Renal artery stenosis-when to screen, what to stent?

Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed

Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort

\ua9 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Individuals with rare kidney diseases account for 5–10% of people with chronic kidney disease, but constitute more than 25% of patients receiving kidney replacement therapy. The National Registry of Rare Kidney Diseases (RaDaR) gathers longitudinal data from patients with these conditions, which we used to study disease progression and outcomes of death and kidney failure. Methods: People aged 0–96 years living with 28 types of rare kidney diseases were recruited from 108 UK renal care facilities. The primary outcomes were cumulative incidence of mortality and kidney failure in individuals with rare kidney diseases, which were calculated and compared with that of unselected patients with chronic kidney disease. Cumulative incidence and Kaplan–Meier survival estimates were calculated for the following outcomes: median age at kidney failure; median age at death; time from start of dialysis to death; and time from diagnosis to estimated glomerular filtration rate (eGFR) thresholds, allowing calculation of time from last eGFR of 75 mL/min per 1\ub773 m2 or more to first eGFR of less than 30 mL/min per 1\ub773 m2 (the therapeutic trial window). Findings: Between Jan 18, 2010, and July 25, 2022, 27 285 participants were recruited to RaDaR. Median follow-up time from diagnosis was 9\ub76 years (IQR 5\ub79–16\ub77). RaDaR participants had significantly higher 5-year cumulative incidence of kidney failure than 2\ub781 million UK patients with all-cause chronic kidney disease (28% vs 1%; p<0\ub70001), but better survival rates (standardised mortality ratio 0\ub742 [95% CI 0\ub732–0\ub752]; p<0\ub70001). Median age at kidney failure, median age at death, time from start of dialysis to death, time from diagnosis to eGFR thresholds, and therapeutic trial window all varied substantially between rare diseases. Interpretation: Patients with rare kidney diseases differ from the general population of individuals with chronic kidney disease: they have higher 5-year rates of kidney failure but higher survival than other patients with chronic kidney disease stages 3–5, and so are over-represented in the cohort of patients requiring kidney replacement therapy. Addressing unmet therapeutic need for patients with rare kidney diseases could have a large beneficial effect on long-term kidney replacement therapy demand. Funding: RaDaR is funded by the Medical Research Council, Kidney Research UK, Kidney Care UK, and the Polycystic Kidney Disease Charity

Re-conceptualising VET: responses to covid-19

The paper addresses the impact of Covid-19 on vocational education and training, seeking to discern the outline of possible directions for its future development within the debates about VET responses to the pandemic. The discussion is set in its socio-economic context, considering debates that engage with the social relations of care and neo-liberalism. The paper analyses discourses that have developed around VET across the world during the pandemic, illustrating both possible continuities and ruptures that may emerge in this field, as the health crisis becomes overshadowed in public policy by the prioritisation of economic recovery and social restoration. The paper concludes that, alongside the possibility of a narrowing of VET to its most prosaic aims and practices, the health crisis could also lead to a re-conceptualisation that develops its radical and emancipatory possibilities in both the global south and north.N/

Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort

Background Individuals with rare kidney diseases account for 5–10% of people with chronic kidney disease, but constitute more than 25% of patients receiving kidney replacement therapy. The National Registry of Rare Kidney Diseases (RaDaR) gathers longitudinal data from patients with these conditions, which we used to study disease progression and outcomes of death and kidney failure. Methods People aged 0–96 years living with 28 types of rare kidney diseases were recruited from 108 UK renal care facilities. The primary outcomes were cumulative incidence of mortality and kidney failure in individuals with rare kidney diseases, which were calculated and compared with that of unselected patients with chronic kidney disease. Cumulative incidence and Kaplan–Meier survival estimates were calculated for the following outcomes: median age at kidney failure; median age at death; time from start of dialysis to death; and time from diagnosis to estimated glomerular filtration rate (eGFR) thresholds, allowing calculation of time from last eGFR of 75 mL/min per 1·73 m2 or more to first eGFR of less than 30 mL/min per 1·73 m2 (the therapeutic trial window). Findings Between Jan 18, 2010, and July 25, 2022, 27 285 participants were recruited to RaDaR. Median follow-up time from diagnosis was 9·6 years (IQR 5·9–16·7). RaDaR participants had significantly higher 5-year cumulative incidence of kidney failure than 2·81 million UK patients with all-cause chronic kidney disease (28% vs 1%; p<0·0001), but better survival rates (standardised mortality ratio 0·42 [95% CI 0·32–0·52]; p<0·0001). Median age at kidney failure, median age at death, time from start of dialysis to death, time from diagnosis to eGFR thresholds, and therapeutic trial window all varied substantially between rare diseases. Interpretation Patients with rare kidney diseases differ from the general population of individuals with chronic kidney disease: they have higher 5-year rates of kidney failure but higher survival than other patients with chronic kidney disease stages 3–5, and so are over-represented in the cohort of patients requiring kidney replacement therapy. Addressing unmet therapeutic need for patients with rare kidney diseases could have a large beneficial effect on long-term kidney replacement therapy demand. Funding RaDaR is funded by the Medical Research Council, Kidney Research UK, Kidney Care UK, and the Polycystic Kidney Disease Charity

Are food brands that carry light claims different?

Little is known about the market performance of brands that carry light claims (for example low fat, low sugar) in comparison to their regular counterparts. In order to fill this gap, we explore whether light brands perform similarly to regular brands in terms of (a) brand performance measures (BPMs), such as market share (MS) and penetration, (b) loyalty levels, and (c) customer sharing. We analyse three product categories (cola, flavoured carbonated beverages and margarine) using UK household panel data provided by Kantar. The results show that when considering standard BPMs (that is MS, penetration and purchase frequency), regular brands receive higher BPMs than light brands. However, when considering repeat purchase loyalty, light brands achieve greater levels of loyalty than their regular counterparts. Finally, light brands share their buyers more with each other than expected, suggesting the existence of market partitions, although these are not isolated as buyers of these brands still buy regular brands. &copy; 2014 Macmillan Publishers Ltd

Optimistic vs. pessimistic endings in climate change appeals

Abstract The use of emotion in climate change appeals is a hotly debated topic. Warning about the perils of imminent mass extinction, climate change communicators are often accused of being unnecessarily ‘doomsday’ in their attempts to foster a sense of urgency and action among the public. Pessimistic messaging, the thinking goes, undermines engagement efforts, straining credulity and fostering a sense of helplessness, rather than concern. Widespread calls for more optimistic climate change messaging punctuate public discourse. This research puts these claims to the test, investigating how affective endings (optimistic vs. pessimistic vs. fatalistic) of climate change appeals impact individual risk perception and outcome efficacy (i.e., the sense that one’s behavior matters). The findings of three online experiments presented in this paper suggest that climate change appeals with pessimistic affective endings increase risk perception (Studies 1 and 2) and outcome efficacy (Study 3), which is the result of heightened emotional arousal (Studies 1–3). Moreover, the results indicate that the mediating effect of emotional arousal is more prevalent among political moderates and conservatives, as well as those who hold either individualistic or hierarchical world views. Given that these audiences generally exhibit lower risk perception and outcome efficacy in relation to climate change, the results suggest that climate change appeals with pessimistic endings could trigger higher engagement with the issue than optimistic endings. These findings are interpreted in light of recent research findings, which suggest that differences in threat-reactivity and emotional arousal may be attributable to brain functions/anatomy mappable to basic motivations for safety and survival. Implications for scholars and practitioners are discussed

Effect of CD40 and sCD40L on Renal Function and Survival in Patients with Renal Artery Stenosis

Activation of the CD40 receptor on the proximal tubular epithelium of the kidney results in fibrosis and inflammation in experimental models of kidney injury. Soluble CD40 ligand is released by activated platelets. The role of CD40-soluble CD40 ligand in patients with ischemic renal disease is unknown. Plasma levels of CD40 and soluble CD40 ligand were measured by enzyme linked immunosorbent assay in a single center cohort of 60 patients with renal artery stenosis recruited from Salford Royal Hospital, Manchester, UK. A natural log transformation of CD40 and soluble CD40 ligand was performed to normalize the data. Estimated glomerular filtration rate was used as the primary indicator of renal function. By univariate analysis low baseline levels of circulating CD40 (R2=0.06, p\u3c0.05) and baseline creatinine (R2=0.08, p=0.022) were associated with loss of kidney function at one-year follow-up, whereas soluble CD40 ligand was not (R2=0.02, p=ns). In a multiple linear regression model CD40 (p\u3c0.02) and baseline creatinine (p\u3c0.01) continued to be significantly associated with a decline in renal function (model R2=0.17, p\u3c0.005). Baseline CD40 levels were somewhat lower in patients who died during follow-up (survivors, 7.3 ± 0.9 pg/ml, n=48 vs. non-survivors, 6.7 ± 1.0 pg/ml, n=12, p=0.06). The CD40/soluble CD40 ligand signaling cascade may be a novel mechanism contributing to the development and progression of renal injury in patients with atherosclerotic renal artery stenosis

Effect of CD40 and sCD40L on renal function and survival in patients with renal artery stenosis

Activation of the CD40 receptor on the proximal tubular epithelium of the kidney results in fibrosis and inflammation in experimental models of kidney injury. Soluble CD40 ligand is released by activated platelets. The role of CD40-soluble CD40 ligand in patients with ischemic renal disease is unknown. Plasma levels of CD40 and soluble CD40 ligand were measured by enzyme linked immunosorbent assay in a single center cohort of 60 patients with renal artery stenosis recruited from Salford Royal Hospital, Manchester, UK. A natural log transformation of CD40 and soluble CD40 ligand was performed to normalize the data. Estimated glomerular filtration rate was used as the primary indicator of renal function. By univariate analysis low baseline levels of circulating CD40 (R(2)=0.06, p<0.05) and baseline creatinine (R(2)=0.08, p=0.022) were associated with loss of kidney function at one-year follow-up, whereas soluble CD40 ligand was not (R(2)=0.02, p=ns). In a multiple linear regression model CD40 (p<0.02) and baseline creatinine (p<0.01) continued to be significantly associated with a decline in renal function (model R(2)=0.17, p<0.005). Baseline CD40 levels were somewhat lower in patients who died during follow-up (survivors, 7.3 ± 0.9 pg/ml, n=48 vs. non-survivors, 6.7 ± 1.0 pg/ml, n=12, p=0.06). The CD40/soluble CD40 ligand signaling cascade may be a novel mechanism contributing to the development and progression of renal injury in patients with atherosclerotic renal artery stenosis