Hyperuricaemia, gout and allopurinol in the CKD Queensland registry

Introduction There is scant data on the role of hyperuricaemia, gout and allopurinol treatment in chronic kidney disease (CKD). Therefore, our aim is to investigate the possible associations between hyperuricaemia, gout, prescription of allopurinol and renal outcomes in patients with CKD. Methods The retrospective cohort study involved 1123 Royal Brisbane and Women’s Hospital (RBWH) patients, enrolled in the CKD.QLD registry from May 2011 to August 2017. Patients were divided into two uric acid categories, with uric acid ≤ 0.36 mmol/L and > 0.36 mmol/L. Association of delta estimated glomerular filtration rate (eGFR) with gout, allopurinol treatment and hyperuricaemia were analysed. Results Patients with an entry urate > 0.36 mmol/L were older, had higher body mass index (BMI) and worse baseline kidney function. Proportion of patients with gout, hyperuricaemia and allopurinol treatment increased with advanced CKD stages. Age-adjusted analysis revealed a significant association between serum urate level and delta eGFR, with no significant association between gout, treatment with allopurinol and delta eGFR. Furthermore, neither gout nor the prescription of allopurinol had a significant effect on the time to renal death (composite end point of kidney replacement therapy or death). Conclusion Hyperuricaemia seemed to be independently associated with faster CKD progression or renal death. This was not observed with gout or prescription of allopurinol. Furthermore, allopurinol was not associated with decreased incidence of cardiovascular events. These data suggest that hyperuricaemia is likely the effect and not the cause of CKD or CKD progression

Critical Speeds and Unbalance Response of Cantilever-Sleeve Rotors Using Finite Elements with Efficient Higher Order Basis Functions

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Genetic Parameters of First Lactation Milk Yield Under Low, Medium and High Production Systems in Kenya, using Test-Day Random Regression Model

The aim of this study was to estimate genetic parameters for test-day milk yield in different production systems in Kenya. 10,923, 19,049 and 26,287 first lactation test-day records from multiple breeds under low, medium and high production systems, respectively, were analysed. On average cows under high production systems were younger and had a higher test-day milk yield than in low and medium production systems. A model fitting fourth order Legendre polynomials was found to be the most parsimonious and was therefore used to model the data. Additive genetic and permanent environmental variances were heterogeneous along different days in milk and between production systems. Heritability and repeatability were also different between days in milk and production systems. Heritability was on average 27%, 48% and 48% and repeatability 72%, 83% and 78% under low, medium and high production systems, respectively. Genetic correlations ranged from -32%, 34% and 45% to unity between daily milk yield in different days in milk under low, medium and high production systems, respectively. These parameters indicate that random regression using Legendre polynomial order four can be used to model test-day milk yield under the three production systems in Kenya. The observed heterogeneity of variance indicates that genetic parameters should be estimated within production systems for sustainable genetic improvement

Determining the association between the type of intervention for ischaemic heart disease and mortality and morbidity in patients with chronic kidney disease

Introduction: Association between chronic kidney disease (CKD) and ischaemic heart disease (IHD) is well known. Clinically, because of the use of intra-arterial contrast, coronary angiograms are sometimes not performed to avoid further deterioration in kidney function amongst CKD patients. Therefore, our aim is to identify whether intervention for non-ST elevation myocardial infarction (NStemi) is associated with increased mortality or further renal deterioration. Method: A retrospective observational cohort study was undertaken involving 144 patients with diagnosis of IHD in the CKD.QLD registry from May 2011 to August 2017, with minimum of 2 years follow-up. Patients were divided into two groups based on whether they obtained an interventional or medical management for NStemi. Results: 59 patients had medical management and 85 patients had intervention for IHD. Patients in the medical management group were observed to be significantly older (median:78vs69years,p<0.05) with worse baseline renal function (median:31vs36ml/min/1.73m3,<0.05) and higher serum urate level (median:0.5vs0.4mmol/L,p=0.2). The interventional group had lower prevalence of diabetes, dyslipidaemia, cerebrovascular disease and peripheral vascular disease, , although this was not significant Kaplan-Meier analysis revealed a significant decrease in mean survival of medically managed group compared to interventional group. Furthermore, post adjustment for age and above comorbidities, medically managed group and higher age were associated with significantly higher mortality. However, the patients in the medically managed and interventional groups had no significant difference in delta eGFR. Conclusion: In this observational study, intervention for IHD was associated with increased survival with no change in renal disease progression in comparison to medically managed patients

Genetic analysis of dairy cattle performance under extensive, semi-intensive and intensive production systems under tropical climate in Kenya

Genetic parameters for milk and fertility traits of dairy cattle managed under extensive, semi intensive and intensive production systems in Kenya were estimated. Univariate and bivariate analyses were used to estimate genetic parameters for 305 days milk yield, lactation length, age at first calving, and calving interval. The heritability estimates for milk yield were moderate to high and ranged from 0.17 to 0.34. Estimated heritability for calving interval was low under all three production systems. Moderate to high heritability was estimated for lactation length and age at first calving. All the estimates varied among the production systems. Genetic correlation estimates among milk yield and fertility traits were negative. Production system specific parameters are essential to achieve optimum genetic gain under the three production systems in Kenya

Breeding objectives for dairy cattle under low, medium and high production systems in the tropics

A deterministic bio-economic model was developed to estimate economic weights for genetic improvement of lactation milk yield, fat yield, age at first calving, calving interval, mature weight and survival under low, medium and high production systems in the Tropics. Input parameters were obtained from dairy production systems in Kenya which has a tropical environment. The highest proportion of revenue is from the sale of milk followed by sale of heifers, cull cows and sale of male calves under all production systems. On the other hand, feed cost is the most important production cost followed by labour, market-ing, reproduction and health costs, respectively. Economic values for the six traits were derived from a profit equation using revenue and production costs per cow per year. The economic values were then discounted using diffusion coefficients which account for differences between traits in the time when the improvement is expressed. Economic weights were robust to changes in input and output prices, changes in feeding strategies, and changes in milk and surplus heifer marketing strategies. Genetic standard deviations were multiplied by economic values to standardise the economic value of traits and to compare their potential for economic response. When expressed as proportion of their sum, these relative economic weights under the low, medium and high production systems for lactation milk yield were 51.36, 59.79 and 63.98%; for fat yield 4.50, 10.69 and 9.05%; for age at first calving 3.16, 2.66 and 0.55%; for calving interval 33.59, 19.88 and 20.05%; for mature weight 1.55, 1.34 and 1.19% and for survival rate 5.84, 5.64 and 5.18%, respectively. The predicted responses followed the same pattern as the relative economic weights. This shows that milk yield and calving interval were most important in all production systems but the value of response for traits differed between production systems with more emphasis on milk yield and less on calving interval in the high production systems. Moderate correlations were estimated between the breeding objective for the low, medium and high production systems. To maximise response in the overall breeding objective, different selection criteria are required for the three production systems