Potassium intake, fibroblast growth factor 23 and clinical outcomes

Chronic kidney disease (CKD) is a major cause of cardiovascular disease and premature death. Characteristic of some patients with CKD is, among other things, a tendence to develop high levels of phosphate and fibroblast growth factor (FGF23) in the blood, which is linked to deterioration of health. Dietary interventions can provide significant health benefits and can aid in the management of CKD. Potassium in particular, which is rich in fruit and vegetable products and which has a blood pressure lowering effect, could be a good option. Furthermore, there are indications that potassium also has beneficial effects on phosphate metabolism.In the first part of his thesis, Yeung investigated the relationship between 24-hour urinary potassium excretion, an indirect measure of potassium intake, and FGF23 with cardiovascular disease, hypertension and premature death in healthy individuals, and different groups of patients. For example, it was found that a low potassium intake or elevated FGF23 blood levels increase the risk of cardiovascular disease, high blood pressure and premature death. What was striking was that people with a high potassium intake also have low FGF23 blood levels.Therefore, in the second part, it was investigated whether potassium supplementation leads to a decrease in FGF23 blood levels. In studies with healthy individuals and patients with CKD, potassium supplementation led to a small but significant decrease in FGF23 blood levels. With this result, further investigation should follow to observe whether lowering FGF23 blood levels through increased potassium intake can improve long-term health outcomes

The social condition of the New Zealand people : a pre-election review of social indicator information

Abstract: Many social commentators have considered that alongside the fiscal transparency enjoined by contemporary New Zealand governments, there should be a complementary social responsibility reporting. This task is usually assigned to social indicator frameworks. However, at present (as the 2017 election looms) there is a faltering in the provision of social indicators which have been in place in New Zealand for almost two decades, with the exception of the recent 2016 survey data from Statistics New Zealand and Ministry of Social Development that were made available within a month of writing this article. Having commented on the current status of the New Zealand social indicator system, we present data from the General Social Survey and the Quality of Life survey to at least convey recent trends in subjective social well-being and reported behaviours and experiences. References are also made to the accumulating literature on social well-being in New Zealand, followed by suggestions for more systematic indicator development and underpinning research

Fibroblast Growth Factor 23 and Adverse Clinical Outcomes in Type 2 Diabetes:a Bitter-Sweet Symphony

Purpose of Review: Fibroblast growth factor 23 (FGF23) is a key phosphate-regulating hormone that has been associated with adverse outcomes in patients with chronic kidney disease (CKD). Emerging data suggest that FGF23 plays a specific role in type 2 diabetes, partly independent of kidney function. We aimed to summarize current literature on the associations between FGF23 and outcomes in patients with type 2 diabetes with or without CKD. Recent Findings: Several cohort studies have shown strong associations between plasma FGF23 and cardiovascular outcomes in diabetic CKD. Moreover, recent data suggest that FGF23 are elevated and may also be a risk factor for cardiovascular disease and mortality in type 2 diabetes patients without CKD, although the magnitude of the association is smaller than in CKD patients. Summary: Diabetes-related factors may influence plasma FGF23 levels, and a higher FGF23 levels seem to contribute to a higher cardiovascular and mortality risk in patients with type 2 diabetes. Although this risk may be relevant in diabetic individuals with preserved kidney function, it is strongly accentuated in diabetic nephropathy. Future studies should clarify if FGF23 is merely a disease severity marker or a contributor to adverse outcomes in type 2 diabetes and establish if antidiabetic medication can modify FGF23 levels

General practice clinicians’ perspectives on involving and supporting children and adult perpetrators in families experiencing domestic violence and abuse

Background. Government and professional guidance encourages general practice clinicians to identify and refer children who experience domestic violence and abuse (DVA) but there is scant understanding of how general practice clinicians currently work with DVA in families. Objectives. The study explored general practice clinicians’ practice with children and their parents experiencing DVA and reflected on the findings in the light of current research and policy guidelines. Methods. Semi-structured interviews with 54 clinicians (42 GPs and 12 practice nurses/nurse practitioners) were conducted across six sites in England. Data were analysed using current literature and emerging themes. Data presented here concern clinicians’ perspectives on engaging with family members when a parent discloses that she is experiencing DVA. Results. When a parent disclosed DVA, clinicians were more likely to consider talking to abusive fathers than talking to children about the abuse. Perspectives varied according to: whether consultation opportunities arose, risks, consent and confidentiality. Perceptions of ‘patient-hood’, relationships and competence shaped clinicians’ engagement. Perpetrators were seen as competent informers and active service users, with potential for accepting advice and support. Clinicians were more hesitant in talking with children. Where this was considered, children tended to be seen as passive informants, only two GPs described direct and on-going consultations with children and providing them with access to support. Conclusion. Clinicians appear more inclined to engage directly with abusive fathers than children experiencing DVA. Clinician skills and confidence to talk directly with children experiencing DVA, in child sensitive ways, should be developed through appropriate training

Phosphate and fibroblast growth factor 23 in diabetes

Diabetes is associated with a strongly elevated risk of cardiovascular disease, which is even more pronounced in patients with diabetic nephropathy. Currently available guideline-based efforts to correct traditional risk factors are only partly able to attenuate this risk, underlining the urge to identify novel treatment targets. Emerging data point towards a role for disturbances in phosphate metabolism in diabetes. In this review, we discuss the role of phosphate and the phosphate-regulating hormone fibroblast growth factor 23 (FGF23) in diabetes. We address deregulations of phosphate metabolism in patients with diabetes, including diabetic ketoacidosis. Moreover, we discuss potential adverse consequences of these deregulations, including the role of deregulated phosphate and glucose as drivers of vascular calcification propensity. Finally, we highlight potential treatment options to correct abnormalities in phosphate and FGF23. While further studies are needed to more precisely assess their clinical impact, deregulations in phosphate and FGF23 are promising potential target in diabetes and diabetic nephropathy

Damage Spreading During Domain Growth

We study damage spreading in models of two-dimensional systems undergoing first order phase transitions. We consider several models from the same non-conserved order parameter universality class, and find unexpected differences between them. An exact solution of the Ohta-Jasnow-Kawasaki model yields the damage growth law $D \sim t^{\phi}$, where $\phi = t^{d/4}$ in $d$ dimensions. In contrast, time-dependent Ginzburg-Landau simulations and Ising simulations in $d= 2$ using heat-bath dynamics show power-law growth, but with an exponent of approximately $0.36$, independent of the system sizes studied. In marked contrast, Metropolis dynamics shows damage growing via $\phi \sim 1$, although the damage difference grows as $t^{0.4}$. PACS: 64.60.-i, 05.50.+qComment: 4 pags of revtex3 + 3 postscript files appended as a compressed and uuencoded file. UIB940320

Urinary Potassium Excretion, Fibroblast Growth Factor 23, and Incident Hypertension in the General Population-Based PREVEND Cohort

High plasma fibroblast growth factor 23 (FGF23) and low potassium intake have each been associated with incident hypertension. We recently demonstrated that potassium supplementation reduces FGF23 levels in pre-hypertensive individuals. The aim of the current study was to address whether 24-h urinary potassium excretion, reflecting dietary potassium intake, is associated with FGF23, and whether FGF23 mediates the association between urinary potassium excretion and incident hypertension in the general population. At baseline, 4194 community-dwelling individuals without hypertension were included. Mean urinary potassium excretion was 76 (23) mmol/24 h in men, and 64 (20) mmol/24 h in women. Plasma C-terminal FGF23 was 64.5 (54.2–77.8) RU/mL in men, and 70.3 (56.5–89.5) RU/mL in women. Urinary potassium excretion was inversely associated with FGF23, independent of age, sex, urinary sodium excretion, bone and mineral parameters, inflammation, and iron status (St. β −0.02, p < 0.05). The lowest sex-specific urinary potassium excretion tertile (HR 1.18 (95% CI 1.01–1.37)), and the highest sex-specific tertile of FGF23 (HR 1.17 (95% CI 1.01–1.37)) were each associated with incident hypertension, compared with the reference tertile. FGF23 did not mediate the association between urinary potassium excretion and incident hypertension. Increasing potassium intake, and reducing plasma FGF23 could be independent targets to reduce the risk of hypertension in the general population

Fractal Profit Landscape of the Stock Market

We investigate the structure of the profit landscape obtained from the most basic, fluctuation based, trading strategy applied for the daily stock price data. The strategy is parameterized by only two variables, p and q. Stocks are sold and bought if the log return is bigger than p and less than -q, respectively. Repetition of this simple strategy for a long time gives the profit defined in the underlying two-dimensional parameter space of p and q. It is revealed that the local maxima in the profit landscape are spread in the form of a fractal structure. The fractal structure implies that successful strategies are not localized to any region of the profit landscape and are neither spaced evenly throughout the profit landscape, which makes the optimization notoriously hard and hypersensitive for partial or limited information. The concrete implication of this property is demonstrated by showing that optimization of one stock for future values or other stocks renders worse profit than a strategy that ignores fluctuations, i.e., a long-term buy-and-hold strategy.Comment: 12 pages, 4 figure

Pretransplant NT-proBNP, Dialysis Vintage, and Posttransplant Mortality in Kidney Transplant Recipients

Background. End-stage kidney disease and dialysis vintage are characterized by accelerated atherosclerosis, volume overload, and progressive left ventricular hypertrophy, leading to elevated N-terminal probrain natriuretic peptide (NT-proBNP) levels. Pretransplant dialysis vintage is associated with excess mortality after transplantation. We want to study whether pretransplant NT-proBNP is associated with posttransplantation mortality and if it explains the association of dialysis vintage with posttransplantation mortality in kidney transplant recipients (KTR). Methods. We measured plasma NT-proBNP on arrival at the hospital before kidney transplantation in 658 KTR between January 1995 and December 2005 in our center. Multivariable Cox regression analyses, adjusted for potential confounders, were used to prospectively study the associations of dialysis vintage and NT-proBNP with all-cause mortality. Results. During median 12.7 (7.8-15.6) years of follow-up after transplantation, 248 (37.7%) KTR died. Dialysis vintage was associated with an increased risk of posttransplant mortality in the fully adjusted model (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.03-1.43; P = 0.02), independent of potential confounders. The association weakened materially and lost significance after further adjustment for NT-proBNP (HR, 1.14; 0.96-1.34; P = 0.14). NT-proBNP was independently associated with all-cause mortality in the fully adjusted model (HR, 1.34; 1.16-1.55; P < 0.001). The association remained independent of adjustment for dialysis vintage (HR, 1.31; 1.13-1.52; P < 0.001). Conclusions. Our study shows that longer dialysis vintage is associated with a higher mortality risk in KTR, and this association might be explained for a considerable part by variation in pretransplant NT-proBNP at the time of transplantation