16 research outputs found
Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial
Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council
Erosional characteristic of cohesive fine grained sediments from lake Dabie
Jezioro Dąbie położone jest w obrębie ujściowego odcinka Dolnej Odry.
Akwen ten ma ważne znaczenie dla żeglugi, gdyż przez jego czaszę przechodzi
główny tor wodny pomiędzy portem Schwedt a Zatoką Pomorską. Zbiornik ten
jest intensywnie zanoszony rumowiskiem polifrakcyjnym ze znaczną zawartością
cząstek pylastych i ilastych oraz materii organicznej. Wysoka zawartość cząstek
pyłów i iłów nadaje rumowisku cechy materiału częściowo spoistego względnie
spoistego. Osadzające się rumowisko powoduje utrudnienia w eksploatacji zbiornika
oraz istotne zmniejszenie jego pojemności. W ciągu 34 lat jego pojemność
zmniejszyła się o 12,1 mln m3, a średni roczny przyrost objętości osadów oceniany
jest na 356 000 m3.
Autorzy przeprowadzili wstępną ocenę parametrów erozji osadów z jeziora
Dąbie na podstawie jego cech fizycznych i reologicznych.The Lake Dąbie is located in Lower Odra estuary. That water region plays
very important role for navigation, because through the Lake Dąbie the main seaway
between Schwedt and Pomeranian Gulf is running. The Lake in strongly silted
with polyfractional sediments with high clay and silt particles content and also
with high organic matter content. That high clay and silt particles content causes
that muds from the Lake have semi-cohesive or cohesive properties. Settled muds cause difficulties in seaway exploitation and significant decrease of its capacity.
During 34 years the Lake Dąbie capacity decreased about 12,1 mln m3. The estimated
mean year increase of sediments volume is equal about 356 000 m3.
The authors performed the preliminary estimation of erosion parameters for
sediments from Lake Dąbie on the base of theirs physical and rheological properties
Estimation of the degradation of the middle Odra river bed and programme of the restoration works
Degradacja koryta Odry jest obserwowana głównie poniżej ostatniego
stopnia na skanalizowanym odcinku tej rzeki. Średni poziom dna obniża się
o około 4–8 cm rocznie, powodując odpowiednie obniżenie tak zwierciadła wody
w rzece, jak i poziomu wody gruntowej w przyległej dolinie. Ta degradacja powoduje
poważne problemy tak dla żeglugi, jak i dla rolnictwa i środowiska przyrodniczego.
Budowa kolejnego ostatniego stopnia we Wrocławiu (1897), Rędzina
(1922) i Brzeg Dolny (1958) miała tylko okresowy pozytywny skutek. Poniżej
każdego z tych stopni zasięg erozji dna wyniósł 50–60 km. W 1994 r. Parzonka
zaproponował koncepcję „karmienia” Odry tuż poniżej nowego stopnia Malczyce
(km 300,0), który będzie działał prawdopodobnie od 2012 r. Władze administracyjne
zdecydowały w 2008 r., że stopień może wejść do eksploatacji pod warunkiem
wykonania ważnych działań naprawczych, uwzględniających potrzeby środowiska
przyrodniczego, żeglugi, rolnictwa i mieszkańców doliny Odry. Program
tych działań naprawczych przewiduje dwa etapy:
– odbudowę (podniesienie) poziomu dna Odry w poszczególnych przekrojach
na odcinku objętym erozją liniową wywołaną oddziaływaniem stopnia
Brzeg Dolny, do wysokości odpowiadającej co najmniej połowie różnicy między
rzędną dna Odry z początku okresu eksploatacji stopnia Brzeg Dolny i rzędną aktualną,
będącą skutkiem 50-letniego okresu erozji dna rzeki (Etap I),
– trwałe utrzymanie tak uzyskanej rzędnej dna Odry w poszczególnych
przekrojach poniżej stopnia Malczyce, poprzez tzw. „karmienie” rzeki (Etap II).The degradation of the Odra river bed is observed mainly below each last
barrage of the channelized river sector Koźle – Wrocław. The mean river bed level
is decreasing of some 4–8 cm yearly, causing the corresponding drop so of water
surface in the river as of the ground water level in the valley. This degradation
causes great problems so for navigation, as for agriculture and environment. The
construction of successives last barrages Wrocław (1897), Rędzin (1922) and
Brzeg Dolny (1958) had only a temporary effect. Below each of these barrages the
river bed erosion continued, concerning a river reach of some 50-60 km. In 1994
Parzonka has proposed the conception of the “feeding” of the Odra just below the
new barrage Malczyce (km 300,0), entering in action probably in 2012. The administration
has decided in 2008, that this barrage can enter in work only after the
accomplishment of important restoration works, taking in account the needs of environment,
of navigation and agriculture and of the human population. The programme
of restoration works provides two steps:
– Step I: the elevation of the Odra bed level on the sector Malczyce–Ścinawa
(km 300 – km 335) minimum by the half on the eroded height.
– Step II: the feeding of the Odra just below the barrage Malczyce on the
length of some 4–5 km, after each flood causing local river bed erosion
The preliminary analysis of silting conditions of the storage reservoir Otmuchow localised in upland region
Autorzy przeprowadzili wstępną analizę warunków zamulania zbiornika
Otmuchów. Specyfiką tego zbiornika jest jego położenie geograficzne w zlewni
oraz pełnione funkcje. Kaskada zbiorników Nysa-Otmuchów położona jest
w środkowym odcinku doliny rzeki Nysy Kłodzkiej w południowo-zachodnim,
podgórskim rejonie województwa opolskiego. Przeanalizowano ogólną charakterystykę
ilości rumowiska dostarczanego do zbiornika i cechy fizyczne osadów
z różnych stref tego zbiornika. Przeanalizowano również warunki zamulania
zbiornika i zmiany jego pojemności w czasie.The authors performed the preliminary analysis of the silting conditions of
the reservoir Otmuchów. The specific of this reservoir is it’s geographic localization
in catchment and hydrotechnic functions. The reservoir Otmuchów-Nysa
cascade is localized in the middle sector of the Nysa Kłodzka river in south-west,
upland region of the Opole District. The main characteristic of the amount of
sediments settled in the reservoir, the physical sediment properties for different
reservoir zones are presented. The authors have also analyzed the silting conditions
in this reservoir, and the changes of the reservoir capacit
Preliminary estimation of dynamic features of muds from lake Dabie
Namuły zalegające w jeziorze Dąbie mają cechy plastyczno-lepkie. Zawierają
one dużą ilość materii organicznej oraz są zanieczyszczone przez ścieki komunalne
i przemysłowe. Obecność tych substancji zmienia w istotny sposób cechy
dynamiczne rumowiska drobnoziarnistego oraz warunki sedymentacji i resuspensji
cząstek stałych. Przez jezioro Dąbie przechodzi ważny tor wodny o długości 14,5 km,
szerokości 150 m i o głębokości gwarantowanej 3,2 m. Jest on okresowo pogłębiany
za pomocą refulerów.
Autorzy przeprowadzili wstępną ocenę własności fizycznych i reologicznych
próbek pobranych z dna jeziora Dąbie w rejonie toru wodnego. Miąższość
warstwy namułów wynosi od 3 do 5 m. Mają one konsystencję płynną, a ich wilgotność
wynosi od 300–500%. Nominalna średnica ziarn d50 waha się od 12–15 μm na
powierzchni do 44–95 μm przy dnie, a zawartość części organicznych zmienia się
od 10–30%. Badania cech reologicznych namułów organicznych wykazały, że zachowują
się one jak ciecze nienewtonowskie. Ich cechy można opisać za pomocą
dwuparametrowego modelu Binghama.The muds settled in the Lake Dąbie have visco-plastic properties. They contain
many organic matter and are polluted by sewage from communities and industry.
The presence of this substances changes clearly the dynamic properties of
the fine grained material, as well the conditions of sedimentation and resuspension
of solid particles. An important navigation way is located in the lake Dąbie with
following parameters: length 14.5 km, width 150 m and guaranteed depth 3.2 m.
This way is periodically deepened by dredgers. The authors have performed a preliminary estimation of the physical and
rheological features of mud samples from the Lake Dąbie in the region of the
navigation way. The thickness of the mud layer is equal 3–5 m. The fine grined
sediments have a liquid consistency, and their water content is equal to some 300-
500%. The nominal granulometric size d50 changes between 12–15 μm for superficial
muds and between 44-95 μm for bottom muds, and the organic matter content
varies between 10 – 30%.
The studies on rheological features of organic sediments proved that they
behave as non-newtonian liquids. Their behaviour can be described by the twoparameter
rheological model of Bingham
Reological characteristics of sedimentation process and erosion of river sediments
Autorzy przeprowadzili ocenę dynamiki zmian koryt rzecznych spowodowanych
przez procesy sedymentacyjne i erozyjne. Zbadano cechy fizyczne i reologiczne
wybranych osadów spoistych i częściowo spoistych. Próbki osadów
pochodziły z nizinnych odcinków rzeki Odra (Polska) i rzeki Warnow (Niemcy).
Charakterystyki reologiczne zbadano za pomocą wiskozymetrów rotacyjnych.
Badane namuły miały cechy typowe dla cieczy nienewtonowskich. Charakterystyki
erozyjne wyznaczono na podstawie metodyki Migniota. Sprawdzono je w skali
naturalnej po przejściu fali powodziowej przez stopień Brzeg Dolny, która spowodowała
częściowe wymycie osadów z górnego stanowiska jazu.The authors performed an estimation of the dynamic of the river bed
changes caused by sedimentation and erosion processes. The physical and
rheological parameters for chosen cohesive and semi-cohesive sediments were investigated.
Mud samples were taken from 3 different localisation on Middle Odra
(Poland) and from 2 localisations on Warnow river (Germany). Rheological characteristics
were studied with use of the rotative viscometer. Erosion characteristics
of the mud’s were studied accordingly to methodology of Migniot [1968]. Results
for Middle Odra were verified in the natural scale during the passage of the catastrophic
flood through barrage Brzeg Dolny in 1997. This flood caused partly erosion
of mud’s from the upstream part of this barrage
Identification of sediment transport in a small river catchment, leading to integral management.
Predicting Kidney Failure, Cardiovascular Disease and Death in Advanced CKD Patients
Introduction: Predicting the timing and occurrence of kidney replacement therapy (KRT), cardiovascular events, and death among patients with advanced chronic kidney disease (CKD) is clinically useful and relevant. We aimed to externally validate a recently developed CKD G4+ risk calculator for these outcomes and to assess its potential clinical impact in guiding vascular access placement. Methods: We included 1517 patients from the European Quality (EQUAL) study, a European multicentre prospective cohort study of nephrology-referred advanced CKD patients aged ≥65 years. Model performance was assessed based on discrimination and calibration. Potential clinical utility for timing of referral for vascular access placement was studied with diagnostic measures and decision curve analysis (DCA). Results: The model showed a good discrimination for KRT and “death after KRT,” with 2-year concordance (C) statistics of 0.74 and 0.76, respectively. Discrimination for cardiovascular events (2-year C-statistic: 0.70) and overall death (2-year C-statistic: 0.61) was poorer. Calibration was fairly accurate. Decision curves illustrated that using the model to guide vascular access referral would generally lead to less unused arteriovenous fistulas (AVFs) than following estimated glomerular filtration rate (eGFR) thresholds. Conclusion: This study shows moderate to good predictive performance of the model in an older cohort of nephrology-referred patients with advanced CKD. Using the model to guide referral for vascular access placement has potential in combating unnecessary vascular surgeries
Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: Results of the EQUAL study
Background: Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods: CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results: Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions: There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men