the activity of the FtsK DNA translocase towards the terminal replichore junction. KOPS motifs have been identified in γ-Proteobacteria and in Bacillus subtilis as closely related G-rich octamers. We have identified the KOPS motif of Lactococcus lactis, a model bacteria of the Streptococcaceae family harbouring a compact and low GC% genome. This motif, 5′-GAAGAAG-3, was predicted in silico using the occurrence and skew characteristics of known KOPS motifs. We show that it is specifically recognized by L. lactis FtsK in vitro and controls its activity in vivo. L. lactis KOPS is thus an A-rich heptamer motif. Our results show that KOPS-controlled chromosome segregation is conserved in Streptococcaceae but that KOPS may show important variation in sequence and length between bacterial families. This suggests that FtsK adapts to its host genome by selecting motifs with convenient occurrence frequencies and orientation skews to orient its activity