Unexpectedly high incidence of Kawasaki Disease in a Canadian Atlantic Province- an 11-year retrospective descriptive study.

Background: Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries with a variable incidence worldwide. Previous studies reported an unexpectedly high incidence of KD in the Canadian Atlantic Provinces. The goals of our study were to validate this finding in the province of Nova Scotia and to carefully review patients' characteristics and disease outcomes.

The resilience of postglacial hunter-gatherers to abrupt climate change.

Understanding the resilience of early societies to climate change is an essential part of exploring the environmental sensitivity of human populations. There is significant interest in the role of abrupt climate events as a driver of early Holocene human activity, but there are very few well-dated records directly compared with local climate archives. Here, we present evidence from the internationally important Mesolithic site of Star Carr showing occupation during the early Holocene, which is directly compared with a high-resolution palaeoclimate record from neighbouring lake beds.

Characterization of a factor H mutation that perturbs the alternative pathway of complement in a family with membranoproliferative GN.

Complement C3 activation is a characteristic finding in membranoproliferative GN (MPGN). This activation can be caused by immune complex deposition or an acquired or inherited defect in complement regulation. Deficiency of complement factor H has long been associated with MPGN.

Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators.

Background: An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important.

Methods: Incidence counts for the years 2003-05 were available from 36 countries worldwide.

A new reconstructive technique for posterior vaginal wall defects, a case report.

Introduction: Post-partum vaginal laxity is a problem encountered by many women. More uncommon is a resulting vaginal defect. In most cases of laxity, a period of extensive physiotherapy can strengthen the pelvic muscles enough for symptoms to be minimized.

Exploring the association between macroeconomic indicators and dialysis mortality.

Background And Objectives: Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population.

Design, Setting, Participants, & Measurements: Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003-2005.

Volcanic ash layers illuminate the resilience of Neanderthals and early modern humans to natural hazards.

Marked changes in human dispersal and development during the Middle to Upper Paleolithic transition have been attributed to massive volcanic eruption and/or severe climatic deterioration. We test this concept using records of volcanic ash layers of the Campanian Ignimbrite eruption dated to ca. 40,000 y ago (40 ka B.

Translating chronic kidney disease epidemiology into patient care--the individual/public health risk paradox.

Background: Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (≈ 13,000 patient-years).

Measuring the population burden of chronic kidney disease: a systematic literature review of the estimated prevalence of impaired kidney function.

Background: Internationally, there have been substantial efforts to improve the early identification of chronic kidney disease (CKD), with a view to improving survival, reducing progression and minimizing cardiovascular morbidity and mortality. In 2002, a new and globally adopted definition of CKD was introduced. The burden of kidney function impairment in the population is unclear and widely ranging prevalence estimates have been reported.

Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts.

We studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected for CKD of diverse etiology. After adjustment for potential confounders and albuminuria, we found that a 15 ml/min per 1.

Global variation in renal replacement therapy for end-stage renal disease.

Background: Incidence rates of renal replacement therapy (RRT) for end-stage renal disease vary considerably worldwide. This study examines the independent association between the general population, health care system and renal service characteristics and RRT incidence rates.

Methods: RRT incidence data (2003-2005) were obtained from renal registries; general population age and health and macroeconomic indices were collected from secondary sources.

The EVEREST study: an international collaboration.

Rates of initiation of renal replacement therapy (RRT), use of home modalities of treatment and patient outcomes vary considerably between countries. This paper reports the methods and baseline characteristics of countries participating in the EVEREST study (n = 46), a global collaboration examining the association between medical and non-medical factors and RRT incidence, modality mix and survival. Numbers of incident and prevalent patients were collected for current (2003-05) and historic (1983-85, 1988-90, 1993-95 and 1998-2000) periods stratified, where available, by age, gender, treatment modality and cause of end stage renal disease (diabetic versus non-diabetic).

Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections.

Background: Almost 30% of chronic haemodialysis (HD) patients are dependent on central venous catheters (CVCs) for their vascular access, and catheter-related bacteraemia (CRB) is the major reason for catheter loss and has been associated with substantial morbidity, including meta-static infections. This systematic review evaluates the benefits and harms of antimicrobial interventions for the prevention of catheter-related infections (CRIs).

Methods: MEDLINE (1950-May 2009), EMBASE (1980-May 2009) CENTRAL (up to May 2009) and bibliographies of retrieved articles were searched for relevant RCTs.

Survival and dialysis initiation: comparing British Columbia and Scotland registries.

Background: Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.

Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials.

Background: A systematic review of randomized controlled trials (RCTs) comparing continuous ambulatory peritoneal dialysis (CAPD) with all forms of automated peritoneal dialysis (APD) was performed to assess their comparative clinical effectiveness.

Methods: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, were searched for relevant RCTs. Analysis was by a random effects model and results expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI).

A prospective national study of acute renal failure treated with RRT: incidence, aetiology and outcomes.

Background: Acute renal failure (ARF) is a diverse condition with no standardized definition and is managed in several sub-specialty areas within hospitals. Its incidence and aetiology are unknown and studies show a wide range of incidences. ARF is becoming more common as the population ages leading to the hypothesis that the incidence is much higher than previous estimates.

Incidence and outcomes in acute kidney injury: a comprehensive population-based study.

Epidemiological studies of acute kidney injury (AKI) and acute-on-chronic renal failure (ACRF) are surprisingly sparse and confounded by differences in definition. Reported incidences vary, with few studies being population-based. Given this and our aging population, the incidence of AKI may be much higher than currently thought.

A new initiative in nephrology: 'Kidney disease: improving global outcomes'.

The burden of kidney disease: Improving global outcomes. Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence of patients requiring replacement therapy. There is an even higher prevalence of patients in earlier stages of CKD, with adverse outcomes such as kidney failure, cardiovascular disease, and premature death.

Collecting unit cost data in multicentre studies. Creating comparable methods.

International comparisons of health care systems and services have created increased interest in the comparability of cost results. This study compared top-down and bottom-up approaches to collecting unit cost data across centres in the context of examining the cost-effectiveness of dialysis therapy across Europe. The study tested whether health care technologies in different countries can be costed using consistent and transparent methods to increase the comparability of results.

Comparison of hemodialysis, hemofiltration, and acetate-free biofiltration for ESRD: systematic review.

Background: We performed a systematic review of randomized controlled trials (RCTs) comparing hemodialysis (HD), hemofiltration (HF), hemodiafiltration (HDF), and acetate-free biofiltration (AFB) in the treatment of patients with end-stage renal disease to assess their clinical effectiveness.

Methods: The Cochrane CENTRAL Registry, MEDLINE, EMBASE, CINAHL, the American College of Physicians Database, Database of Abstracts of Reviews of Effectiveness, and reference lists were searched for randomized trials of HF, HDF, and AFB compared with HD; HDF compared with AFB; and HF compared with HDF. Two reviewers extracted data for all-cause mortality; hypotension, headache, nausea, vomiting, and any other adverse symptoms; quality of life (QoL); hospitalization; dialysis adequacy; and end-of-treatment beta 2 -microglobulin levels.

The burden of kidney disease: improving global outcomes.

Chronic kidney disease (CKD) is a worldwide public health problem. There is an increasing incidence and prevalence of patients with kidney failure requiring replacement therapy, with poor outcomes and high cost. There is an even higher prevalence of patients in earlier stages of CKD, with adverse outcomes such as kidney failure, cardiovascular disease, and premature death.

Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure.

Background: Home hemodialysis offers potential advantages over hospital hemodialysis, including the opportunity for more frequent and/or longer dialysis sessions. Expanding home hemodialysis services may help cope with the increasing numbers of people requiring hemodialysis.

Methods: We sought comparative studies or systematic reviews of home versus hospital/satellite unit hemodialysis for people with end-stage renal failure (ESRF).