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 m(2)) 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 m(2)/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

Neutrals as brokers of peacebuilding ideas?

Neutral states have traditionally been seen as favoring specific norms in international relations. Being itself originally a legal concept, neutrality was intimately linked to the importance and the respect of international law. Additionally, neutral states were seen as promoters of humanitarian ideals and elements we would in our days label as peace-building. Based on these considerations, the article tackles the more general assumption according to which neutral states would in general play a disproportionate role in promoting new “positive” ideas into the international relations because a) they have a tradition of doing so which was intimately linked to their survival as states and to their political culture, b) they have a comparative advantage in doing so because the ideas they bring in are not seen as part of hidden agendas in promoting other power-related goals, and c) the type of ideas they have been and they still are promoting always aimed at either preventing war or limiting the negative effects of war