Disease progression in pre-dialysis patients: renal function, symptoms, and health-related quality of life

This thesis investigated the effect of several risk factors on objectively assessed disease progression (renal function decline and time until the start of renal replacement therapy) and subjectively assessed disease progression (disease-related symptoms and health-related quality of life) in patients with chronic kidney disease on specialized pre-dialysis care. Furthermore, we explored (un)known mechanisms that may determine renal function decline in pre-dialysis patients. The conclusions are: low blood pressure, low proteinuria levels, and low cholesterol levels are associated with a slower objectively assessed disease progression. However, in elderly patients low blood pressure is a marker for an earlier start of renal replacement therapy. Concerning subjectively assessed disease progression, only in young patients treated with anemia-medication, high hemoglobin levels are associated with a better health-relate d quality of life. Furthermore, symptoms increase and health-related quality of life decreases during pre-dialysis care. Therefore, these markers are good candidates for defining the optimal moment to start with dialysis. This thesis also showed that black patients experience a faster renal function decline than white patients. A possible explanation could be the stronger negative consequences of diabetes mellitus in black patients. Finally, at middle-age, renal function is higher in longevity families, revealing possible new genetic mechanisms.UBL - phd migration 201

Disease progression in pre-dialysis patients: renal function, symptoms, and health-related quality of life

This thesis investigated the effect of several risk factors on objectively assessed disease progression (renal function decline and time until the start of renal replacement therapy) and subjectively assessed disease progression (disease-related symptoms and health-related quality of life) in patients with chronic kidney disease on specialized pre-dialysis care. Furthermore, we explored (un)known mechanisms that may determine renal function decline in pre-dialysis patients. The conclusions are: low blood pressure, low proteinuria levels, and low cholesterol levels are associated with a slower objectively assessed disease progression. However, in elderly patients low blood pressure is a marker for an earlier start of renal replacement therapy. Concerning subjectively assessed disease progression, only in young patients treated with anemia-medication, high hemoglobin levels are associated with a better health-relate d quality of life. Furthermore, symptoms increase and health-related quality of life decreases during pre-dialysis care. Therefore, these markers are good candidates for defining the optimal moment to start with dialysis. This thesis also showed that black patients experience a faster renal function decline than white patients. A possible explanation could be the stronger negative consequences of diabetes mellitus in black patients. Finally, at middle-age, renal function is higher in longevity families, revealing possible new genetic mechanisms

The impact of extended closing times of alcohol outlets on alcohol‐related injuries in the nightlife areas of Amsterdam: a controlled before‐and‐after evaluation

Background and aims The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol‐related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. Design A controlled before‐and‐after evaluation to compare changes in alcohol‐related injuries between intervention and control areas. Setting Central district of Amsterdam, The Netherlands. Participants Alcohol‐related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). Measurements Alcohol‐related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. Findings After 1 April 2009, intervention areas showed a larger change in the level of alcohol‐related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00–5.59 a.m., weekend days, men, individuals aged 25–34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. Conclusions A 1‐hour extension of alcohol outlet closing times in some of Amsterdam's nightlife areas was associated with 34% more alcohol‐related injuries

HYPERURICEMIA IS NOT ASSOCIATED WITH DECLINE OF KIDNEY FUNCTION IN PRE-DIALYSIS PATIENTS

Clinical epidemiolog

Course of Symptoms and Health-Related Quality of Life during Specialized Pre-Dialysis Care

Clinical epidemiolog

Translational research in nephrology: chronic kidney disease prevention and public health

This narrative review evaluates translational research with respect to five important risk factors for chronic kidney disease (CKD): physical inactivity, high salt intake, smoking, diabetes and hypertension. We discuss the translational research around prevention of CKD and its complications both at the level of the general population, and at the level of those at high risk, i.e. people at increased risk for CKD or CKD complications. At the population level, all three lifestyle risk factors (physical inactivity, high salt intake and smoking) have been translated into implemented measures and clear population health improvements have been observed. At the ‘high-risk’ level, the lifestyle studies reviewed have tended to focus on the individual impact of specific interventions, and their wider implementation and impact on CKD practice are more difficult to establish. The treatment of both diabetes and hypertension appears to have improved, however the impact on CKD and CKD complications was not always clear. Future studies need to investigate the most effective translational interventions in low and middle income countries

Multiple imputation: dealing with missing data

Clinical epidemiolog

Uric acid: association with rate of renal function decline and time until start of dialysis in incident pre-dialysis patients

Clinical epidemiolog

Differences in Progression to ESRD between Black and White Patients Receiving Predialysis Care in a Universal Health Care System

Clinical epidemiolog