Small steps towards the potential of ‘preventive’ treatment of early phosphate loading in chronic kidney disease patients

Few clinical studies have investigated the value of phosphate (P)-lowering therapies in early chronic kidney disease (CKD) patients in whom hyperphosphataemia has not yet clearly developed and they report conflicting and even unexpected results. In this issue of Clinical Kidney Journal, de Krijger et al. found that sevelamer carbonate (4.8 g/day for 8 weeks) did not induce a significant reduction of pulse wave velocity (PWV) and that fibroblast growth factor 23 (FGF23) did not decrease despite a decline in 24-h urine P excretion. To some extent these findings challenge the concept that 'preventive' P binder therapy to lower FGF23 is a useful approach, at least over this short period of time. Interestingly, in a subgroup of patients with absent or limited abdominal vascular calcification, treatment did result in a statistically significant reduction in adjusted PWV, suggesting that PWV is amenable to improvement in this subset. Interpretation of the scarce and heterogeneous observations described in early CKD remains difficult and causality and/or the possibility of 'preventive' treatment may not yet be completely disregarded. Moreover, de Krijger et al. contribute to the identification of new sources of bias and methodological issues that may lead to more personalized treatments, always bearing in mind that not all patients and not all P binders are equal

La zona norte de Formentera

Abstract not availabl

Satisfacción vital, síntomas depresivos y apoyo social percibido en pacientes con insuficiencia cardiaca

This research examined life satisfaction, depressive symptoms and perceived social support in two groups of adults (N = 120; age 40-89 years). The first was formed by stable heart failure (HF) outpatients and the second was a control group of similar age. Perceived social support was the only significant predictor of life satisfaction in the control group but, in the HF group, life satisfaction was associated with more social support and less depressive symptoms. Gender (men > women) was also an important predictor of life satisfaction in both groups, but more significantly in the HF one. All womenreported more depressive symptoms and less life satisfaction than men. Female HR patients also perceived more social support than male patients did. Finally, a partial mediation of depressive symptoms in the association between social support and life satisfaction was found in the HF group.En esta investigación se analizaron la satisfacción vital, los síntomas depresivos y el apoyo social percibido en dos grupos de adultos (N =120; rango = 40-89 años), uno formado por pacientes no hospitalizados con insuficiencia cardiaca (IC) estable y otro control con personas de similar edad. El apoyo social percibido fue el único predictor significativo de la satisfacción vital en el grupo control, mientras que en el grupo con IC, se asociaba con más apoyo social y menos síntomas depresivos. El género fue también un predictor importante de la satisfacción vital (hombres > mujeres), aunque de forma más significativa en el grupo con IC. Todas las mujeres informaban más síntomas depresivos y menos satisfacción vital que los hombres. En el grupo IC, las mujeres también percibían más apoyo social que los varones. Finalmente, se encontró en este grupo que la asociación entre apoyo social y satisfacción vital estaba parcialmente mediada por los síntomas depresivos

Causal explanations for the evolution of ‘low gear’ locomotion in insular ruminants

Aim: Mammals on islands often undergo remarkable evolutionary changes. The acquisition of ‘low gear’ locomotion, namely short and robust limb elements, has been typically associated with the island syndrome in large mammals and, especially, ruminants. Here we provide an investigative framework to examine biotic and abiotic selective factors hypothesized to influence evolution of this peculiar type of gait. Location: Islands worldwide. Taxon: Bovidae. Methods: We calculated response variables associated with ‘low gear’ locomotion in 21 extinct and extant insular bovids. We assembled data on the physiography of 11 islands and on life history and ecological traits of the focal taxa. We estimated 10 predictors (island area and four topographic indices, body mass, body size divergence, number of predators and competitors, large mammal richness) and used multiple regressions, regression trees, and random forests to assess their contextual importance. Results: The acquisition of ‘low gear’ locomotion generally happens on islands with a small number of competitors. However, the roughness of the island terrain appears to be also important, without being a main driver. Finally, although the most extreme cases of ‘low gear’ locomotion occurred on islands with no mammalian predators, our models show a non-significant relationship with this factor. Main conclusions: The evolution of ‘low gear’ locomotion in insular ruminants does not simply result from phyletic dwarfing and predatory release. Variation in morphological responses within Bovidae to ecological and topographic traits suggests, instead, a complex interplay of biotic and abiotic factors. Current understanding on the main drivers of species evolutionary pathways and biogeographic patterns are disproportionally based on few taxa, mainly vertebrates, and in some extreme cases (like this one) even on few species. Here we show how adding more data, even within the same taxonomic group, can challenge historically accepted macroevolutionary and macroecological concepts