Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium.

Rationale & Objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD staging framework.

Study Design: Cross-sectional individual participant-level analyses in a global consortium.

Risk Factors for Prognosis in Patients With Severely Decreased GFR.

Introduction: Patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m (corresponding to CKD stage G4+) comprise a minority of the overall CKD population but have the highest risk for adverse outcomes. Many CKD G4+ patients are older with multiple comorbidities, which may distort associations between risk factors and clinical outcomes.

Presentation, pathology and prognosis of renal disease in type 2 diabetes.

Objective: Non-diabetic renal disease (NDRD) is common in patients with type 2 diabetes (T2D), but the relationship between its presentation and prognosis is unknown.

Research Design And Methods: In a retrospective cohort study, we compared renal and patient survival among 263 patients with T2D who had native renal biopsies between 2002 and 2008 from three Auckland hospitals in New Zealand. The presence of diabetic nephropathy (DN), NDRD or mixed (DN and NDRD) was determined from biopsy.

Malignancy in Membranous Nephropathy: Evaluation of Incidence.

Background: Membranous nephropathy (MN) can be associated with malignancy. However, the relative risk for malignancy remains unclear. It has been reported that higher numbers of inflammatory cells seen in the glomeruli at biopsy correlate with the occurrence of malignancy in patients with MN and might be used to direct screening.

Bile Nephropathy in Flucloxacillin-Induced Cholestatic Liver Dysfunction.

Kidney injury in the context of cholestatic liver dysfunction is not uncommon; this has been historically referred to as cholemic nephrosis implying a direct deleterious renal effect of cholemia. However, scepticism about the exact role that bile and its constituents play in this injury has led to the disappearance of the term. We describe a case of severe AKI due to bile nephropathy with bile casts in flucloxacillin-induced liver dysfunction.

Reversible Deterioration in Hypophosphatasia Caused by Renal Failure With Bisphosphonate Treatment.

Hypophosphatasia is an inborn error of metabolism caused by mutations in the ALPL gene. It is characterized by low serum alkaline phosphatase (ALP) activity and defective mineralization of bone, but the phenotype varies greatly in severity depending on the degree of residual enzyme activity. We describe a man with compound heterozygous mutations in ALPL, but no previous bone disease, who suffered numerous disabling fractures after he developed progressive renal failure (for which he eventually needed dialysis treatment) and was prescribed alendronate treatment.

Association between GFR estimated by multiple methods at dialysis commencement and patient survival.

Background And Objectives: The Initiating Dialysis Early and Late study showed that planned early or late initiation of dialysis, based on the Cockcroft and Gault estimation of GFR, was associated with identical clinical outcomes. This study examined the association of all-cause mortality with estimated GFR at dialysis commencement, which was determined using multiple formulas.

Design, Setting, Participants, & Measurements: Initiating Dialysis Early and Late trial participants were stratified into tertiles according to the estimated GFR measured by Cockcroft and Gault, Modification of Diet in Renal Disease, or Chronic Kidney Disease-Epidemiology Collaboration formula at dialysis commencement.

Emissions of polycyclic aromatic hydrocarbons (PAHs) and nitro-PAHs from heavy-duty diesel vehicles with DPF and SCR.

Unlabelled: In total, 24 polycyclic aromatic hydrocarbons (PAHs) in both gas and particle phases and 35 nitro-PAHs in particle phase were analyzed in the exhaust from heavy-duty diesel vehicles equipped with after-treatment for particulate matter (PM) and NO(x) control. The test vehicles were carried out using a chassis dynamometer under highway cruise, transient Urban Dynamometer Driving Schedule (UDDS), and idle operation. The after-treatment efficiently abated more than 90% of the total PAHs.

In-use NOx emissions from model year 2010 and 2011 heavy-duty diesel engines equipped with aftertreatment devices.

The California Air Resources Board (ARB) undertook this study to characterize the in-use emissions of model year (MY) 2010 or newer diesel engines. Emissions from four trucks: one equipped with an exhaust gas recirculation (EGR) and three equipped with EGR and a selective catalytic reduction (SCR) device were measured on two different routes with three different payloads using a portable emissions measurement system (PEMS) in the Sacramento area. Results indicated that brake-specific NOx emissions for the truck equipped only with an EGR were independent of the driving conditions.

Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial.

Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

Effect of early initiation of dialysis on cardiac structure and function: results from the echo substudy of the IDEAL trial.

Background: Abnormalities of cardiac structure and function are common in patients undergoing dialysis, and cardiovascular disease is the major cause of mortality in this group. Heart failure is a common clinical manifestation of cardiovascular disease and is preceded by left ventricular hypertrophy (LVH). There are variable reports about the impact of dialysis on LVH, both deleterious and beneficial.

Robotic remote presence technology in the surgical intensive care unit.

Background: A national shortage of intensivists coupled with an increased demand for 24/7 intensive care unit (ICU) attending coverage poses staffing problems. To extend physician availability, many institutions have adopted varying forms of remote presence technology (RPT). The authors examine their experience with robotic technology to extend physician presence.

Increased prevalence of albuminuria among non-European peoples with type 2 diabetes.

Background: A high incidence of albuminuria, varying by ethnicity, has been found in a number of populations worldwide. There have been few opportunities to explore the prevalence of albuminuria as a marker of chronic kidney disease while adjusting for other risk factors in the different ethnic groups in New Zealand.

Methods: We examined the association between albuminuria and ethnicity using cross-sectional data from a large cohort study of type 2 diabetes conducted in New Zealand.

A randomized, controlled trial of early versus late initiation of dialysis.

Background: In clinical practice, there is considerable variation in the timing of the initiation of maintenance dialysis for patients with stage V chronic kidney disease, with a worldwide trend toward early initiation. In this study, conducted at 32 centers in Australia and New Zealand, we examined whether the timing of the initiation of maintenance dialysis influenced survival among patients with chronic kidney disease.

Methods: We randomly assigned patients 18 years of age or older with progressive chronic kidney disease and an estimated glomerular filtration rate (GFR) between 10.

Effect of advanced aftertreatment for PM and NO(x) control on heavy-duty diesel truck emissions.

Emissions from four heavy-duty and medium-duty diesel vehicles were tested in six different aftertreatment configurations using a chassis dynamometer. The aftertreatment included four different diesel particle filters (DPF) and two prototype selective catalytic reduction (SCR) devices for NO(x) control. The goal of the project was to fully characterize emissions from various in-use vehicles meeting the 2007 particulate matter (PM) standard for the United States and California and to provide a snapshot of emissions from 2010 compliant vehicles.

Is computerized tomography useful in identifying abdominal catastrophes in patients presenting with peritonitis?

Background: Peritonitis is a significant source of morbidity and mortality in patients on peritoneal dialysis (PD). Symptoms may persist, requiring an emergency laparotomy. Although increasingly used, we find that, in PD patients, abdominal computerized tomography (CT) is ineffective in determining significant pathology.

Measurements of in-use emissions from modern vehicles using an on-board measurement system.

Emissions from "low emitting" modern vehicles were measured on-road using a Fourier transform infrared (FTIR) on-board emissions measurement system. Twenty vehicles were tested on road and on a chassis dynamometer. A subset of four vehicles was tested on a test track as well as on the dynamometer.

Atrial fibrillation in haemodialysis patients: do the guidelines for anticoagulation apply?

Aim: Atrial fibrillation (AF) is common in haemodialysis patients, but the risks and benefits of anticoagulation in this group are not well characterized. We investigated the prevalence of AF, its associated risk factors, and the incidence of stroke and haemorrhage in a cohort of haemodialysis patients.

Methods: We retrospectively reviewed 155 patients undergoing maintenance haemodialysis on 1 April 2003 (age 56.

Acute renal failure in patients with pre-existing renal dysfunction following coronary artery bypass grafting.

Background: Pre-existing renal dysfunction predisposes to acute renal failure (ARF) in patients undergoing coronary artery bypass grafting. We assessed the incidence and impact of the development of ARF in this patient population in our unit.

Methods: One-hundred and six patients had a preoperative serum creatinine of >or=0.

Obesity is a risk factor for peritonitis in the Australian and New Zealand peritoneal dialysis patient populations.

Objective: The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up.

Design: Retrospective observational cohort study of the Australian and New Zealand PD patient population.

Setting: Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.

The Initiating Dialysis Early and Late (IDEAL) study: study rationale and design.

Objectives: The primary objective of the IDEAL study is to determine whether the timing of dialysis initiation has an effect on survival in subjects with end-stage renal disease (ESRD). The secondary objectives are to determine the impact of "early start" versus "late start" dialysis on nutritional and cardiac morbidity, quality of life, and economic cost.

Design: Prospective multicenter randomized controlled trial.