Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied \u201ccountry-specific\u201d factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a \u201cone-size-fits-all\u201d approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions

Comparing production-biomass ratios of benthos and suprabenthos in macrofaunal marine crustaceans

Using available data from the literature, we compared the productionbiomass ratios (P/B) between the suprabenthic (= hyperbenthic) and the benthic (infaunaepifauna) species within the group of the macrofaunal marine crustaceans. This data set consists of 91 P/B estimates (26 for suprabenthos and 65 for infaunaepifauna) for 49 different species. Suprabenthic crustacean P/B was significantly higher than P/B of benthic crustacean (post-hoc Scheffé test; one-way analysis of covariance, ANCOVA; p < 103) and also of other (noncrustacean) benthic invertebrate (p < 104). Predictive multilinear regression (MLR) analysis for macrofaunal marine crustaceans showed P/B to depend significantly on mean annual temperature (T) and mean individual weight (W) (R2 = 0.367). Adding the variable swimming capacity increased goodness-of-fit to R2 = 0.528. The higher P/B of suprabenthic (= swimming) macrofauna in comparison with that of the benthic compartment seems to be related to the most apparent feature of the suprabenthos, its swimming capacity. The high P/Bs reported for suprabenthic species indicate how a nontrivial part of benthic production can be ignored if suprabenthos is not well sampled, therefore biasing the models of energy flow generated for trophic webs