Miracle-dz/UniFAR-FTUs huggingface dataset:
Combined high serum ferritin and low iron saturation in hemodialysis patients: the role of inflammation.

BACKGROUND Serum ferritin, frequently used as a marker of iron status in individuals with chronic kidney disease, is also an inflammatory marker. The concurrent combination of high serum ferritin and low iron saturation ratio (ISAT) usually poses a diagnostic dilemma. We hypothesized that serum ferritin > or =500 ng/ml, especially in the seemingly paradoxical presence of ISAT level <25%, is more strongly associated with inflammation than with iron in maintenance hemodialysis (MHD) patients. DESIGN, SETTING, AND PARTICIPANTS In 789 MHD patients in the Los Angeles area, the association of serum ferritin > or =500 ng/ml with inflammatory markers, including IL-6 (IL-6) and C-reactive protein levels, and malnutrition-inflammation score (MIS) was examined. RESULTS After multivariate adjustment for case-mix and other measures of malnutrition-inflammation complex, MHD patients with serum ferritin > or =500 ng/ml and ISAT <25% had higher odds ratio for serum C-reactive protein > or =10 mg/L. The area under the receiver operating characteristic curves for the continuum of ISAT and IL-6 in detecting a serum ferritin > or =500 ng/ml were identical (0.57 versus 0.56, P = 0.7). The combination of IL-6 with ISAT yielded a higher area under the receiver operating characteristic curve (0.61) than either ISAT or IL-6 alone (P = 0.03 and P = 0.02, respectively). CONCLUSION In MHD patients, ferritin values above 500 ng/ml, especially in paradoxical conjunction with low ISAT, are associated with inflammation. Strategies to dissociate inflammation from iron metabolism to mitigate the confounding impact of inflammation on iron and to improve iron treatment responsiveness may improve anemia management in chronic kidney disease.
Pharmacokinetic Characteristics of Ibandronate and Tolerability of DP-R206 (150 mg Ibandronate/24,000 IU Vitamin D3) Compared to the Ibandronate (150 mg) Monotherapy in Healthy Adults

Ibandronate (a bisphosphonate) is commonly used as an treatment of osteoporosis in combinationwith vitamin D. Monthly DP-R206-a novel, fixed-dose combination tablet (150 mg ibandronate/24,000 IU vitamin D3)-was recently developed to enhance patient compliance. This open,randomized, two-period crosso.
Improving the discharge planning process: a systems study

The complexity of the discharge planning process is such that it is often difficult to achieve in a totally efficient and effective manner. In this paper a systems approach is adopted in analysing the discharge planning process in a general surgical ward in order to understand better the nature of this complexity. Adopting a soft systems methodology it is shown that the major issues to be addressed relate to the need for a more seamless service provision and more effective utilisation of resources. Conceptual models are formulated which enable comparison to be made between current provision and the issues that need to be addressed. This in turn results in the creation of an agenda of items for change, from cultural, organisational and technological perspectives, which can be considered in terms of their feasibility and desirability. Key proposals highlighted, so as to improve discharge planning, include: the need for greater co-operation between the many healthcare professions involved; the adoption, particularly on the part of nursing staff, of a more holistic approach with regard to the needs of their patients; enhancing the utilisation of nursing staff; and moving towards a greater adoption of information and communication technologies as a means of achieving more effective communication. More generally, the paper provides an example of the role that soft systems analysis can play as an aid in dealing with the complexities of healthcare processes and their management.
Prevalence of malnutrition among infants in Sana'a city, Yemen

Background: The Infant's undernutrition is a significant health problem in Yemen. We aimed to determine the prevalence of malnutrition among infants attending maternal and child health centers in Sana'a city. Methods: A descriptive cross-sectional survey was conducted among 400 Yemeni infants aged less than 1 year attended to MCHC in Sana'a city from March to May 2012. A multi-stage sampling technique was used to selected study participants. Data on demographic characteristics of infants and anthropometric measurements were collected using a structured questionnaire as a face to face interview. Data were analyzed using both WHO Anthro and SPSS software program. WHO Anthro was used to calculate the Z-score needed to determine the prevalence of malnutrition among infants. The final clear dataset are imported to SPSS. Results: The mean age of infants was 4.3±3 months. 47.5% were boys and 52.5% were girls. The prevalence of wasting 11.8% is classified as “high”, the prevalence of stunting 40% is classified as “very high”, and the prevalence of underweight 20.3% is classified as “medium”. A statistical significant difference was not found by sex regarding wasting, stunting and underweight while statistical significant difference was found by age (χ2-test, P
Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative.

BACKGROUND AND OBJECTIVES Vascular access standards are predominantly based on older, single-center reports; however, the hemodialysis population has changed dramatically and primary arteriovenous fistula failure is a huge problem. This prospective, multicenter study used standardized definitions to analyze patency rates and potential risk factors that affect functional patency and late arteriovenous fistula functionality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Eleven centers participated in a guidelines implementation program. All new permanent vascular accesses were included. Patency and functional patency, defined as access survival from creation and from first dialysis use, respectively, were calculated using Kaplan-Meier analysis. Risk factors for primary functional patency loss (intervention-free interval) and secondary failure (abandonment) were determined using regression models. RESULTS A total of 491 arteriovenous fistulas were placed in 395 patients. Six-, 12-, and 18-mo secondary patency and functional patency were 75 +/- 2.0, 70 +/- 2.3, and 67 +/- 2.7% and 90 +/- 1.9, 88 +/- 2.2, and 86 +/- 2.7%, respectively. Primary failure rate was 40%. Thrombosis rate was 0.14 per patient-year. Diabetes and arteriovenous fistula surveillance were significantly associated with primary functional patency loss. Preoperative duplex was inversely related to secondary failure. The secondary failure rate per hospital varied from 0 to 39%. CONCLUSIONS This study showed a marked difference between patency and functional patency, likely to be explained by high primary failure rates. Hemodialysis patients with diabetes can be expected to have reduced primary functional patency rates, but if treated adequately, then arteriovenous fistula functionality can be maintained as long as in patients without diabetes.
The CKD-EPI equation for estimating GFR from serum creatinine: real improvement or more of the same?

The Cockcroft-Gault equation was published in 1976 and was widely adopted for estimation of creatinine clearance from serum creatinine levels (1). The equation was developed using two steps: First, urinary creatinine excretion per body weight (UV/kg) was estimated from age in hospitalized patients; creatinine clearance was then calculated by multiplying by weight and dividing by serum creatinine (P) using the standard “UV/P” clearance formula. Not surprising, the high-risk patients who were used to develop the Cockcroft-Gault equation had lower muscle mass (creatinine excretion) than healthier individuals in the general population (2). The lack of a standardized serum creatinine assay has also been considered a problem with the Cockcroft-Gault equation, but this is not the case. Serum creatinine assay calibration has no influence on the coefficients of the Cockcroft-Gault equation, because the regression did not involve serum creatinine. Because the Cockcroft-Gault equation was developed using only white men, however, the model was not optimized to account for gender and race differences in muscle mass. Nonetheless, the Cockcroft-Gault equation is still used widely, particularly for drug dosing, for which estimates in ml/min units are desired. Because the Cockcroft-Gault equation has been used to determine recommended dosages for various medications (3), there is a consistent approach when using this equation to adjust medication dosage. However, the clinician should keep in mind that many dosing recommendations were made prior to serum creatinine standardization. By contrast, the most widely used GFR-estimating equation today is the Modification of Diet in Renal Disease (MDRD) equation, which was published in 1999 and later simplified (4,5). This equation automatically estimates GFR from serum creatinine for most laboratories (6). This equation was developed using patients who who had CKD identified …
Bluetongue in northern Europe: the story so far

BLUETONGUE was first seen in northern Europe in August 2006 when there was a sudden incursion of bluetongue virus (BTV) serotype 8 (BTV-8). The disease recurred in 2007, with serious consequences for affected countries because of its rapid spread over a wide area of mainland Europe, and caused direct (due to both clinical and subclinical disease) and indirect (due to significant trade restrictions) losses. The virus arrived in the UK in August 2007. The availability of BTV-8 vaccine in 2008 led to one of the biggest mass vaccination campaigns ever experienced across Europe. The success of this vaccination programme was mixed, as the serotype continued to spread through France. The situation was further complicated by the arrival of BTV serotype 1 (BTV-1) in the Iberian Peninsula and, later, France; BTV serotype 6 (BTV-6) in the Netherlands, Germany and Belgium; BTV serotype 11 (BTV-11) in Belgium; and the so-called Toggenburg orbivirus in Switzerland. This article reviews the events relating to the bluetongue outbreaks in Europe and the UK in 2007/08, describes the control methods that are currently available and the rationale for their use, and discusses what the likely course of the management of this disease might be in the future.
An Evidence-Based Clinical Approach to Suicide Prevention in the Department of Defense: The Collaborative Assessment and Management of Suicidality (CAMS)

There are few evidence-based approaches for the treatment of suicidality particularly within the Department of Defense settings (DoD) (Schoenbaum, Heinssen, & Pearson, 2009). This article describes a relatively new suicide-specific approach called the “Collaborative Assessment and Management of Suicidality” (CAMS). There is growing evidence that CAMS can meaningfully impact suicidal ideation, overall symptom distress, increase hope, and may positively impact non-mental health utilization. The prospect of using CAMS within military treatment facilities is discussed as a means of clinically assessing and treating suicidal ideation and related behaviors for military personnel.
Novel links between the long pentraxin 3, endothelial dysfunction, and albuminuria in early and advanced chronic kidney disease.

BACKGROUND AND OBJECTIVES Albuminuria and inflammation predict cardiovascular events. Pentraxin 3, an inflammatory mediator produced by, among others, endothelial cells, may have a role in atherogenesis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In 207 Swedish patients with stage 5 chronic kidney disease and 79 Turkish patients with type 2 diabetes and proteinuria and normal renal function, whether serum pentraxin 3 levels are associated with albuminuria and endothelial dysfunction was studied. RESULTS Patients with stage 5 chronic kidney disease and a high degree of albuminuria more often had diabetes and higher levels of pentraxin 3, vascular cellular adhesion molecule-1, and blood pressure. Moreover, pentraxin 3 was independently associated with 24-h urinary albumin excretion. In patients with type 2 diabetes, pentraxin 3 was significantly higher than in control subjects. Patients with type 2 diabetes and more proteinuria had higher pentraxin 3, C-reactive protein, glycosylated hemoglobin, insulin, and homeostasis model assessment index as well as lower flow-mediated dilation and serum albumin. Pentraxin 3 was positively correlated with C-reactive protein, homeostasis model assessment index, and carotid intima-media thickness and negatively with flow-mediated dilation. Pentraxin 3 and glomerular filtration rate were independently associated with 24-h urinary protein excretion. Only pentraxin 3 and proteinuria were significantly and independently associated with flow-mediated dilation. CONCLUSIONS In two different renal cohorts, one of stage 5 chronic kidney disease and one of type 2 diabetes and normal renal function, pentraxin 3 was independently associated with proteinuria. Moreover, both pentraxin 3 and proteinuria were associated with endothelial dysfunction in patients with type 2 diabetes.
Role of residual renal function in phosphate control and anemia management in chronic hemodialysis patients.

BACKGROUND AND OBJECTIVES There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output≥100 ml/24 h (n=295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output<100 ml/24 h, n=274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models. RESULTS Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR>4.13 ml/min per 1.73 m2), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9±1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. CONCLUSIONS This study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged.
Must health literacy be a prerequisite for kidney transplantation?

Patients with ESRD want kidney transplants! A study of the impact of health literacy on access of dialysis patients to transplantation in this issue of CJASN found 90% favoring transplantation as their preferred modality of therapy (1). Regardless of original kidney disease, age, gender, ethnicity, educational status, income level, dialysis provider, or health literacy , from a patient's perspective, transplantation is the best option. Yet fewer than 25% of patients with ESRD have functioning transplants, and only 20% of dialysis patients populate transplant waiting lists despite estimates that perhaps as many as half would live longer with a transplant than on dialysis (2-4). Why does delivery of renal replacement therapy (RRT) in the United States, offered to all Medicare-eligible patients as an entitlement accompanied by a mandate to provide optimal services, deviate so markedly from their expressed preferences (5)? Perhaps the patients studied by Grubbs et al . (1) do not represent most dialysis patients. Ayanian et al . (6) found that fewer than 40% of patients who began dialysis were aware of transplantation as an option, but after education regarding treatment modalities, the patients they studied in Alabama, southern California, Michigan, and the mid-Atlantic area expressed sentiments remarkably similar to the Bay Area patients in the article by Grubbs et …
Adverse safety events in chronic kidney disease: the frequency of "multiple hits".

BACKGROUND AND OBJECTIVES Chronic kidney disease (CKD) lacks standardized patient safety indicators (PSIs); however, undetected safety events are likely to contribute to adverse outcomes in this disease. This study sought to determine the proportion of CKD patients who experience multiple potentially hazardous events from varied causes and to identify risk factors for the occurrence of "multiple hits. " DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A sample of patients with CKD (n = 70,154) in the Veterans Health Administration (VHA) were retrospectively examined for the occurrence of one or more safety events from a set of indicators defined a priori, including Agency for Healthcare Research and Quality (AHRQ) PSIs, hypoglycemia, hyperkalemia, and dosing for selected medications not accounting for CKD. RESULTS Approximately half of the cohort participants experienced one or two adverse safety events, whereas 7% had three or four (multiple) distinct events. Individuals with three or four of the predesignated safety events were more likely to be diabetic, non-Caucasian, have an estimated GFR (eGFR) < 30 ml/min/1.73 m(2), and be < or =65 yr of age. A "Safety Risk Index" was developed using these characteristics, and those subjects that had all four traits were 25 times as likely to have three or four adverse safety events versus those with none of the characteristics. CONCLUSIONS Patients with CKD are at a high risk for safety events pertinent to this disease and a substantial number are subject to multiple events from a diverse set of safety indicators, which could have important consequences in disease outcomes.
A comparison of SF-36 and SF-12 composite scores and subsequent hospitalization and mortality risks in long-term dialysis patients.

BACKGROUND AND OBJECTIVES The Short Form 12 (SF-12) has not been validated for long-term dialysis patients. The study compared physical and mental component summary (PCS/MCS) scores from the SF-36 with those from the embedded SF-12 in a national cohort of dialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All 44,395 patients who had scorable SF-36 and SF-12 from January 1, 2006, to December 31, 2006, and were treated at Fresenius Medical Care, North America facilities were included. Death and first hospitalization were followed for up to 1 year from the date of survey. Correlation and agreement were obtained between PCS-36 and PCS-12 and MCS-36 and MCS-12; then Cox models were constructed to compare associated hazard ratios (HRs) between them. RESULTS Physical and mental dimensions both exhibited excellent intraclass correlation coefficients of 0.94. Each incremental point for both PCS-12 and PCS-36 was associated with a 2.4% lower adjusted HR of death and 0.4% decline in HR for first hospitalization (both P < 0.0001). Corresponding improvement in HR of death for each MCS point was 1.2% for MCS-12 and 1.3% for MCS-36, whereas both had similar 0.6% lower HR for hospitalization per point (all P < 0.0001). CONCLUSIONS The use of the SF-12 alone or as part of a larger survey is valid in dialysis patients. Composite scores from the SF-12 and SF-36 have similar prognostic association with death and hospitalization risk. Prospective longitudinal studies of SF-12 surveys that consider responsiveness to specific clinical, situational, and interventional changes are needed in this population.
Association of arterial rigidity with incident kidney disease and kidney function decline: the Health ABC study.

BACKGROUND AND OBJECTIVE The association of large arterial rigidity and kidney function decline in longitudinal analyses is not well established. This study evaluated the association of aortic pulse wave velocity (aPWV) and pulse pressure (PP) with rapid kidney function decline and incident CKD in the Health, Aging and Body Composition study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Participants were 2129 older adults with a baseline measurement of aPWV, PP, and cystatin C and at least one additional measurement of cystatin C, either at year 3 or year 10. Outcomes were rapid kidney function decline (estimated GFRcysC loss of >3 ml/min per 1.73 m(2) per year) and incident CKD (eGFRcysC < 60 ml/min per 1.73 m(2) in participants with baseline estimated GFR > 60 ml/min per 1.73 m(2)). Multivariate regression models were used to evaluate association of aPWV and PP with each outcome. RESULTS Mean (SD) baseline estimated GFRcysC was 79±29 ml/min per 1.73 m(2). Median follow-up duration was 8.9 years. In multivariable analyses, aPWV was not associated with rapid decline (odds ratio [OR], 95% confidence interval [CI] 1.16, 0.89-1.52) but was associated with incident CKD (incident rate ratio [IRR], 95% CI, 1.39, 1.09-1.77) and PP was associated with both rapid decline (OR, 95% CI 1.10, 1.04-1.16) and incident CKD (IRR, 95% CI, 1.06, 1.01-1.11). CONCLUSIONS Large arterial stiffness assessed by aPWV and pulsatility assessed by PP were associated with incident CKD among older adults. Pulsatility assessed by PP was associated with rapid kidney function decline and incident CKD. Future research should determine whether interventions targeting arterial rigidity will prevent CKD development and progression.
Patterns and prognostic value of total and differential leukocyte count in chronic kidney disease.

BACKGROUND AND OBJECTIVES The purpose of this study was to evaluate the levels and patterns of total and differential leukocyte counts and their prognostic importance in a cohort of people with and without chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 153 veterans without CKD and 267 with, blood leukocyte count was measured at baseline and then repeatedly over a decade. The patterns of change in leukocyte count between the two groups were compared. In the CKD cohort, the spikes in leukocyte counts were compared to the combined endpoint of ESRD and death. RESULTS Patients with CKD had more granulocytes and eosinophils and fewer lymphocytes. Over time, granulocytes increased and lymphocytes decreased in those with and without CKD. In addition, in those with CKD, over time eosinophils fell and monocytes increased. Compared with their non-CKD counterparts, patients with CKD had between 1.5- and 3.0-fold more spikes in leukocyte counts. Independent risk factors for the combined endpoint were associated with spikes in the leukocyte counts of absolute and percent eosinophil count, percent granulocyte, and percent monocyte counts. In a multivariate adjusted joint model, both granulocyte and monocyte spikes were independently associated with ESRD and death (hazard ratio 1.67 and 1.52 respectively, P < 0.05). CONCLUSIONS Compared with those without CKD, patients with CKD have more eosinophils and granulocytes and fewer lymphocytes. Greater variation in leukocytes is seen. Spikes in granulocyte and monocyte percentages among patients with CKD are of independent prognostic importance.