Survival of patients treated with extended-hours haemodialysis in Europe : an analysis of the ERA-EDTA Registry

Background. Previous US studies have indicated that haemodialysis with >= 6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods. We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association-European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5-4h/treatment), EHD (three times weekly, >= 6h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results. From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.10.8h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 +/- 0.2h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62-0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71-0.90)]. Conclusions. EHD is associated with better survival in European patients treated with haemodialysis three times weekly.Peer reviewe

Mechanisms for a nutrient-conserving carbon pump in a seasonally stratified, temperate continental shelf sea

Continental shelf seas may have a significant role in oceanic uptake and storage of carbon dioxide (CO2) from the atmosphere, through a ‘continental shelf pump’ mechanism. The northwest European continental shelf, in particular the Celtic Sea (50°N 8°W), was the target of extensive biogeochemical sampling from March 2014 to September 2015, as part of the UK Shelf Sea Biogeochemistry research programme (UK-SSB). Here, we use the UK-SSB carbonate chemistry and macronutrient measurements to investigate the biogeochemical seasonality in this temperate, seasonally stratified system. Following the onset of stratification, near-surface biological primary production during spring and summer removed dissolved inorganic carbon and nutrients, and a fraction of the sinking particulate organic matter was subsequently remineralised beneath the thermocline. Water column inventories of these variables throughout 1.5 seasonal cycles, corrected for air-sea CO2 exchange and sedimentary denitrification and anammox, isolated the combined effect of net community production (NCP) and remineralisation on the inorganic macronutrient inventories. Overall inorganic inventory changes suggested that a significant fraction (>50%) of the annual NCP of around 3 mol-C m–2 yr–1 appeared to be stored within a long-lived organic matter (OM) pool with a lifetime of several months or more. Moreover, transfers into and out of this pool appeared not to be in steady state over the one full seasonal cycle sampled. Accumulation of such a long-lived and potentially C-rich OM pool is suggested to be at least partially responsible for the estimated net air-to-sea CO2 flux of ∼1.3 mol-C m–2 yr–1 at our study site, while providing a mechanism through which a nutrient-conserving continental shelf pump for CO2 could potentially operate in this and other similar regions

Ventral and dorsal striatal dopamine efflux and behavior in rats with simple vs. co-morbid histories of cocaine sensitization and neonatal ventral hippocampal lesions

xposing animal models of mental illness to addictive drugs provides an approach to understanding the neural etiology of dual diagnosis disorders. Previous studies have shown that neonatal ventral hippocampal lesions (NVHL) in rats produce features of both schizophrenia and addiction vulnerability. Objective This study investigated ventral and dorsal striatal dopamine (DA) efflux in NVHL rats combined with behavioral sensitization to cocaine. Methods Adult NVHL vs. SHAM-operated rats underwent a 5-day injection series of cocaine (15 mg/kg/day) vs. saline. One week later, rats were cannulated in nucleus accumbens SHELL, CORE, or caudate–putamen. Another week later, in vivo microdialysis sampled DA during locomotor testing in which a single cocaine injection (15 mg/kg) was delivered. Results NVHLs and cocaine history significantly increased behavioral activation approximately 2-fold over SHAM-saline history rats. DA efflux curves corresponded time dependently with the cocaine injection and locomotor curves and varied significantly by striatal region: Baseline DA levels increased 5-fold while cocaine-stimulated DA efflux decreased by half across a ventral to dorsal striatal gradient. However, NVHLs, prior cocaine history, and individual differences in behavior were not underpinned by differential DA efflux overall or within any striatal region.Conclusion Differences in ventral/dorsal striatal DA efflux are not present in and are not required for producing differential levels of acute cocaine-induced behavioral activation in NVHLs with and without a behaviorally sensitizing cocaine history. These findings suggest other neurotransmitter systems, and alterations in striatal network function post-synaptic to DA transmission are more important to understanding the interactive effects of addictive drugs and mental illness

A comprehensive quantification of global nitrous oxide sources and sinks

Nitrous oxide (N2O), like carbon dioxide, is a long-lived greenhouse gas that accumulates in the atmosphere. Over the past 150 years, increasing atmospheric N2O concentrations have contributed to stratospheric ozone depletion1 and climate change2, with the current rate of increase estimated at 2 per cent per decade. Existing national inventories do not provide a full picture of N2O emissions, owing to their omission of natural sources and limitations in methodology for attributing anthropogenic sources. Here we present a global N2O inventory that incorporates both natural and anthropogenic sources and accounts for the interaction between nitrogen additions and the biochemical processes that control N2O emissions. We use bottom-up (inventory, statistical extrapolation of flux measurements, process-based land and ocean modelling) and top-down (atmospheric inversion) approaches to provide a comprehensive quantification of global N2O sources and sinks resulting from 21 natural and human sectors between 1980 and 2016. Global N2O emissions were 17.0 (minimum–maximum estimates: 12.2–23.5) teragrams of nitrogen per year (bottom-up) and 16.9 (15.9–17.7) teragrams of nitrogen per year (top-down) between 2007 and 2016. Global human-induced emissions, which are dominated by nitrogen additions to croplands, increased by 30% over the past four decades to 7.3 (4.2–11.4) teragrams of nitrogen per year. This increase was mainly responsible for the growth in the atmospheric burden. Our findings point to growing N2O emissions in emerging economies—particularly Brazil, China and India. Analysis of process-based model estimates reveals an emerging N2O–climate feedback resulting from interactions between nitrogen additions and climate change. The recent growth in N2O emissions exceeds some of the highest projected emission scenarios3,4, underscoring the urgency to mitigate N2O emissions

L’hémodialyse longue nocturne au domicile : Une technique ancienne remise au goût du jour

Home hemodialysis therapy orientation is rising since 2011 in France due to technical progress in dialysis machines, with a simplified use, an ultrapure and sparing dialysate delivery. The most frequent therapy is short daily dialysis sessions with performing results in terms of water and salt balance, depuration and mainly on autonomy and flexibility. In this article, we describe the organization of an alternative therapy with long nocturnal low flow hemodialysis in a dialyzed patient since 2006 after a graft failure. We discuss the benefits of this therapy, first results, eventual barriers to this method specially the occurrence of an adverse event, security and benefit of a telemonitoring and teleassistance that we develop for this occasion.L’hémodialyse à domicile (HDD) se développe en France depuis 2011 en raison des progrès techniques apportés aux machines de dialyse, d’utilisation simplifiée, de la quantité limitée et de la qualité renforcée du dialysat. Réalisée le plus souvent sur un mode quotidien, en séances courtes, l’HDD apporte des résultats performants en terme de contrôle hydro sodé, d’épuration mais surtout en flexibilité et autonomie. Dans ce travail, nous décrivons l’organisation d’une technique alternative à l’hémodialyse quotidienne à bas débit (HDQBD), l’hémodialyse longue nocturne (HDLN) à bas débit de dialysat chez une patiente dialysée depuis 2006 après un échec de greffe. Nous discutons l’avantage de ce mode de dialyse, les premiers résultats, les freins possibles notamment la peur d’un événement adverse, les conditions de sécurité et l’avantage d’un système de télésurveillance/assistance développé pour cette occasion. Cet article est mis à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International

Effets d'un réentraînement à l'effort sur ergocycle pendant les séances de dialyse chez les insuffisants rénaux chroniques hémodialysés : intérêt d'un travail individualisé au premier seuil ventilatoire. [Effects of exercise training on ergocycle during hemodialysis in patients with end stage renal disease: Relevance of the anaerobic threshold intensity].

International audienceBACKGROUND: Chronic kidney failure (CRF) in addition to cardiovascular comorbidities and aging decrease physical activity capacity. An adapted rehabilitation program might be strongly recommended in this population. The aim of the study is to evaluate a 3months exercise training program with ergocycle at the anaerobic threshold (AT) during dialysis sessions on effort tolerance, quality of life, blood pressure and lipidic disorders. METHODS: Six patients meanly aged 72 were evaluated before (t(0)) and after (t(3)) the rehabilitation program by: maximal cardiorespiratory ergotest, a 6-Minute Walk Test (6MWT) and 2 quality of life tests: Medical Outcome Survey Short Form 36-items and the Kidney Disease Quality of Life (SF 36, KDQol). RESULTS: Physical activity during dialysis is well tolerated. There was no undesirable event during rehabilitation sessions. The dyspnea and muscular weariness threshold linked to the AT increased meanly by 39% (8.83±0.87 vs. 12.25±1.23mL/min per kg). Distances walked during 6 MWT increased for all patients (351.83±72.17 vs. 412.80±82meters) Moreover, physical component scale improved (+4.7), mean systolic blood pressure (-7mmHg) and mean triglycerides concentration (-19%) decreased. CONCLUSION: An exercise training program during dialysis sessions with ergocycle and working intensity based on AT seems safe and an effective alternative to improve the effort functional capacity by hemodialysis patients