Iron Deficiency and Erythropoietin Excess: Two Sides of the Same Coin?:studies in patients with chronic kidney disease and in the general population

Anemia of chronic kidney disease (CKD) is an important complication in patients with CKD and in renal transplant recipients (RTRs). An important cause of anemia of CKD is iron deficiency. The general aim of this thesis was to assess the consequences of iron deficiency in CKD patients, RTRs, and in the general population. We identified in this thesis that iron deficiency independently of anemia is associated with adverse outcomes in RTRs. This is contrary to daily clinical practice, where iron deficiency is generally considered only relevant in presence of anemia. Importantly, in the following chapters we showed that the detrimental effects of iron deficiency seem, at least to a large extent, attributable to increased levels of fibroblast growth factor 23 (FGF23) in CKD patients, RTRs and in the general population. FGF23 is an osteocyte-derived hormone which is an essential regulator of phosphate and vitamin D metabolism. Similarly, we showed that the associations between erythropoietin (EPO), both endogenous as exogenous, and adverse outcomes are related to increased FGF23 levels. This thesis highlights the importance of iron deficiency, and unravels that both iron deficiency as high EPO levels are associated with increased levels of FGF23. Finally, this thesis contains the rationale and design study of TransplantLines, the largest biobank worldwide that comprises all types of solid organ transplant recipients. This study will be of uttermost importance in upcoming years for further unraveling the interplay between iron deficiency, high levels of EPO and FGF23, and outcomes

Cognitive Load Effect on Moral Decision Making

Cognitive Load Effect on Moral Decision Making Elise Crause, Merry Bailey, Liz Eisenga, Caroline Hopper Choices are made each day to determine the outcome of our lives. To better understand the human process of decision making, philosophers and psychologists have examined moral dilemmas. Cognitive load is a type of stress that alters decision-making and the likelihood of choosing a self-motivated behavior over a behavior that benefits another person or group. For this study, moral dilemmas were given in sets of two before and after a cognitive-load-inducing task. The cognitive-load-inducing task required participants to verbally answer subtraction problems until the answer was correct or time had run out, and the level of stress was measured using two physiological predictors of stress, heart rate and skin conductivity. Our study aimed to determine the effect of an increased cognitive load on the level of selfishness that the participants exhibited when making decisions for a series of moral dilemmas. We conducted our research through the measures of moral dilemmas, heart rate, and skin conductance (Bauer et al., 2022)

Do Attachment Styles Predict General Wellness?

Attachment has been shown to be indicative of many different specific facets of health and wellbeing. (Rapoza et al., 2016) Generally secure attachment seems to be predictive of positive life outcomes and vice versa. (Kwon & Choi, 2022) However, there is a lack of integrative research done which examines wellness as a general construct or how the different facets of wellness interact in relation to attachment. In this study we created a construct of “general wellness” (social, emotional, and physical wellness) and examined its relationship with attachment style. 40 Belmont students (by means of a Qualtrics survey) were given an assessment of general wellbeing and then of attachment style. We anticipate that anxious and avoidant attachment will be negatively related to general wellness. Additionally, we hypothesize that avoidance will be negatively related to social wellness and anxiety will be negatively related to emotional wellness. The style of parent to child attachment has lasting implications for a child’s adulthood wellness. The findings of this study could be used to help parents improve their children\u27s social, emotional, and physical wellness, starting with how they relate to them when they are young

Sodium-Glucose Cotransporter 2 Inhibitors and Kidney Outcomes:True Renoprotection, Loss of Muscle Mass or Both?

Inhibitors of sodium-glucose cotransporter 2 (SGLT2) have emerged as practice-changing treatments for patients with type 2 diabetes, reducing both the risk of cardiovascular events and kidney events. However, regarding the latter, caution is warranted, as these kidney endpoints are defined using glomerular filtration rate estimations based on creatinine, the non-enzymatic product of creatine residing in muscles. Creatinine-based estimations of the glomerular filtration rate are only valid if the treatment has no effect on changes in muscle mass over time. Yet, circumstantial evidence suggests that treatment with SGLT2 inhibitors does result in a loss of muscle mass, rendering serum creatinine-based kidney endpoints invalid. Currently, it cannot be excluded that the described renoprotective effect of SGLT2 inhibitors is in part or in whole the consequence of a loss of muscle mass. Post-hoc analyses of existing trials or new trials based on kidney function markers independent of muscle mass can provide more definitive answers on the proposed renoprotective effects of SGLT2 inhibitors

Body fat estimates from bioelectrical impedance equations in cardiovascular risk assessment:The PREVEND cohort study

AIMS: To investigate prospectively the association of body fat percentage (BF%) estimates using various equations from bioelectrical impedance analysis (BIA) with cardiovascular events, compared with body mass index (BMI) and waist circumference. METHODS AND RESULTS: We used data of 34 BIA-BF%-equations that were used for estimation of BF% in 6486 (men = 3194, women = 3294) subjects. During a median follow-up of 8.3 years, 510 (7.9%) cardiovascular events (363 in men; 147 in women) occurred. In men, the crude hazard ratio (95% confidence interval) for BF% from the best predicting BIA-BF%-equation was 3.97 (3.30-4.78) against 2.13 (1.85-2.45) for BF% from the BIA device's BIA-BF%-equation, 1.34 (1.20-1.49) for BMI and 1.49 (1.40-1.73) for waist circumference per log-1-SD increase of all. In women, the hazard ratios for best predicting BIA-BF%-equation, BIA device estimation, BMI and waist circumference were 3.80 (2.85-4.99), 1.89 (1.57-2.28), 1.35 (1.21-1.51) and 1.52 (1.31-1.75), respectively. After adjustments for age, Framingham cardiovascular disease risk score and creatinine excretion - a marker of muscle mass - BF%s and BMI remained independently associated with cardiovascular events in both men and women, while waist circumference was independently associated with cardiovascular events in men, but not in women. According to discrimination ability (C-index) and additive predictive value (net reclassification index and integrated discrimination index) on obesity measures to the Framingham cardiovascular disease risk score, BF% was superior to BMI and waist circumference in both men and women. CONCLUSIONS: BF% was independently associated with future cardiovascular events. Body fat estimates from the best-predicting BIA-BF%-equations can be a more predictive measurement in cardiovascular risk assessment than BMI or waist circumference