Inflammation and erythropoiesis-stimulating agent response in hemodialysis patients : a self-matched longitudinal study of anemia management in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Rationale & objective: Previous studies of inflammation and anemia management in hemodialysis (HD) patients may be biased due to patient differences. We used a self-matched longitudinal design to test whether new inflammation, defined as an acute increase in C-reactive protein (CRP) level, reduces hemoglobin response to erythropoiesis-stimulating agent (ESA) treatment. Study design: Self-matched longitudinal design. Setting & participants: 3,568 new inflammation events, defined as CRP level > 10 mg/L following a 3-month period with CRP level ≤ 5 mg/L, were identified from 12,389 HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4 to 6 (2009-2018) in 10 countries in which CRP is routinely measured. Predictor: "After" (vs "before") observing a high CRP level. Outcomes: Within-patient changes in hemoglobin level, ESA dose, and ESA hyporesponsiveness (hemoglobin 6,000 [Japan] or >8,000 [Europe] U/wk). Analytical approach: Linear mixed models and modified Poisson regression. Results: Comparing before with after periods, mean hemoglobin level decreased from 11.2 to 10.9 g/dL (adjusted mean change, -0.26 g/dL), while mean ESA dose increased from 6,320 to 6,960 U/wk (adjusted relative change, 8.4%). The prevalence of ESA hyporesponsiveness increased from 7.6% to 12.3%. Both the unadjusted and adjusted prevalence ratios of ESA hyporesponsiveness were 1.68 (95% CI, 1.48-1.91). These associations were consistent in sensitivity analyses varying CRP thresholds and were stronger when the CRP level increase was sustained over the 3-month after period. Limitations: Residual confounding by unmeasured time-varying risk factors for ESA hyporesponsiveness. Conclusions: In the 3 months after HD patients experienced an increase in CRP levels, hemoglobin levels declined quickly, ESA doses increased, and the prevalence of ESA hyporesponsiveness increased appreciably. Routine CRP measurement could identify inflammation as a cause of worsened anemia. In turn, these findings speak to a potentially important role for anemia therapies that are less susceptible to the effects of inflammation

Coastal erosion and mangrove progradation of Southern Thailand

Approximately 60% of the southern Thai coastline used to be occupied by mangroves according to the first mangrove forest assessment in 1961. During the past three decades, these mangrove areas have been reduced to about 50% with less than 10% left on the east coast. Coastal erosion and accretion occur irregularly along the coast but an intensification of erosion has been noticed during the past decade. This study assessed the relationship between mangrove presence and changes in coastal area. Mangrove colonization rates were assessed using in situ transects and remote sensing time series. Both methods led to comparable estimates ranging between 5 and 40 m

Epidemiology and health outcomes associated with hyperkalemia in a primary care setting in England

Abstract Background Real-world incidence, clinical consequences, and healthcare resource utilization (HRU) of hyperkalemia (HK) remain poorly characterized, particularly in patients with specific comorbidities. Methods Data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases were analyzed to determine incidence of an index HK event, subsequent clinical outcomes, and HRU in the English population. Factors associated with index HK in a primary care setting were also identified for those with an index HK event during the study period (2009–2013) and matched controls. Results The overall incidence rate of an index HK event was 2.9 per 100 person-years. Use of renin–angiotensin–aldosterone system inhibitors was strongly associated with HK (odds ratio, 13.6–15.9). Few patients (5.8%) had serum potassium (K+) retested ≤ 14 days following the index event; among those retested, 32% had HK. Following an index HK event, all-cause hospitalization, HK recurrence, and kidney function decline were the most common outcomes (incidence rates per 100 person-years: 14.1, 8.1, and 6.7, respectively), with higher rates in those with comorbidities or K+ > 6.0 mmol/L. Mortality and arrhythmia rates were higher among those with K+ > 6.0 mmol/L. Older age, comorbid diabetes mellitus, and mineralocorticoid receptor antagonist use were associated with HK recurrence. Relatively few patients received testing or prescriptions to treat HK following an event. Conclusions Severe index HK events were associated with adverse outcomes, including arrhythmia and mortality. Despite this, retesting following an index event was uncommon, and incidence of recurrence was much higher than that of the index event