Sample records for kamchatka depression ckd

  1. Early Holocene volcanism in CKD (Kamchatka) as a mechanical probe of the stress level in the crust. (United States)

    Simakin, Alexander; Shaposhnikova, Olga


    The last (late Pleistocene) glaciation in Kluychevskaya group of volcanoes (KGV) can be considered as a large scale mechanical experiment allowing evaluation of the level of the global geodynamic stresses in the crust of North Kamchatka. KGV is located in the Central Kamchatka depression (CKD). Formation of the CKD can be connected with accretion of Kronotsky paleoarc to the Kamchatka edge c.a. 5 Mys ago. At the compression stage zone of the contact was thickened so that lower part can reach PT parameters of basalt-eclogite transition. Suggested carbonates contamination of the mantle wedge during accretion (Simakin et al., 2015) can became a source of CO2 facilitating eclogite formation. Dense eclogitic keel and trench retreat following accretion can be the driving forces of the CKD rift formation. Extension is partially accommodated (several mm/yr eastward motion) on the eastern border of CKD in the zone of the normal faulting (Kozhurin et al., 2006). And partially extension is accommodated by the formation of the series of dykes of submeridional direction marked by monogenic cones on the surface. At the last phase of the Pleistocene glaciation KGV was covered by the ice cap with 80 km diameter and above 1000 m maximum thickness on the slopes. After the fast deglaciation surface uplift has produced horizontal compression (Simakin and Muravyev, 2015; Pagli and Sigmundsson, 2008). Addition of the deglacial compression to the geodynamic extension turns s1 direction to the horizontal latitudinal one. Due to the horizontal compression areal of eruptions was expanded towards edges of the former glacier. Numerical modeling demonstrates that maximum level of the glacial stress is proportional to the ice gravity load and is estimated to be 5.8-7.5 MPa. Initially principle compressive stress due to the deglaciation was higher than geodynamic one abs(s1,glac) > abs(s1,geod). Time of the volcanism return to the basic submeridional direction marked the moment of viscous

  2. Mantle temperature control on composition of arc magmas along the Central Kamchatka Depression (United States)

    Portnyagin, Maxim; Constantin Manea, Vlad


    Abundant volcanism in the Central Kamchatka Depression (CKD)adjacent to the Kamchatka-Aleutian Arc junction occurswhere the Pacific slab edge is subducting beneath Kamchatka.Here we summarize published data on CKD rocks and demonstratea systematic south-to-north change of their compositions frommoderately fractionated basalt-andesite tholeiitic series tohighly fractionated basalt-rhyolite calc-alkaline series includinghigh-magnesian andesites near the slab edge. Localized slabmelting at the slab edge cannot explain these regional geochemicalvariations. Instead, we propose that the thermal state of themantle wedge can be the key factor governing the compositionof CKD magmas. We integrate the results from petrology and numericmodeling to demonstrate the northward decrease of the mantlewedge temperatures beneath CKD volcanoes, which correlates withdecreasing slab dip, length of mantle columns, and magma flux.We envision two petrogenetic models, which relate the compositionof erupted magmas to the subduction parameters beneath the CKD.The first model suggests that mantle temperature governs melt-peridotiteequilibria and favors generation of andesitic primary meltsin cold mantle regions above the shallowly subducting Pacificslab edge. Alternatively, mantle temperature may control magmaticproductivity along the CKD, which decreases sharply toward theslab edge and thus allows more extensive magma fractionationdeeper in the crust and mixing of highly evolved and mantle-derivedmagmas to generate Si-rich "primitive" magmas. These resultspoint to a possible casual link between deep mantle and shallowcrustal magmatic processes. Similar effects of mantle temperatureon the composition and productivity of arc magmatism are expectedelsewhere, particularly in volcanic regions associated withsignificant slab dip variation along the arc.

  3. Kamchatka


    Alessandra Russo


    Photo prise de : « La péninsule du Kamchatka est située à l’extrême frontière orientale de la Fédération de Russie, au nord du Japon et au Sud-Ouest de l’Alaska. Celle-ci s’étire sur 1500 km du nord au sud et 470 km dans sa plus grande largeur entre les latitudes 50°51’N (hauteur de Bruxelles) et 64°50’N». Qu’est-ce que tout cela a à voir avec le déchaînement de la dictature argentine ? En 1976 une famille porteña se voi...

  4. Kamchatka

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    Alessandra Russo


    Full Text Available Photo prise de : « La péninsule du Kamchatka est située à l’extrême frontière orientale de la Fédération de Russie, au nord du Japon et au Sud-Ouest de l’Alaska. Celle-ci s’étire sur 1500 km du nord au sud et 470 km dans sa plus grande largeur entre les latitudes 50°51’N (hauteur de Bruxelles et 64°50’N». Qu’est-ce que tout cela a à voir avec le déchaînement de la dictature argentine ? En 1976 une famille porteña se voi...

  5. Deciphering petrogenic processes using Pb isotope ratios from time-series samples at Bezymianny and Klyuchevskoy volcanoes, Central Kamchatka Depression (United States)

    Kayzar, Theresa M.; Nelson, Bruce K.; Bachmann, Olivier; Bauer, Ann M.; Izbekov, Pavel E.


    The Klyuchevskoy group of volcanoes in the Kamchatka arc erupts compositionally diverse magmas (high-Mg basalts to dacites) over small spatial scales. New high-precision Pb isotope data from modern juvenile (1956-present) erupted products and hosted enclaves and xenoliths from Bezymianny volcano reveal that Bezymianny and Klyuchevskoy volcanoes, separated by only 9 km, undergo varying degrees of crustal processing through independent crustal columns. Lead isotope compositions of Klyuchevskoy basalts-basaltic andesites are more radiogenic than Bezymianny andesites (208Pb/204Pb = 37.850-37.903, 207Pb/204Pb = 15.468-15.480, and 206Pb/204Pb = 18.249-18.278 at Bezymianny; 208Pb/204Pb = 37.907-37.949, 207Pb/204Pb = 15.478-15.487, and 206Pb/204Pb = 18.289-18.305 at Klyuchevskoy). A mid-crustal xenolith with a crystallization pressure of 5.2 ± 0.6 kbars inferred from two-pyroxene geobarometry and basaltic andesite enclaves from Bezymianny record less radiogenic Pb isotope compositions than their host magmas. Hence, assimilation of such lithologies in the middle or lower crust can explain the Pb isotope data in Bezymianny andesites, although a component of magma mixing with less radiogenic mafic recharge magmas and possible mantle heterogeneity cannot be excluded. Lead isotope compositions for the Klyuchevskoy Group are less radiogenic than other arc segments (Karymsky—Eastern Volcanic Zone; Shiveluch—Northern Central Kamchatka Depression), which indicate increased lower-crustal assimilation beneath the Klyuchevskoy Group. Decadal timescale Pb isotope variations at Klyuchevskoy demonstrate rapid changes in the magnitude of assimilation at a volcanic center. Lead isotope data coupled with trace element data reflect the influence of crustal processes on magma compositions even in thin mafic volcanic arcs.

  6. Subfossil chironomids from Kamchatka

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    Larisa Nazarova


    Full Text Available Chironomid head capsules from surface sediments in Kamchatka reflect a rich and diverse fauna. We observed a relatively high abundance of head capsules from the subfamily Diamesinae. An unknown morphotype of Tanytarsini, 'Tanytarsini type klein', was found in the lake sediments of two lakes from Central and southern Kamchatka.

  7. Chronic Kidney Disease (CKD) (United States)

    ... CKD treated? Kidney-friendly diet for CKD What causes chronic kidney disease (CKD)? Anyone can get CKD. Some people are ... and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, ...

  8. Assessing the Altitude and Dispersion of Volcanic Plumes Using MISR Multi-angle Imaging from Space: Sixteen Years of Volcanic Activity in the Kamchatka Peninsula, Russia (United States)

    Flower, Verity J. B.; Kahn, Ralph A.


    Volcanic eruptions represent a significant source of atmospheric aerosols and can display local, regional and global effects, impacting earth systems and human populations. In order to assess the relative impacts of these events, accurate plume injection altitude measurements are needed. In this work, volcanic plumes generated from seven Kamchatka Peninsula volcanoes (Shiveluch, Kliuchevskoi, Bezymianny, Tolbachik, Kizimen, Karymsky and Zhupanovsky), were identified using over 16 years of Multi-angle Imaging SpectroRadimeter (MISR) measurements. Eighty-eight volcanic plumes were observed by MISR, capturing 3-25% of reported events at individual volcanoes. Retrievals were most successful where high intensity events persisted over a period of weeks to months. Compared with existing ground and airborne observations, and alternative satellite-based reports compiled by the Global Volcanism Program (GVP), MISR plume height retrievals showed general consistency; the comparison reports appear to be skewed towards the region of highest concentration observed in MISR-constrained vertical plume extent. The report observations display less discrepancy with MISR toward the end of the analysis period, with improvements in the suborbital data likely the result of the deployment of new instrumentation. Conversely, the general consistency of MISR plume heights with conventionally reported observations supports the use of MISR in the ongoing assessment of volcanic activity globally, especially where other types of volcanic plume observations are unavailable. Differences between the northern (Shiveluch, Kliuchevskoi, Bezymianny and Tolbachik) and southern (Kizimen, Karymsky and Zhupanovsky) volcanoes broadly correspond to the Central Kamchatka Depression (CKD) and Eastern Volcanic Front (EVF), respectively, geological sub-regions of Kamchatka distinguished by varying magma composition. For example, by comparison with reanalysis-model simulations of local meteorological conditions

  9. Composition and pools of humus in natural and agrogenic soils of the Kamchatka Peninsula (United States)

    Kiseleva, I. V.; Purtova, L. N.; Kostenkov, N. M.


    Differentiation of Kamchatka soils with respect to the composition and pools of humus is discussed. Very low and low pools of humus of the fulvate type are typical of the ocherous and stratified ocherous volcanic soils of the eastern coastal zone and the Central Kamchatka Depression. Ocherous volcanic soils of the Western Kamchatka Lowland are characterized by the low and moderate pools of the humate-fulvate humus. Agrogenic soils are characterized by the higher pools of humus in the upper 20 cm in comparison with their natural analogues, which is largely related to changes in the physical properties of the soils under the impact of tillage.

  10. 1952 Kamchatka Peninsula, Russia Images (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The tsunami was generated by a magnitude 9.0 (Mw) earthquake on Kamchatka where it caused severe damage. The tsunami then struck Midway (3,000 kilometers away), the...

  11. Holocene Lake Records on Kamchatka (United States)

    Diekmann, Bernhard; Biskaborn, Boris; Chapligin, Bernhard; Dirksen, Oleg; Dirksen, Veronika; Hoff, Ulrike; Meyer, Hanno; Nazarova, Larisa


    The availibility of terrestrial records of Holocene palaeoenvironmental changes in eastern Siberia still is quite limited, compared to other regions on the northern hemisphere. In particular, the Kamchatka Peninsula as an important climate-sensitive region is very underrepresented. Situated at the border of northeastern Eurasia, the maritime-influenced terrestrial setting of Kamchatka offers the potential to pinpoint connections of environmental changes between the periglacial and highly continental landmasses of eastern Siberia and the sub-Arctic Pacific Ocean and Sea of Okhotsk. The study region lies at the eastern end-loop of the global thermohaline ocean conveyor belt and is strongly affected by atmospheric teleconnections. Volcanic, tectonic, and glacial processes overprint palaeoenvironmental changes in addition to primary climate forcing. In order to widen our understanding of plaeoclimate dynamics on Kamchatka, sediment cores from different lake systems and peat sections were recovered and analysed by a multi-proxy approach, using sedimentological and geochemical data as well as fossil bioindicators, such as diatoms, pollen, and chironomids. Chronostratigraphy of the studied records was achieved through radiocarbon dating and tephrostratigraphy. Sediment cores with complete Holocene sedimentary sequences were retrieved from Lake Sokoch, an up to six metre deep lake of proglacial origin, situated at the treeline in the Ganalsky Ridge of southern central Kamchatka (53°15,13'N, 157°45.49' E, 495 m a.s.l.). Lacustrine sediment records of mid- to late Holocene age were also recovered from the up to 30 m deep Two-Yurts Lake, which occupies a former proglacial basin at the eastern flank of the Central Kamchatka Mountain Chain, the Sredinny Ridge (56°49.6'N, 160°06.9'E, 275 m a.s.l.). In addition to sediment coring in the open and deep Two-Yurts Lake, sediment records were also recovered from peat sections and small isolated forest lakes to compare

  12. Epidemiology of hypertension in CKD. (United States)

    Horowitz, Bruce; Miskulin, Dana; Zager, Philip


    Both hypertension (HTN) and CKD are serious interrelated global public health problems. Nearly 30% and 15% of US adults have HTN and CKD, respectively. Because HTN may cause or result from CKD, HTN prevalence is higher and control more difficult with worse kidney function. Etiology of CKD, presence and degree of albuminuria, and genetic factors all influence HTN severity and prevalence. In addition, socioeconomic and lifestyle factors influence HTN prevalence and control. There are racial and ethnic disparities in the prevalence, treatment, risks, and outcomes of HTN in patients with CKD. Control of blood pressure (BP) in Hispanic and African Americans with CKD is worse than it is whites. There are disparities in the patterns of treatment and rates of progression of CKD in patients with HTN. The presence and severity of CKD increase treatment resistance. HTN is also extremely prevalent in patients receiving hemodialysis, and optimal targets for BP control are being elucidated. Although the awareness, treatment, and control of HTN in CKD patients is improving, control of BP in patients at all stages of CKD remains suboptimal.

  13. [Causes and characteristics of CKD]. (United States)

    Moriyama, Toshiki


    Chronic kidney disease (CKD) is common in Japan and worldwide. The estimated prevalence of CKD in Japanese adults was 10.6% in 2005, based on the survey conducted by the Japanese Society of Nephrology. The most common risk factors for CKD include diabetes, hypertension and cardiovascular disease. Major outcomes of CKD include progression to kidney failure and increased risk for cardiovascular disease. CKD is usually silent until its late stages, thus many patients with CKD are detected only shortly before the onset of symptomatic kidney failure, when there are few opportunities to prevent adverse outcomes. Earlier detection allows for more time for evaluation and treatment but requires explicit testing strategies for asymptomatic individuals at increased risk. Understanding the strengths and limitations of CKD testing and risk factors of CKD is critical for appropriate management of CKD patients. The goal of this paper is to discuss CKD testing and early detection in clinical practice and its application to public health initiatives, with attention to limitations and appropriate interpretation.

  14. Dietary Patterns and CKD Progression. (United States)

    Banerjee, Tanushree; Liu, Yang; Crews, Deidra C


    Chronic kidney disease (CKD) patients and their clinicians seek ways to mitigate the risk of CKD progression and its associated complications. Emerging data suggest that dietary modifications may be beneficial adjuvant approaches to reducing the risk of adverse CKD outcomes. This review focuses on several different dietary patterns, including the Dietary Approaches to Stop Hypertension and Mediterranean diets, and their kidney health benefits. We discuss how healthful dietary patterns are lower in dietary acid load and how improving diet quality may slow the progression of CKD. We also discuss some barriers that may impede socially disadvantaged individuals from following healthful diets. Dietary patterns low in dietary acid load might slow the progression of CKD. Current evidence suggests that a reduction in dietary acid load could be beneficial in patients with CKD, but the supremacy of any particular diet is yet to be established. Additional randomized controlled dietary interventions among CKD patients are needed to inform evidence-based recommendations, which can be tailored to an individual's preferences and ability to access healthful foods. © 2016 S. Karger AG, Basel.

  15. Exercise in Individuals with CKD


    Johansen, Kirsten L.; Painter, Patricia


    There are few studies evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This review covers the rationale for exercise among patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population.

  16. Volcanism and Subduction: The Kamchatka Region (United States)

    Eichelberger, John; Gordeev, Evgenii; Izbekov, Pavel; Kasahara, Minoru; Lees, Jonathan

    The Kamchatka Peninsula and contiguous North Pacific Rim is among the most active regions in the world. Kamchatka itself contains 29 active volcanoes, 4 now in a state of semi-continuous eruption, and I has experienced 14 magnitude 7 or greater earthquakes since accurate recording began in 1962. At its heart is the uniquely acute subduction cusp where the Kamchatka and Aleutian Arcs and Emperor Seamount Chain meet. Volcanism and Subduction covers coupled magmatism and tectonics in this spectacular region, where the torn North Pacific slab dives into hot mantle. Senior Russian and American authors grapple with the dynamics of the cusp with perspectives from the west and east of it, respectively, while careful tephrostratigraphy yields a remarkably precise record of behavior of storied volcanoes such as Kliuchevskoi and Shiveluch. Towards the south, Japanese researchers elucidate subduction earthquake processes with unprecedented geodetic resolution. Looking eastward, new insights on caldera formation, monitoring, and magma ascent are presented for the Aleutians. This is one of the first books of its kind printed in the English language. Students and scientists beginning research in the region will find in this book a useful context and introduction to the region's scientific leaders. Others who wish to apply lessons learned in the North Pacific to their areas of interest will find the volume a valuable reference.

  17. Niacin and progression of CKD. (United States)

    Streja, Elani; Kovesdy, Csaba P; Streja, Dan A; Moradi, Hamid; Kalantar-Zadeh, Kamyar; Kashyap, Moti L


    Niacin is the oldest drug available for the treatment of dyslipidemia. It has been studied extensively and tested in clinical trials of atherosclerotic cardiovascular disease prevention and regression in the general population, but not specifically in patients with chronic kidney disease (CKD), who are at extremely high residual risk despite current therapy. Despite the current controversy about recent trials with niacin, including their limitations, there may be a place for this agent in select patients with CKD with dyslipidemia. Niacin has a favorable unique impact on factors affecting the rate of glomerular filtration rate decline, including high-density lipoprotein (HDL) particle number and function, triglyceride levels, oxidant stress, inflammation and endothelial function, and lowering of serum phosphorus levels by reducing dietary phosphorus absorption in the gastrointestinal tract. These effects may slow glomerular filtration rate decline and ultimately improve CKD outcomes and prevent cardiovascular risk. This review presents the clinically relevant concept that niacin holds significant potential as a renoprotective therapeutic agent. In addition, this review concludes that clinical investigations to assess the effect of niacin (in addition to aggressive low-density lipoprotein cholesterol lowering) on reduction of cardiovascular events in patients with CKD with very low HDL cholesterol (or those with identified dysfunctional HDL) and elevated triglyceride levels need to be considered seriously to address the high residual risk in this population.


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    Vadim A. Saltykov


    Full Text Available The paper describes seismicity of Kamchatka for the period of 2008 and presents 2D distribution of background seismicity parameters calculated from data published in the Regional Catalogue of Kamchatka Earthquakes. Parameters under study are total released seismic energy, seismic activity A10, slope of recurrence graph γ, parameters of RTL, ΔS and Z-function methods, and clustering of earthquakes. Estimations of seismicity are obtained for a region bordered by latitude 50.5–56.5N, longitude 156E–167E, with depths to 300 km. Earthquakes of energy classes not less than 8.5 as per the Fedotov’s classification are considered. The total seismic energy released in 2008 is estimated. According to a function of annual seismic energy distribution, an amount of seismic energy released in 2008 was close to the median level (Fig. 1. Over 2/3 of the total amount of seismic energy released in 2008 resulted from three largest earthquakes (МW ≥ 5.9. About 5 percent of the total number of seismic events are comprised of grouped earthquakes, i.e. aftershocks and swarms. A schematic map of the largest earthquakes (МW ≥ 5.9 and grouped seismic events which occurred in 2008 is given in Fig. 2; their parameters are listed in Table 1. Grouped earthquakes are excluded from the catalogue. A map showing epicenters of independent earthquakes is given in Fig. 3. The slope of recurrence graph γ and seismic activity A10 is based on the Gutenberg-Richter law stating the fundamental property of seismic process. The recurrence graph slope is calculated from continuous exponential distribution of earthquakes by energy classes. Using γ is conditioned by observations that in some cases the slope of the recurrence graph decreases prior to a large earthquake. Activity A10 is calculated from the number of earthquakes N and recurrence graph slope γ. Average slopes of recurrence graph γ and seismic activity A10 for the area under study in 2008 are calculated; our

  19. Colored Height and Shaded Relief, Kamchatka Peninsula (United States)


    Russia's Kamchatka Peninsula, lying between the Sea of Okhotsk to the west and the Bering Sea and Pacific Ocean to the east, is one of the most active volcanic regions along the Pacific Ring of Fire. It covers an area about the size of Colorado but contains more than 100 volcanoes stretching across the 1000-kilometer-long (620-mile-long) land mass. A dozen or more of these have active vents, with the youngest located along the eastern half of the peninsula. This color-coded shaded relief image, generated with data from the Shuttle Radar Topography Mission (SRTM), shows Kamchatka's volcanic nature to dramatic effect.Kliuchevskoi, one of the most active and renowned volcanoes in the world, dominates the main cluster of volcanoes called the Kliuchi group, visible as a circular feature in the center-right of the image. The two other main volcanic ranges lie along northeast-southwest lines, with the older, less active range occupying the center and western half of Kamchatka. The younger, more active belt begins at the southernmost point of the peninsula and continues upward along the Pacific coastline.Two visualization methods were combined to produce this image: shading and color coding of topographic height. The shade image was derived by computing topographic slope in the north-south direction, so northern slopes appear bright and southern slopes appear dark. Color coding is directly related to topographic height, with green at the lower elevations, rising through yellow and brown to white at the highest elevations.The Shuttle Radar Topography Mission flew aboard the Space Shuttle Endeavour, launched on February 11, 2000. The mission used the same radar instrument that comprised the Spaceborne Imaging Radar-C/X-Band Synthetic Aperture Radar that flew twice on the Space Shuttle Endeavour in 1994. The Shuttle Radar Topography Mission was designed to collect three-dimensional measurements of the Earth's surface. To collect the 3-D data, engineers added a 60-meter (200

  20. Holocene environmental change in Kamchatka: A synopsis (United States)

    Brooks, S. J.; Diekmann, B.; Jones, V. J.; Hammarlund, D.


    We present a synthesis of the results of a multiproxy, multisite, palaeoecological study of Holocene environmental change in Kamchatka, Far East Russia, details of which are presented elsewhere in the volume. We summarise the results of the analyses of pollen, diatom, chironomid, and testate amoebae assemblages, together with stable isotopes of oxygen and carbon, and sediment characteristics from the sediments of five lakes and a peat succession on a latitudinal gradient of the Kamchatka Peninsula, to infer environmental change and establish the major climate forcers and climatic teleconnections. There are synchronous shifts in the assemblage composition of most of the biota and across most sites at 6.5-6.2 ka BP, 5.2 ka BP, 4.0 ka BP, and 3.5 ka BP, suggesting a response to strong regional climate forcing at these times. These dates correspond to the warmest part of the Holocene Thermal Maximum (HTM) (6.5-6.2 ka BP), the beginning of the Neoglacial cooling (5.2 ka BP), the coolest and wettest part of the Neoglacial (4.0 ka BP), and a switch to warmer and drier conditions at 3.5 ka BP. Our results provide evidence for the penetration and domination of different air masses at different periods during the Holocene. Cool and dry periods in winter (e.g., at 6.0 ka BP) were driven by a relatively weak pressure gradient between the Siberian High and the Aleutian Low, whereas cool, wet periods in winter (e.g., the Neoglacial and during the LIA) developed when these two systems increased in strength. Warm, dry, continental periods in summer (e.g., at 2.5 ka BP) were driven by a weakening of the Siberian High. We find that the timing of the HTM in Kamchatka is later than in the Eurasian arctic but similar to northern Europe and the sub-arctic part of eastern Siberia. This progressive onset of the HTM was due to the effects of postglacial ice-sheet decay that modulated the routes of westerly storm tracks in Eurasia. A major ecosystem driver was the Siberian dwarf pine Pinus

  1. CKD273, a New Proteomics Classifier Assessing CKD and Its Prognosis (United States)

    Argilés, Àngel; Siwy, Justyna; Duranton, Flore; Gayrard, Nathalie; Dakna, Mohammed; Lundin, Ulrika; Osaba, Lourdes; Delles, Christian; Mourad, Georges; Weinberger, Klaus M.; Mischak, Harald


    National Kidney Foundation CKD staging has allowed uniformity in studies on CKD. However, early diagnosis and predicting progression to end stage renal disease are yet to be improved. Seventy six patients with different levels of CKD, including outpatients and dialysed patients were studied for transcriptome, metabolome and proteome description. High resolution urinary proteome analysis was blindly performed in the 53 non-anuric out of the 76 CKD patients. In addition to routine clinical parameters, CKD273, a urinary proteomics-based classifier and its peptides were quantified. The baseline values were analyzed with regard to the clinical parameters and the occurrence of death or renal death during follow-up (3.6 years) as the main outcome measurements. None of the patients with CKD2730.55. Unsupervised clustering analysis of the CKD273 peptides separated the patients into two main groups differing in CKD associated parameters. Among the 273 biomarkers, peptides derived from serum proteins were relatively increased in patients with lower glomerular filtration rate, while collagen-derived peptides were relatively decreased (p<0.05; Spearman). CKD273 was different in the groups with different renal function (p<0.003). The CKD273 classifier separated CKD patients according to their renal function and informed on the likelihood of experiencing adverse outcome. Recently defined in a large population, CKD273 is the first proteomic-based classifier successfully tested for prognosis of CKD progression in an independent cohort. PMID:23690958

  2. Depressants (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Depressants KidsHealth > For Teens > Depressants A A A What's ... How Can Someone Quit? Avoiding Depressants What Are Depressants? Depressants are drugs that calm nerves and relax ...

  3. Masked Uncontrolled Hypertension in CKD. (United States)

    Agarwal, Rajiv; Pappas, Maria K; Sinha, Arjun D


    Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension ≥135/85 mmHg; either nighttime hypertension ≥120/70 mmHg or daytime hypertension; and 24-hour hypertension ≥130/80 mmHg) or by home BP monitoring (hypertension ≥135/85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (κ coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a κ coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring.

  4. The Kamchatka-Aleutian Collision Zone: Mother of All Cusps (United States)

    Lees, J. M.


    The Kamchatka subduction zone represents a key to the understanding of volcanism, tectonics and mantle dynamics. The termination of the Pacific plate in the northern part of the Kamchatka slab is the prime location to investigate the cusp-ward shoaling of seismicity, the volumetrically spectacular production of magma with unusual geochemical signatures and slab edge ablation associated with mantle flow around the leading edge of the plate. In addition, the Kamchatka subduction zone is further complicated by the subduction of the aseismic ridge, the Meiji Seamounts. The three-dimensional structural configuration of the subducting pacific slab, the Komandorsky basin and the volcanic arc all suggest that absence of Pacific slab north of latitude. Tomographic analyses show a deep low velocity zone below Kliuchevskoi Volcano, suggesting a deep source near the crust-mantle interface. The intense volcanic production rates of the northern part of the Kamchatka Arc indicate that a prolific source feeds the surface expression of the cusp. Extensive heating at the exposed slab edge provides a source of heat for the Kliuchevskoi group. In this presentation I will review the critical observations and conclusions regarding cusp dynamics in Kamchatka and the Pacific Rim.

  5. Nutrition and Physical Activity in CKD patients

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    Adamasco Cupisti


    Full Text Available Chronic kidney disease (CKD patients are at risk for protein-energy wasting, abnormal body composition and impaired physical capacity. These complications lead to increased risk of hospitalization, morbidity and mortality.In CKD patient as well as in healthy people, there is a close association between nutrition and physical activity. Namely, inadequate nutrient (energy intake impairs physical performance thus favoring a sedentary lifestyle: this further contributes to loss of muscle strength and mass, which limit the quality of life and rehabilitation of CKD patients. In CKD as well as in end-stage-renal-disease patients, regular physical activity coupled with adequate energy and protein intake counteracts protein-energy wasting and related comorbidity and mortality. In summary, exercise training can positively influence nutritional status and the perception of well-being of CKD patients and may facilitate the anabolic effects of nutritional interventions.

  6. Geyser Valley on the Kamchatka Peninsula (United States)


    On June 2, a devastating mudslide in the world-renowned Geyser Valley on the Kamchatka Peninsula virtually obliterated the natural wonder, forcing the emergency evacuation of visitors and national park personnel. The site, which is the Kamchatka Peninsula's main tourist attraction, consists of some 200 thermal pools created by the area's intense volcanic activity, including about 90 geysers covering an area of four square kilometers (2.5 square miles). It is one of only five sites in the world where the impressive eruptions of steam and boiling-hot water can be found. According to witnesses, a powerful mudslide 1.5 kilometers (one mile) long and 200 meters (600 feet) wide buried more than two-thirds of the valley beneath tens of meters of snow, dirt, trees and boulders (right image), and created a temporary lake submerging more geysers. With its 14 spectral bands from the visible to the thermal infrared wavelength region, and its high spatial resolution of 15 to 90 meters (about 50 to 300 feet), ASTER images Earth to map and monitor the changing surface of our planet. ASTER is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra spacecraft. The instrument was built by Japan's Ministry of Economy, Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products. The broad spectral coverage and high spectral resolution of ASTER provides scientists in numerous disciplines with critical information for surface mapping, and monitoring of dynamic conditions and temporal change. Example applications are: monitoring glacial advances and retreats; monitoring potentially active volcanoes; identifying crop stress; determining cloud morphology and physical properties; wetlands evaluation; thermal pollution monitoring; coral reef degradation; surface temperature mapping of soils and geology; and measuring surface heat balance. The U.S. science team is located at NASA's Jet

  7. Upper gastrointestinal bleeding in patients with CKD. (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching


    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  8. Boreal Forests of Kamchatka: Structure and Composition

    Directory of Open Access Journals (Sweden)

    Markus P. Eichhorn


    Full Text Available Central Kamchatka abounds in virgin old-growth boreal forest, formed primarily by Larix cajanderi and Betula platyphylla in varying proportions. A series of eight 0.25–0.30 ha plots captured the range of forests present in this region and their structure is described. Overall trends in both uplands and lowlands are for higher sites to be dominated by L. cajanderi with an increasing component of B. platyphylla with decreasing altitude. The tree line on wet sites is commonly formed by mono-dominant B. ermanii forests. Basal area ranged from 7.8–38.1 m2/ha and average tree height from 8.3–24.7 m, both being greater in lowland forests. Size distributions varied considerably among plots, though they were consistently more even for L. cajanderi than B. platyphylla. Upland sites also contained a dense subcanopy of Pinus pumila averaging 38% of ground area. Soil characteristics differed among plots, with upland soils being of lower pH and containing more carbon. Comparisons are drawn with boreal forests elsewhere and the main current threats assessed. These forests provide a potential baseline to contrast with more disturbed regions elsewhere in the world and therefore may be used as a target for restoration efforts or to assess the effects of climate change independent of human impacts.

  9. CKD and nonalcoholic fatty liver disease. (United States)

    Targher, Giovanni; Chonchol, Michel B; Byrne, Christopher D


    The possible link between nonalcoholic fatty liver disease and chronic kidney disease (CKD) recently has attracted considerable scientific interest. Accumulating clinical evidence indicates that the presence and severity of nonalcoholic fatty liver disease is associated significantly with CKD (defined as decreased estimated glomerular filtration rate and/or proteinuria) and that nonalcoholic fatty liver disease predicts the development and progression of CKD, independently of traditional cardiorenal risk factors. Experimental evidence also suggests that nonalcoholic fatty liver disease itself may exacerbate systemic and hepatic insulin resistance, cause atherogenic dyslipidemia, and release a variety of proinflammatory, procoagulant, pro-oxidant, and profibrogenic mediators that play important roles in the development and progression of CKD. However, despite the growing evidence linking nonalcoholic fatty liver disease with CKD, it has not been definitively established whether a causal association exists. The clinical implication for these findings is that patients with nonalcoholic fatty liver disease may benefit from more intensive surveillance or early treatment interventions to decrease the risk of CKD. In this review, we discuss the evidence linking nonalcoholic fatty liver disease with CKD and the putative mechanisms by which nonalcoholic fatty liver disease contributes to kidney damage. We also briefly discuss current treatment options for this increasingly prevalent disease that is likely to have an important future impact on the global burden of disease.

  10. Does AKI truly lead to CKD? (United States)

    Rifkin, Dena E; Coca, Steven G; Kalantar-Zadeh, Kamyar


    Acute kidney injury (AKI) has been implicated as an independent risk factor for the development of CKD in recent observational studies. The presumption in the nephrology community is that this association represents a causal relationship. However, because of potential problems related to residual confounding (shared risk factors), ascertainment bias (sicker patients have more follow-up assessments), misclassification of exposure (problems with defining baseline kidney function and AKI representing a discrete event versus progression of renal disease), and misclassification of outcome (de novo CKD versus CKD progression), it is difficult to conclude with certainty that AKI is truly causal for CKD. In this review we highlight several of the Hill causality criteria to examine the existing evidence and point out the missing elements that preclude defining AKI as a cause of CKD in the general population. Only well-designed studies with rigorous assessment of kidney function in all participants (AKI and non-AKI) before and after the episode or hospitalization or randomized, controlled trials demonstrating that prevention or treatment of AKI reduces the incidence of subsequent CKD can clarify the causal nature of the AKI-CKD relationship.

  11. Management of Gout and Hyperuricemia in CKD. (United States)

    Vargas-Santos, Ana Beatriz; Neogi, Tuhina


    Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. Geochemistry of the late Holocene rocks from the Tolbachik volcanic field, Kamchatka: Quantitative modelling of subduction-related open magmatic systems (United States)

    Portnyagin, Maxim; Duggen, Svend; Hauff, Folkmar; Mironov, Nikita; Bindeman, Ilya; Thirlwall, Matthew; Hoernle, Kaj


    We present new major and trace element, high-precision Sr-Nd-Pb (double spike), and O-isotope data for the whole range of rocks from the Holocene Tolbachik volcanic field in the Central Kamchatka Depression (CKD). The Tolbachik rocks range from high-Mg basalts to low-Mg basaltic trachyandesites. The rocks considered in this paper represent mostly Late Holocene eruptions (using tephrochronological dating), including historic ones in 1941, 1975-1976 and 2012-2013. Major compositional features of the Tolbachik volcanic rocks include the prolonged predominance of one erupted magma type, close association of middle-K primitive and high-K evolved rocks, large variations in incompatible element abundances and ratios but narrow range in isotopic composition. We quantify the conditions of the Tolbachik magma origin and evolution and revise previously proposed models. We conclude that all Tolbachik rocks are genetically related by crystal fractionation of medium-K primary magmas with only a small range in trace element and isotope composition. The primary Tolbachik magmas contain ~ 14 wt.% of MgO and ~ 4% wt.% of H2O and originated by partial melting (~ 6%) of moderately depleted mantle peridotite with Indian-MORB-type isotopic composition at temperature of ~ 1250 °C and pressure of ~ 2 GPa. The melting of the mantle wedge was triggered by slab-derived hydrous melts formed at ~ 2.8 GPa and ~ 725 °C from a mixture of sediments and MORB- and Meiji-type altered oceanic crust. The primary magmas experienced a complex open-system evolution termed Recharge-Evacuation-Fractional Crystallization (REFC). First the original primary magmas underwent open-system crystal fractionation combined with periodic recharge of the magma chamber with more primitive magma, followed by mixing of both magma types, further fractionation and finally eruption. Evolved high-K basalts, which predominate in the Tolbachik field, and basaltic trachyandesites erupted in 2012-2013 approach steady-state REFC

  13. Becoming Aboriginal: Experiences of a European Woman in Kamchatka's Wilderness. (United States)

    Churikova, Victoria


    A Russian woman describes how living in remote Kamchatka helped her develop an aboriginal perspective. Chopping wood, hauling water, gathering food, alternately homeschooling her children and sending them to an ecological school, and interacting with local aboriginal people taught her the importance of conserving natural resources and living in…

  14. Viruses in acidic geothermal environments of the Kamchatka Peninsula

    DEFF Research Database (Denmark)

    Bize, Ariane; Peng, Xu; Prokofeva, Maria


    Screening for viruses in samples taken from acidic hot springs of Kamchatka (Russia) revealed a collection of morphotypes, including linear, spherical and complex fusiform shapes, which show partial similarity to those found in acidic geothermal environments in other geographical locations. One...

  15. Depression (United States)

    ... overview URL of this page: // Depression - overview To use the sharing features on this ... older adults Major depression Persistent depressive disorder Postpartum depression Premenstrual ... Review Date 1/4/2016 Updated by: Timothy Rogge, ...

  16. Epidemiology and Challenges to the Management of Advanced CKD. (United States)

    Hazzan, Azzour D; Halinski, Candice; Agoritsas, Sofia; Fishbane, Steven; DeVita, Maria V


    Advanced CKD is a period of CKD that differs greatly from earlier stages of CKD in terms of treatment goals. Treatment during this period presents particular challenges as further loss of kidney function heralds the need for renal replacement therapy. Successful management during this period increases the likelihood of improved transitions to ESRD. However, there are substantial barriers to optimal advanced CKD care. In this review, we will discuss advanced CKD definitions and epidemiology and outcomes.

  17. Metabolic Acidosis of CKD: An Update. (United States)

    Kraut, Jeffrey A; Madias, Nicolaos E


    The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to acidosis, high-anion gap acidosis, or both can be found at all stages of CKD. The acidosis can be associated with muscle wasting, bone disease, hypoalbuminemia, inflammation, progression of CKD, and increased mortality. Administration of base may decrease muscle wasting, improve bone disease, and slow the progression of CKD. Base is suggested when serum bicarbonate concentration is  24 mEq/L might be associated with worsening of cardiovascular disease adds complexity to treatment decisions. Further study of the mechanisms through which metabolic acidosis contributes to the progression of CKD, as well as the pathways involved in mediating the benefits and complications of base therapy, is warranted.

  18. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Otto Drachmann


    The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued......, that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression...

  19. Depression

    DEFF Research Database (Denmark)

    Kessing, Lars Veddel; Bukh, Jens Drachmann


    , that these diagnostic criteria represent an oversimplification, which has blurred the concept of depression. We suggest a greater emphasis on the depressed mood as the core symptom of depression, which may increase the specificity of the diagnosis. Furthermore, basic principles for the treatment of depression......The prevalence of depression is not clearly established, but estimated to 3-4% in a Danish questionnaire study. Lifetime's prevalences of 12-17% are reported in other community samples. In the current diagnostic system depression is defined categorically and operationally. It has been argued...

  20. Depressants (United States)

    ... judgment and mental functioning nausea and vomiting memory loss (depressants can cause users to have no memory of events that happened while they were under the influence) Long-Term Effects When people misuse depressants over a long ...

  1. Depression

    DEFF Research Database (Denmark)

    Cizza, G; Ravn, Pernille; Chrousos, G P


    Existing studies of the relationship between depression and osteoporosis have been heterogeneous in their design and use of diagnostic instruments for depression, which might have contributed to the different results on the comorbidity of these two conditions. Nevertheless, these studies reveal...... a strong association between depression and osteoporosis. Endocrine factors such as depression-induced hypersecretion of corticotropin-releasing hormone and hypercortisolism, hypogonadism, growth hormone deficiency and increased concentration of circulating interleukin 6, might play a crucial role...... in the bone loss observed in subjects suffering from major depression....

  2. Most recent fall deposits of Ksudach Volcano, Kamchatka, Russia (United States)

    Bursik, M.; Melekestsev, I. V.; Brajtseva, O. A.


    Three of four Plinian eruptions from Ksudach Volcano are among the four largest explosive eruptions in southern Kamchatka during the past 2000 years. The earliest of the eruptions was voluminous and was accompanied by an ignimbrite and the fifth and most recent Cddera collapse event at Ksudach. The isopach pattern is consistent with a column height of 23 km. The three more recent and smaller eruptions were from the Shtyubel' Cone, within the fifth caldera. Using isopach and grain size isopleth patterns, column heights ranged from >10 to 22 kin. Although the oldest eruption may have produced a large acidity peak in the Greenland ice, the three Shtyubel' events may not be related to major acid deposition. Thus it is possible that few if any of the uncorrelated acidity peaks of the past 2000 years in Greenland ice cores result from eruptions in southern Kamchatka.

  3. Third International Volcanological Field School in Kamchatka and Alaska (United States)

    Melnikov, D.; Eichelberger, J.; Gordeev, E.; Malcolm, J.; Shipman, J.; Izbekov, P.


    The Kamchatka State University, Institute of Volcanology and Seismology FEB RAS (Petropavlovsk-Kamchatsky, Russia) and University of Alaska Fairbanks have developed an international field school focused on explosive volcanism of the North Pacific. The concept of the field school envisages joint field studies by young Russian scientists and their peers from the United States and Japan. Beyond providing first-hand experience with some of Earth's most remarkable volcanic features, the intent is to foster greater interest in language study, cultures, and ultimately in international research collaborations. The students receive both theoretical and practical knowledge of active volcanic systems, as well experience in working productively in a harsh environment. Each year, the class is offered in both Alaska and Kamchatka. The Alaska session is held in the Valley of Ten Thousand Smokes, Katmai National Park, product of the greatest volcanic eruption of the 20th century. A highlight in 2005 was the discovery of a new 70-m crater atop Trident Volcano. Also this year, we added the Great Tolbachik Eruption of 1975-76 to the itinerary of the Kamchatka school. Day trips were conducted to summit craters of New Tolbachik volcanoes and Plosky Tolbachik, Tolbachik lava flows; fumarole fields of Mutnovsky volcano, and a geothermal area and 60 MWe power plant. Students who attended both the Alaska and Kamchatka sessions could ponder the implications of great lateral separation of active vents - 10 km at Katmai and 30 km at Tolbachik - with multiple magmas and non-eruptive caldera collapse at the associated stratocones. During the evenings and on days of bad weather, the school faculty conducted lectures on various topics of volcanology in either Russian or English, with translation. The field school is a strong stimulus for growth of young volcanologists and cooperation among Russia, USA and Japan, leading naturally to longer student exchange visits and to joint research projects.

  4. Depression

    DEFF Research Database (Denmark)

    Pouwer, Frans


    There is ample evidence that depression is000  a common comorbid health issue in people with type 1 or type 2 diabetes. Reviews have also concluded that depression in diabetes is associated with higher HbA1c levels, less optimal self-care behaviours, lower quality of life, incident vascular...... complications and higher mortality rates. However, longitudinal studies into the course of depression in people with type 1 diabetes remain scarce. In this issue of Diabetologia, Kampling and colleagues (doi: 10.1007/s00125-016-4123-0 ) report the 5 year trajectories of depression in adults with newly diagnosed...... type 1 diabetes (mean age, 28 years). Their baseline results showed that shortly after the diagnosis of type 1 diabetes a major depressive episode was diagnosed in approximately 6% of participants, while 8% suffered from an anxiety disorder. The longitudinal depression data showed that, in a 5 year...

  5. A randomized trial of dietary sodium restriction in CKD

    National Research Council Canada - National Science Library

    McMahon, Emma J; Bauer, Judith D; Hawley, Carmel M; Isbel, Nicole M; Stowasser, Michael; Johnson, David W; Campbell, Katrina L


    There is a paucity of quality evidence regarding the effects of sodium restriction in patients with CKD, particularly in patients with pre-end stage CKD, where controlling modifiable risk factors may...

  6. Monitoring recreational impacts in wilderness of Kamchatka (on example of Kronotsky State Natural Biosphere Preserve) (United States)

    Anya V. Zavadskaya


    This paper describes an assessment and monitoring program that was designed and initiated for monitoring recreational impacts in a wilderness in Kamchatka. The framework of the recreational assessment was tested through its application to a case study conducted during the summers of 2008 and 2009 in the Kronotsky State Natural Biosphere Preserve (Kamchatka peninsula,...

  7. Depression. (United States)

    Strock, Margaret

    Approximately ten percent of the population suffers from a depressive illness each year. Although the economic cost is high, the cost in human suffering is immeasurable. To help educate the population about this disorder, this paper presents a definition of depression and its common manifestations. The symptoms that people often experience are…

  8. Depression

    DEFF Research Database (Denmark)

    Johansen, Jon O. J.


    Nyhederne er fulde af historier om depression. Overskrifter som: ’Danskerne propper sig med lykkepiller’ eller ‘depression er stadigvæk tabu’ går tit igen i dagspressen. Men hvor er nuancerne, og hvorfor gider vi læse de samme historier igen og igen? Måske er det fordi, vores egne forestillinger er...

  9. Defective skeletal mineralization in pediatric CKD. (United States)

    Wesseling-Perry, Katherine


    Although traditional diagnosis and treatment of renal osteodystrophy focused on changes in bone turnover, current data demonstrate that abnormalities in skeletal mineralization are also prevalent in pediatric chronic kidney disease (CKD) and likely contribute to skeletal morbidities that continue to plague this population. It is now clear that alterations in osteocyte biology, manifested by changes in osteocytic protein expression, occur in early CKD before abnormalities in traditional measures of mineral metabolism are apparent and may contribute to defective skeletal mineralization. Current treatment paradigms advocate the use of 1,25(OH)2vitamin D for the control of secondary hyperparathyroidism; however, these agents fail to correct defective skeletal mineralization and may exacerbate already altered osteocyte biology. Further studies are critically needed to identify the initial trigger for abnormalities of skeletal mineralization as well as the potential effects that current therapeutic options may have on osteocyte biology and bone mineralization.

  10. Pharmacologic Issues in treating hypertension in CKD. (United States)

    Sica, Domenic A


    Antihypertensive drugs are prescribed to patients with CKD to slow down the rate of loss of residual kidney function; to reduce proteinuria, when present; and to protect other target organs from damage that is mediated by elevated blood pressure (BP). In most patients, a diuretic and a renin system blocking drug, such as an angiotensin-converting enzyme inhibitor, angiotensin receptor antagonist, or an aldosterone receptor antagonist are used. Often, 3 or more drugs are needed to achieve BP goals. Many drugs are eliminated through the kidney and in some cases dosage reductions are advisable to avoid adverse effects from high levels of medication. This article will review the various classes of antihypertensive drugs used in the management of high BP in patients with CKD, with an emphasis on pitfalls that arise when kidney function is impaired. 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  11. Prevalence of symptoms of depression among patients with chronic ...

    African Journals Online (AJOL)

    chronic kidney disease (CKD) and these include depression, dementia ..... mortality among patients hospitalized with congestive heart failure. Am J ... quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation.

  12. Urinary Sodium and Potassium Excretion and CKD Progression. (United States)

    He, Jiang; Mills, Katherine T; Appel, Lawrence J; Yang, Wei; Chen, Jing; Lee, Belinda T; Rosas, Sylvia E; Porter, Anna; Makos, Gail; Weir, Matthew R; Hamm, L Lee; Kusek, John W


    CKD is a major risk factor for ESRD, cardiovascular disease, and premature death. Whether dietary sodium and potassium intake affect CKD progression remains unclear. We prospectively studied the association of urinary sodium and potassium excretion with CKD progression and all-cause mortality among 3939 patients with CKD in the Chronic Renal Insufficiency Cohort Study. Urinary sodium and potassium excretion were measured using three 24-hour urine specimens, and CKD progression was defined as incident ESRD or halving of eGFR. During follow-up, 939 CKD progression events and 540 deaths occurred. Compared with the lowest quartile of urinary sodium excretion (CKD progression, 1.45 (1.08 to 1.95) for all-cause mortality, and 1.43 (1.18 to 1.73) for the composite outcome of CKD progression and all-cause mortality after adjusting for multiple covariates, including baseline eGFR. Additionally, compared with the lowest quartile of urinary potassium excretion (CKD progression, 0.98 (0.71 to 1.35) for all-cause mortality, and 1.42 (1.15 to 1.74) for the composite outcome. These data indicate that high urinary sodium and potassium excretion are associated with increased risk of CKD progression. Clinical trials are warranted to test the effect of sodium and potassium reduction on CKD progression.

  13. Depression (United States)

    ... Different people have different symptoms. Some symptoms of depression include: Persistent sad, anxious, or “empty” mood Feelings of hopelessness or pessimism Feelings of guilt, worthlessness, or helplessness ...

  14. Depression (United States)

    ... caring for children and aging parents, abuse, and poverty may trigger depression in some people. Medical illness – ... federal government website managed by the Office on Women’s Health in the Office of the Assistant Secretary ...

  15. The KISS Project - Exploring the magmatic system beneath Kamchatka's volcanoes (United States)

    Luehr, Birger-G.; Shapiro, Nikolai; Abkadyrov, Ilyas; Sens-Schönfelder, Christoph; Koulakov, Ivan; Jakovlev, Andrey; Abramenkov, Sergey; Saltykov, Vadim A.; Heit, Benjamin; Weber, Michael; Gordeev, Evgeny I.; Chebrov, Victor N.


    In a joint initiative of GFZ with Russian (IPGG, IVS, KGBS) and a French partner (IPGP) a temporary seismological network has been installed around the Klyuchevskoy volcanic group in Central Kamchatka. The Klyuchevskoy volcanic group is an ensemble of 13 stratovolcanoes with very different compositions and eruption styles in a ~70km diameter area which produced at least 30 VEI≥2 episodes during the last 15 years. Latest activity of the highest volcano Klyuchevskoy (4754 m) was in spring 2015. The group is located right on the triple junction between Asian, Pacifc and North American plates where the Hawaiian-Emperor seamount chain separates the Aleutian and the Kuril-Kamchatka trenches. The complex setting presumably leads to processes like increased melting at slab edges and/or accelerated mantle flow which affect the volcanism and might be responsible for the unparalleled concentration of volcanic activity in the Klyuchevskoy group. Due to the difficult field conditions and special permitting regulations seismological investigations have been rare in Kamchatka. In this consortium we build strongly on the experience of the Kamchatkan partners for permitting and logistics. Installation was done to about 50% by helicopter. Funding was provided via a grant from the Russian Science Foundation (grant 14-47-00002) to the IVS/KBGS/IPGG, the GFZ, and the IPGP. 60 of the stations were provided by the GFZ instrument pool GIPP. Including the permanent stations operated by KGBS and temporary stations provided by the partners, the network consist of 98 stations and will record earthquakes volcanic signals and the ambient field over one year in an area of approximately 150 by 150km.

  16. A randomized trial of dietary sodium restriction in CKD. (United States)

    McMahon, Emma J; Bauer, Judith D; Hawley, Carmel M; Isbel, Nicole M; Stowasser, Michael; Johnson, David W; Campbell, Katrina L


    There is a paucity of quality evidence regarding the effects of sodium restriction in patients with CKD, particularly in patients with pre-end stage CKD, where controlling modifiable risk factors may be especially important for delaying CKD progression and cardiovascular events. We conducted a double-blind placebo-controlled randomized crossover trial assessing the effects of high versus low sodium intake on ambulatory BP, 24-hour protein and albumin excretion, fluid status (body composition monitor), renin and aldosterone levels, and arterial stiffness (pulse wave velocity and augmentation index) in 20 adult patients with hypertensive stage 3-4 CKD as phase 1 of the LowSALT CKD study. Overall, salt restriction resulted in statistically significant and clinically important reductions in BP (mean reduction of systolic/diastolic BP, 10/4 mm Hg; 95% confidence interval, 5 to 15 /1 to 6 mm Hg), extracellular fluid volume, albuminuria, and proteinuria in patients with moderate-to-severe CKD. The magnitude of change was more pronounced than the magnitude reported in patients without CKD, suggesting that patients with CKD are particularly salt sensitive. Although studies with longer intervention times and larger sample sizes are needed to confirm these benefits, this study indicates that sodium restriction should be emphasized in the management of patients with CKD as a means to reduce cardiovascular risk and risk for CKD progression.

  17. Retarding chronic kidney disease (CKD progression: a practical nutritional approach for non-dialysis CKD

    Directory of Open Access Journals (Sweden)

    Vincenzo Bellizzi


    Full Text Available This is a case report on a patient with non-dialysis chronic kidney disease (CKD in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA—“Retarding CKD progression: readily available through comprehensive nutritional management?”—and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections—basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD—linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD • What nutritional assessment/monitoring for protein-energy wasting (PEW should be employed? • Is a body mass index (BMI of 21 kg/m2 adequate? • What phosphate target should be pursued? • What are the nutritional habits in patients with incident CKD? • What protein needs and amount of dietary protein should be pursued? • Does the quality of protein matter? • What amount of dietary salt should be employed? How should this be obtained? • How should normal serum phosphate be achieved? • What diet should be recommended? Is a vegetarian diet an option? Second visit: Major nutritional targets in non-dialysis CKD • Consequences of unintentional weight loss • What is the role of the renal dietitian in helping the patient adhere to a renal diet? Intermediate visits: Nutritional follow-up in non-dialysis CKD • What treatment for calcium/parathyroid hormone (PTH will affect CKD progression? Final visits: • Would a dietary recall/intensive dietary education improve adherence with

  18. CKD-induced wingless/integration1 inhibitors and phosphorus cause the CKD-mineral and bone disorder. (United States)

    Fang, Yifu; Ginsberg, Charles; Seifert, Michael; Agapova, Olga; Sugatani, Toshifumi; Register, Thomas C; Freedman, Barry I; Monier-Faugere, Marie-Claude; Malluche, Hartmut; Hruska, Keith A


    In chronic kidney disease, vascular calcification, renal osteodystrophy, and phosphate contribute substantially to cardiovascular risk and are components of CKD-mineral and bone disorder (CKD-MBD). The cause of this syndrome is unknown. Additionally, no therapy addresses cardiovascular risk in CKD. In its inception, CKD-MBD is characterized by osteodystrophy, vascular calcification, and stimulation of osteocyte secretion. We tested the hypothesis that increased production of circulating factors by diseased kidneys causes the CKD-MBD in diabetic mice subjected to renal injury to induce stage 2 CKD (CKD-2 mice). Compared with non-CKD diabetic controls, CKD-2 mice showed increased renal production of Wnt inhibitor family members and higher levels of circulating Dickkopf-1 (Dkk1), sclerostin, and secreted klotho. Neutralization of Dkk1 in CKD-2 mice by administration of a monoclonal antibody after renal injury stimulated bone formation rates, corrected the osteodystrophy, and prevented CKD-stimulated vascular calcification. Mechanistically, neutralization of Dkk1 suppressed aortic expression of the osteoblastic transcription factor Runx2, increased expression of vascular smooth muscle protein 22-α, and restored aortic expression of klotho. Neutralization of Dkk1 did not affect the elevated plasma levels of osteocytic fibroblast growth factor 23 but decreased the elevated levels of sclerostin. Phosphate binder therapy restored plasma fibroblast growth factor 23 levels but had no effect on vascular calcification or osteodystrophy. The combination of the Dkk1 antibody and phosphate binder therapy completely treated the CKD-MBD. These results show that circulating Wnt inhibitors are involved in the pathogenesis of CKD-MBD and that the combination of Dkk1 neutralization and phosphate binding may have therapeutic potential for this disorder.

  19. Holocene pollen record from Lake Sokoch, interior Kamchatka (Russia), and its paleobotanical and paleoclimatic interpretation (United States)

    Dirksen, Veronika; Dirksen, Oleg; van den Bogaard, Christel; Diekmann, Bernhard


    maritime-like conditions. Since ca. 1300 year BP forests retreated and replaced by shrublands, tundra and bogs, pointing to cool and wet climate and likely increased back continentality. A prominent re-advance of stone birch forest shown atop the record, most probably reflects recent warming trend. The reconstructed cool periods correlate well with Holocene glacial advances in neighboring mountain areas and with the tree ring and ice core records from the Central Kamchatka Depression. The Lake Sokoch pollen record, being consistent with the previously obtained regional paleoclimatic data, yet contributes new detailed information, especially for the late Holocene.

  20. [Treatment of CKD-MBD targeting the parathyroid gland]. (United States)

    Isozaki, Yudai; Komaba, Hirotaka


    Secondary hyperparathyroidism is a major component of chronic kidney disease-mineral and bone disorder (CKD-MBD) and has a considerable impact on morbidity and mortality through the development of high-turnover bone disease and vascular calcification. Thus, management of secondary hyperparathyroidism is important for improving the outcomes of CKD patients. Because there is a fundamental difference in the pathogenesis of secondary hyperparathyroidism between predialysis and dialysis patients, different therapeutic approach should be considered for each condition. In this article, we summarize the treatment of CKD-MBD for managing secondary hyperparathyroidism, with a particular focus on the difference between predialysis and dialysis stages of CKD.

  1. CKD of Uncertain Etiology: A Systematic Review. (United States)

    Lunyera, Joseph; Mohottige, Dinushika; Von Isenburg, Megan; Jeuland, Marc; Patel, Uptal D; Stanifer, John W


    Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses. We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies. We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure. Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across high-risk populations may help elucidate the importance of region-specific versus global risk factors. Copyright © 2016 by the American Society of Nephrology.

  2. CKD-MBD: an endless story. (United States)

    Brancaccio, Diego; Cozzolino, Mario


    Renal failure is a growing problem that involves a large part of the population and has a great social impact, with often incapacitating complications, mainly related to mineral bone disorders (MBD) and cardiovascular diseases. Analysis of the recent scientific literature confirms that a large number of chronic kidney disease (CKD) patients develop an early derangement of the parameters of Ca-P metabolism in which phosphate homeostasis and a reduced endogenous synthesis of calcitriol play a critical role. Recent findings from several large observational studies have also suggested that the benefits of vitamin D receptor activators may extend beyond the traditional parathyroid hormone-lowering effect, and could result in direct cardiovascular and metabolic benefits. Treatment of secondary hyperparathyroidism has become even more complex with the arrival of the calcium-sensing receptor agonist cinacalcet hydrochloride and with the uncovering of novel mechanisms responsible for secondary hyperparathyroidism. The aim of this review is the analysis of some of the recent contributions in the field of CKD-MBD, to update the understanding of the pathogenetic mechanisms and possibly the most appropriate therapeutic approach in this field.

  3. Depression. (United States)

    McCarron, Robert M; Vanderlip, Erik R; Rado, Jeffrey


    This issue provides a clinical overview of depression, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  4. Changes of geoacoustic emission directivity at «Mikizha» site associated with earthquakes in Kamchatka

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    Marapulets Yuriy


    Full Text Available To investigate high frequency geoacoustic emission, a receiving system based on a compound vector receiver was installed in Kamchatka. It allows the authors to determine the direction of sound wave arrival. In the result of data analysis for the period from August 2008 to January 2016, it was determined that anomalies of geoacoustic emission directivity occur during the majority of the earthquakes with Ks > 9.0 in the South of Kamchatka.

  5. Evolution and genesis of volcanic rocks from Mutnovsky Volcano, Kamchatka (United States)

    Simon, A.; Yogodzinski, G. M.; Robertson, K.; Smith, E.; Selyangin, O.; Kiryukhin, A.; Mulcahy, S. R.; Walker, J. D.


    This study presents new geochemical data for Mutnovsky Volcano, located on the volcanic front of the southern portion of the Kamchatka arc. Field relationships show that Mutnovsky Volcano is comprised of four distinct stratocones, which have grown over that past 80 ka. The youngest center, Mutnovsky IV, has produced basalts and basaltic andesites only. The three older centers (Mutnovsky I, II, III) are dominated by basalt and basaltic andesite (60-80% by volume), but each has also produced small volumes of andesite and dacite. Across centers of all ages, Mutnovsky lavas define a tholeiitic igneous series, from 48-70% SiO2. Basalts and basaltic andesites have relatively low K2O and Na2O, and high FeO* and Al2O3 compared to volcanic rocks throughout Kamchatka. The mafic lavas are also depleted in the light rare earth elements (REEs), with chondrite-normalized La/Sm arc volcanic rocks worldwide. Radiogenic isotope ratios (Sr, Nd, Pb, Hf) are similar for samples from all four eruptive centers, and indicate that all samples were produced by melting of a similar source mixture. No clear age-progressive changes are evident in the compositions of Mutnovsky lavas. Mass balance and assimilation-fractional crystallization (AFC) modeling of major and rare earth elements (REEs) indicate that basaltic andesites were produced by FC of plagioclase, clinopyroxene and olivine from a parental basalt, combined with assimilation of a melt composition similar to dacite lavas present at Mutnovsky. This modeling also indicates that andesites were produced by FC of plagioclase from basaltic andesite, combined with assimilation of dacite. Dacites erupted from Mutnovsky I and II have low abundances of REEs, and do not appear to be related to mafic magmas by FC or AFC processes. These dacites are modeled as the products of dehydration partial melting at mid-crustal levels of a garnet-free, amphibole-bearing basaltic rock, which itself formed in the mid-crust by emplacement of magma that

  6. Uric Acid as a Target of Therapy in CKD (United States)

    Jalal, Diana I.; Chonchol, Michel; Chen, Wei; Targher, Giovanni


    The prevalence of chronic kidney disease (CKD) has risen and will continue to rise in the United States and worldwide. This is alarming considering that CKD remains an irreversible condition and patients who progress to chronic kidney failure suffer reduced quality of life and high mortality rates. As such, it is imperative to identify modifiable risk factors to develop strategies to slow CKD progression. One such factor is hyperuricemia. Recent observational studies have associated hyperuricemia with kidney disease. In addition, hyperuricemia is largely prevalent in patients with CKD. Data from experimental studies have revealed several potential mechanisms by which hyperuricemia may contribute to the development and progression of CKD. In this manuscript we offer a critical review of the experimental evidence linking hyperuricemia to CKD, we highlight the gaps in our knowledge on the topic as it stands today, and we review the observational and interventional studies that have examined the potential nephro-protective effect of lowering uric acid in CKD patients . While uric acid may also be linked to cardiovascular disease and mortality in patients with CKD, this review will focus only on uric acid as a potential therapeutic target to prevent kidney disease onset and progression. PMID:23058478

  7. Epidemiology of CKD Regression in Patients under Nephrology Care. (United States)

    Borrelli, Silvio; Leonardis, Daniela; Minutolo, Roberto; Chiodini, Paolo; De Nicola, Luca; Esposito, Ciro; Mallamaci, Francesca; Zoccali, Carmine; Conte, Giuseppe


    Chronic Kidney Disease (CKD) regression is considered as an infrequent renal outcome, limited to early stages, and associated with higher mortality. However, prevalence, prognosis and the clinical correlates of CKD regression remain undefined in the setting of nephrology care. This is a multicenter prospective study in 1418 patients with established CKD (eGFR: 60-15 ml/min/1.73m²) under nephrology care in 47 outpatient clinics in Italy from a least one year. We defined CKD regressors as a ΔGFR ≥0 ml/min/1.73 m2/year. ΔGFR was estimated as the absolute difference between eGFR measured at baseline and at follow up visit after 18-24 months, respectively. Outcomes were End Stage Renal Disease (ESRD) and overall-causes Mortality.391 patients (27.6%) were identified as regressors as they showed an eGFR increase between the baseline visit in the renal clinic and the follow up visit. In multivariate regression analyses the regressor status was not associated with CKD stage. Low proteinuria was the main factor associated with CKD regression, accounting per se for 48% of the likelihood of this outcome. Lower systolic blood pressure, higher BMI and absence of autosomal polycystic disease (PKD) were additional predictors of CKD regression. In regressors, ESRD risk was 72% lower (HR: 0.28; 95% CI 0.14-0.57; pCKD stage. CKD regression occurs in about one-fourth patients receiving renal care in nephrology units and correlates with low proteinuria, BP and the absence of PKD. This condition portends better renal prognosis, mostly in earlier CKD stages, with no excess risk for mortality.

  8. Quality of Life and Outcomes in African Americans with CKD (United States)

    Fischer, Michael J.; Wang, Xuelei; Brooks, Deborah; Bruce, Marino; Charleston, Jeanne; Cleveland, William H.; Dowie, Donna; Faulkner, Marquetta; Gassman, Jennifer; Hiremath, Leena; Kendrick, Cindy; Kusek, John W.; Norris, Keith C.; Thornley-Brown, Denyse; Greene, Tom; Lash, James P.


    Low health-related quality of life (HRQOL) has been associated with increased risk for hospitalization and death in ESRD. However, the relationship of HRQOL with outcomes in predialysis CKD is not well understood. We evaluated the association between HRQOL and renal and cardiovascular (CV) outcomes in 1091 African Americans with hypertensive CKD enrolled in the African American Study of Kidney Disease and Hypertension (AASK) trial and cohort studies. Outcomes included CKD progression (doubling of serum creatinine/ESRD), CV events/CV death, and a composite of CKD progression or death from any cause (CKD progression/death). We assessed HRQOL, including mental health composite (MHC) and physical health composite (PHC), using the Short Form-36 survey. Cox regression analyses were used to assess the relationship between outcomes and five-point decrements in MHC and PHC scores using measurements at baseline, at the most recent annual visit (time-varying), or averaged from baseline to the most recent visit (cumulative). During approximately 10 years of follow-up, lower mean PHC score was associated with increased risk of CV events/CV death and CKD progression/death across all analytic approaches, but only time-varying and cumulative decrements were associated with CKD progression. Similarly, lower mean MHC score was associated with increased risk of CV events/CV death regardless of analytic approach, while only time-varying and cumulative decrements in mean MHC score was associated with CKD progression and CKD progression or death. In conclusion, lower HRQOL is associated with a range of adverse outcomes in African Americans with hypertensive CKD. PMID:24700865

  9. Arterial and Cellular Inflammation in Patients with CKD. (United States)

    Bernelot Moens, Sophie J; Verweij, Simone L; van der Valk, Fleur M; van Capelleveen, Julian C; Kroon, Jeffrey; Versloot, Miranda; Verberne, Hein J; Marquering, Henk A; Duivenvoorden, Raphaël; Vogt, Liffert; Stroes, Erik S G


    CKD associates with a 1.5- to 3.5-fold increased risk for cardiovascular disease. Both diseases are characterized by increased inflammation, and in patients with CKD, elevated C-reactive protein level predicts cardiovascular risk. In addition to systemic inflammation, local arterial inflammation, driven by monocyte-derived macrophages, predicts future cardiovascular events in the general population. We hypothesized that subjects with CKD have increased arterial and cellular inflammation, reflected by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography computed tomography (PET/CT) of the arterial wall and a migratory phenotype of monocytes. We assessed (18)F-FDG uptake in the arterial wall in 14 patients with CKD (mean±SD age: 59±5 years, mean±SD eGFR: 37±12 ml/min per 1.73 m(2)) but without cardiovascular diseases, diabetes, or inflammatory conditions and in 14 control subjects (mean age: 60±11 years, mean eGFR: 86±16 ml/min per 1.73 m(2)). Compared with controls, patients with CKD showed increased arterial inflammation, quantified as target-to-background ratio (TBR) in the aorta (TBRmax: CKD, 3.14±0.70 versus control, 2.12±0.27; P=0.001) and the carotid arteries (TBRmax: CKD, 2.45±0.65 versus control, 1.66±0.27; Pinflammation, observed in patients with CKD but without overt atherosclerotic disease and with few traditional risk factors, may contribute to the increased cardiovascular risk associated with CKD. The concomitant elevation of monocyte activity may provide novel therapeutic targets for attenuating this inflammation and thereby preventing CKD-associated cardiovascular disease. Copyright © 2017 by the American Society of Nephrology.

  10. Management of hypertension in CKD: beyond the guidelines. (United States)

    Judd, Eric; Calhoun, David A


    Hypertension (HTN) and CKD are closely associated with an intermingled cause and effect relationship. Blood pressure (BP) typically rises with declines in kidney function, and sustained elevations in BP hasten progression of kidney disease. This review addresses current management issues in HTN in patients with CKD including altered circadian rhythm of BP, timing of antihypertensive medication dosing, BP targets, diagnostic challenges in evaluating secondary forms of HTN, and the role of salt restriction in CKD. HTN in patients with CKD is often accompanied by a decrease in the kidney's ability to remove salt. Addressing this salt sensitivity is critical for the management of HTN in CKD. In addition to the well-established use of an ACEI or angiotensin receptor blocker, dietary salt restriction and appropriate diuretic therapy make up the mainstay of HTN treatment in patients with CKD. Bedtime dosing of antihypertensive medications can restore nocturnal dips in BP, and future clinical practice guidelines may recommend bedtime dosing of 1 or more antihypertensive medications in patients with CKD.

  11. Bisphophonates in CKD Patients with Low Bone Mineral Density

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    Wen-Chih Liu


    Full Text Available Patients with chronic kidney disease-mineral and bone disorder (CKD-MBD have a high risk of bone fracture because of low bone mineral density and poor bone quality. Osteoporosis also features low bone mass, disarranged microarchitecture, and skeletal fragility, and differentiating between osteoporosis and CKD-MBD in low bone mineral density is a challenge and usually achieved by bone biopsy. Bisphosphonates can be safe and beneficial for patients with a glomerular filtration rate of 30 mL/min or higher, but prescribing bisphosphonates in advanced CKD requires caution because of the increased possibility of low bone turnover disorders such as osteomalacia, mixed uremic osteodystrophy, and adynamic bone, even aggravating hyperparathyroidism. Therefore, bone biopsy in advanced CKD is an important consideration before prescribing bisphosphonates. Treatment also may induce hypocalcemia in CKD patients with secondary hyperparathyroidism, but vitamin D supplementation may ameliorate this effect. Bisphosphonate treatment can improve both bone mineral density and vascular calcification, but the latter becomes more unlikely in patients with stage 3-4 CKD with vascular calcification but no decreased bone mineral density. Using bisphosphonates requires considerable caution in advanced CKD, and the lack of adequate clinical investigation necessitates more studies regarding its effects on these patients.

  12. Modification of diet in renal disease (MDRD study and CKD epidemiology collaboration (CKD-EPI equations for Taiwanese adults.

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    Ling-I Chen

    Full Text Available Estimated glomerular filtration rate (eGFR using the Modification of Diet in Renal Disease (MDRD study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults.This cross-sectional study compared the Taiwanese eGFR equations, the MDRD study, and the CKD-EPI equations with inulin clearance (Cin. A total of 695 adults including 259 healthy volunteers and 436 CKD patients were recruited. Participants from the Kaohsiung Medical University Hospital were used as the development set (N = 556 to develop the Taiwanese eGFR equations, whereas participants from the National Taiwan University Hospital were used as the validation set (N = 139 for external validation.The Taiwanese eGFR equations were developed by using the extended Bland-Altman plot in the development set. The Taiwanese MDRD equation was 1.309 × MDRD0.912, Taiwanese CKD-EPI was 1.262×CKD-EPI0.914 and Taiwanese four-level CKD-EPI was 1.205 × four-level CKD-EPI0.914. In the validation set, the Taiwanese equations had the lowest bias, the Taiwanese equations and the Japanese CKD-EPI equation had the lowest RMSE, whereas the Taiwanese and the Japanese equations had the best precision and the highest P30 among all equations. However, the Taiwanese MDRD equation had higher concordance correlation than did the Taiwanese CKD-EPI, the Taiwanese four-level CKD-EPI and the Japanese equations. Moreover, only the Taiwanese equations had no proportional bias among all of the equations. Finally, the Taiwanese MDRD equation had the best diagnostic performance in terms of ordinal logistic regression among all of the equations.The Taiwanese MDRD equation is better than the MDRD, CKD-EPI, Japanese, Asian, Thai, Taiwanese CKD-EPI, and Taiwanese four-level CKD-EPI equations for Taiwanese adults.

  13. Iridium anomaly in the Cretaceous section of the Eastern Kamchatka (United States)

    Savelyev, Dmitry; Savelyeva, Olga


    The origin of iridium anomalies is widely discussed with regard to massive fauna and flora extinction at several geologic boundaries. Two hypotheses are most popular, cosmogenic and volcanogenic. Anomalies of iridium are known at many stratigraphic levels, both at the geologic series borders and within geologic series. Our studies revealed increased content of iridium in a section of Cretaceous oceanic deposits on the Kamchatsky Mys Peninsula (Eastern Kamchatka, Russia). The investigated section (56°03.353´N, 163°00.376´E) includes interbedded jaspers and siliceous limestones overlaying pillow-basalts. These deposits belong to the Smagin Formation of the Albian-Cenomanian age. In the middle and upper parts of the section two beds of black carbonaceous rocks with sapropelic organic matter were observed. Their formation marked likely episodes of oxygen depletion of oceanic intermediate water (oceanic anoxic events). Our geochemical studies revealed an enrichment of the carbonaceous beds in a number of major and trace elements (Al2O3, TiO2, FeO, MgO, K2O, P2O5, Cu, Zn, Ni, Cr, V, Mo, Ba, Y, Zr, Nb, REE, U, Au, Pt etc.) in comparison with associating jaspers and limestones. There are likely different sources which contributed to the enrichment. It is possible however to correlate the excess of Al, Ti, Zr, Nb with volcanogenic admixture, which is absent in limestones and jaspers. A possible source of the volcanogenic material was local volcanism as suggested by the close association of the investigated section with volcanic rocks (basaltic lavas and hyaloclastites). The basalts of the Smagin Formation were previously proposed to originate during Cretaceous activity of the Hawaiian mantle plume (Portnyagin et al., Geology, 2008). Neutron activation analysis indicated increased up to 9 ppb concentration of Ir at the bottom of the lower carbonaceous bed (inorganic part of the sample was analyzed comprising 46% of the bulk rock). In other samples Ir content was below

  14. Effects of dietary interventions on incidence and progression of CKD. (United States)

    Jain, Nishank; Reilly, Robert F


    Traditional strategies for management of patients with chronic kidney disease (CKD) have not resulted in any change in the growing prevalence of CKD worldwide. A historic belief that eating healthily might ameliorate kidney disease still holds credibility in the 21(st) century. Dietary sodium restriction to dietary net acid load could be beneficial in patients with CKD, but the supremacy of any particular diet has yet to be established. More trials of dietary interventions are needed, especially in diabetic nephropathy, before evidence-based recommendations can be made. In the meantime, nephrologists should discuss healthy dietary habits with their patients and provide individualized care aimed at maximizing the potential benefits of dietary intervention, reducing the incidence of CKD and delaying its progression to end-stage renal disease. Keeping in mind the lack of data on hard outcomes, dietary recommendations should take into account barriers to adherence and be tailored to different cultures, ethnicities and geographical locations.

  15. Lagrangian study of temporal changes of a surface flow through the Kamchatka Strait

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    Prants, S V; Uleysky, M Yu; Budyansky, M V


    Using Lagrangian methods we analyze a 20-year-long estimate of water flux through the Kamchatka Strait in the northern North Pacific based on AVISO velocity field. It sheds new light on the flux pattern and its variability on annual and monthly time scales. Strong seasonality in surface outflow through the strait could be explained by temporal changes in the wind stress over the northern and western Bering Sea slopes. Interannual changes in a surface outflow through the Kamchatka Strait correlate significantly with the Near Strait inflow and Bering Strait outflow. Enhanced westward surface flow of the Alaskan Stream across the $174^\\circ$ E section in the northern North Pacific is accompanied by an increased inflow into the Bering Sea through the Near Strait. In summer, the surface flow pattern in the Kamchatka Strait is determined by passage of anticyclonic and cyclonic mesoscale eddies. The wind stress over the Bering basin in winter - spring is responsible for eddy generation in the region.

  16. Approach to the Treatment of Chronic Metabolic Acidosis in CKD. (United States)

    Raphael, Kalani L


    Chronic metabolic acidosis is not uncommon in patients with chronic kidney disease (CKD). Clinical practice guidelines suggest that clinicians administer alkali to maintain serum bicarbonate level at a minimum of 22 mEq/L to prevent the effects of acidosis on bone demineralization and protein catabolism. Small interventional studies support the notion that correcting acidosis slows CKD progression as well. Furthermore, alkaline therapy in persons with CKD and normal bicarbonate levels may also preserve kidney function. Observational studies suggest that targeting a serum bicarbonate level near 28 mEq/L may improve clinical outcomes above and beyond targeting a value ≥ 22 mEq/L, yet values > 26 mEq/L have been reported to be associated with incident heart failure and mortality in the CRIC (Chronic Renal Insufficiency Cohort) Study. Furthermore, correcting acidosis may provoke vascular calcification. This teaching case discusses several uncertainties regarding the management of acidosis in CKD, such as when to initiate alkali treatment, potential side effects of alkali, and the optimum serum bicarbonate level based on current evidence in CKD. Suggestions regarding the maximum sodium bicarbonate dose to administer to patients with CKD to achieve the target serum bicarbonate concentration are offered.

  17. Gray matter volume and white matter lesions in chronic kidney disease : exploring the association with depressive symptoms

    NARCIS (Netherlands)

    Meurs, Maaike; Roest, Annelieke M.; Groenewold, Nynke A.; Franssen, Casper F. M.; Westerhuis, Ralf; Kloppenburg, Wybe Douwe; Doornbos, Bennard; Beukema, Lindy; Lindmae, Hanna; de Groot, Jan Cees; van Tol, Marie-Jose; de Jonge, Peter


    Objective: Chronic kidney disease (CKD) is associated with structural brain damage and with a high prevalence of depression. We therefore investigated structural brain alterations in both gray and white matter in CKD patients, focusing on depression-related (frontal-subcortical) regions. Method: Thi

  18. Epidemiology of CKD Regression in Patients under Nephrology Care.

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    Silvio Borrelli

    Full Text Available Chronic Kidney Disease (CKD regression is considered as an infrequent renal outcome, limited to early stages, and associated with higher mortality. However, prevalence, prognosis and the clinical correlates of CKD regression remain undefined in the setting of nephrology care. This is a multicenter prospective study in 1418 patients with established CKD (eGFR: 60-15 ml/min/1.73m² under nephrology care in 47 outpatient clinics in Italy from a least one year. We defined CKD regressors as a ΔGFR ≥0 ml/min/1.73 m2/year. ΔGFR was estimated as the absolute difference between eGFR measured at baseline and at follow up visit after 18-24 months, respectively. Outcomes were End Stage Renal Disease (ESRD and overall-causes Mortality.391 patients (27.6% were identified as regressors as they showed an eGFR increase between the baseline visit in the renal clinic and the follow up visit. In multivariate regression analyses the regressor status was not associated with CKD stage. Low proteinuria was the main factor associated with CKD regression, accounting per se for 48% of the likelihood of this outcome. Lower systolic blood pressure, higher BMI and absence of autosomal polycystic disease (PKD were additional predictors of CKD regression. In regressors, ESRD risk was 72% lower (HR: 0.28; 95% CI 0.14-0.57; p<0.0001 while mortality risk did not differ from that in non-regressors (HR: 1.16; 95% CI 0.73-1.83; p = 0.540. Spline models showed that the reduction of ESRD risk associated with positive ΔGFR was attenuated in advanced CKD stage. CKD regression occurs in about one-fourth patients receiving renal care in nephrology units and correlates with low proteinuria, BP and the absence of PKD. This condition portends better renal prognosis, mostly in earlier CKD stages, with no excess risk for mortality.

  19. Cause-Specific Deaths in Non-Dialysis-Dependent CKD. (United States)

    Navaneethan, Sankar D; Schold, Jesse D; Arrigain, Susana; Jolly, Stacey E; Nally, Joseph V


    CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFRCauses of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m(2) decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.

  20. Late Glacial to Holocene paleoenvironmental change on the northwestern Pacific seaboard, Kamchatka Peninsula (Russia) (United States)

    Pendea, Ionel Florin; Ponomareva, Vera; Bourgeois, Joanne; Zubrow, Ezra B. W.; Portnyagin, Maxim; Ponkratova, Irina; Harmsen, Hans; Korosec, Gregory


    We used a new sedimentary record from a small kettle wetland to reconstruct the Late Glacial and Holocene vegetation and fire history of the Krutoberegovo-Ust Kamchatsk region in eastern Kamchatka Peninsula (Russia). Pollen and charcoal data suggest that the Late Glacial landscape was dominated by a relatively fire-prone Larix forest-tundra during the Greenland Interstadial complex (GI 1) and a subarctic steppe during the Younger Dryas (GS1). The onset of the Holocene is marked by the reappearance of trees (mainly Alnus incana) within a fern and shrub dominated landscape. The Holocene Thermal Maximum (HTM) features shifting vegetational communities dominated by Alnus shrubs, diverse forb species, and locally abundant aquatic plants. The HTM is further defined by the first appearance of stone birch forests (Betula ermanii) - Kamchatka's most abundant modern tree species. The Late Holocene is marked by shifts in forest dynamics and forest-graminoid ratio and the appearance of new non-arboreal taxa such as bayberry (Myrica) and meadow rue (Filipendula). Kamchatka is one of Earth's most active volcanic regions. During the Late Glacial and Holocene, Kamchatka's volcanoes spread large quantities of tephra over the study region. Thirty-four tephra falls have been identified at the site. The events represented by most of these tephra falls have not left evidence of major impacts on the vegetation although some of the thicker tephras caused expansion of grasses (Poaceae) and, at least in one case, forest die-out and increased fire activity.

  1. Epimeria abyssalis sp. n. from the Kuril-Kamchatka Trench (Crustacea, Amphipoda, Epimeriidae) (United States)

    Shimomura, Michitaka; Tomikawa, Ko


    Abstract A new deep-sea epimeriid, Epimeria abyssalis is described from the Kuril-Kamchatka Trench, in the northwestern Pacific. This species differs from its congeners in having a short rostrum and a telson with deep and narrow Y-shaped excavation. Epimeria abyssalis is the deepest recorded Epimeria species. A key to the north Pacific species of Epimeria is provided. PMID:28174500

  2. [Clinicopathological study of chronic kidney diseases (CKD)]. (United States)

    Yoshida, Haruyoshi


    up-to-date information and techniques in clinical nephrology. From this hospital, I published a paper in Kidney International entitled, "Mesangiolytic glomerulopathy in severe congestive heart failure", based on the autopsy cases collected at the Pathology Department. This paper became a milestone in starting to study the role of chronic hypoxia in CKD. In 1999, I was elected as a professor of the Department of Clinical Laboratories, Faculty of Medicine, University of Fukui. In Fukui, I could extend my hypoxia study to cellular levels and diabetic mouse experiments in collaboration with Dr. Kimura, Dr. Li, Dr. Takahashi and many other doctors and technicians. When overviewing my research history, I realize that I was fortunate to be involved at the starting point of every laboratory with energetic mood and that I was supported and helped by many people.

  3. The Role of Physical Activity in the CKD Setting

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    Filippo Aucella


    Full Text Available A sedentary lifestyle contributes to the development of cardiovascular disease, hypertension, diabetes and probably cancer in the general population; this cluster of disease may be defined the diseasome of physical inactivity. Also in CKD/ESRD patients physical activity is strikingly low. As a result of growing evidence suggestive of cardiovascular benefit among the CKD population with exercise, the National Kidney Foundation recommended counseling by nephrologists to increase patients' levels of physical activity in their guideline about management of cardiovascular disease. Therefore, to maintain the well-being and functional capacity of renal patients attention should be directed toward maintaining strength and aerobic fitness as well as focusing on renal function and anemia or other comorbidities. All CKD/ESRD patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their level of physical activity.

  4. Risk Prediction in CKD: The Rational Alignment of Health Care Resources in CKD 4/5 Care. (United States)

    Wojciechowski, Peter; Tangri, Navdeep; Rigatto, Claudio; Komenda, Paul


    CKD is a well-recognized global epidemic with consequences on patient morbidity, mortality, and health care resources. In the United States and Canada, a financial premium is often paid to programs and providers for caring for patients with Stage 4 to 5 CKD (not on dialysis) and is justified by the intensive care required by these patients, particularly in preparation for dialysis. About half of all patients with CKD Stages 3 and 4 never progress to kidney failure, and more than a quarter of them have stable kidney function for years. Among patients with Stage 3 CKD, even fewer progresses to kidney failure but small subpopulations with certain characteristics (eg, younger age, higher levels of proteinuria) have a more predictable trajectory. Clearly, a more robust method of screening patients for nephrology referral and subsequent enrollment into multidisciplinary clinics is needed to provide better efficiency within the health care system. The Kidney Failure Risk Equation is a generalizable CKD risk prediction model that has been externally validated and allows for the efficient risk-based triaging of nephrology referrals with a significant benefit to decreasing wait times. It is also efficiently used in a multidisciplinary kidney disease clinic with aiding timing in modality planning and frequency of follow-ups. The overall potential benefit of this system should allow for appropriate allocation of human resources to those at highest risk to yield optimal care in the most cost-effective manner to the health care system.

  5. Chronic kidney disease (CKD) special interest group (SIG) networking session. (United States)

    Campoy, Sally


    The issue of reimbursement for NP is not an issue in the VA system, although it can be a barrier for the private sector. How to make this cost-effective was discussed during the networking session and will continue to be explored. The nephrology nurse is in a key position to participate in CKD clinics/programs. By virtue of his/her nursing expertise in assessment, incorporation of psychosocial factors, and patient education, the nurse can play a pivotal role in successful management of persons with CKD.

  6. Genomics in CKD: Is This the Path Forward? (United States)

    Nadkarni, Girish N; Horowitz, Carol R


    Recent advances in genomics and sequencing technology have led to a better understanding of genetic risk in CKD. Genetics could account in part for racial differences in treatment response for medications including antihypertensives and immunosuppressive medications due to its correlation with ancestry. However, there is still a substantial lag between generation of this knowledge and its adoption in routine clinical care. This review summarizes the recent advances in genomics and CKD, discusses potential reasons for its underutilization, and highlights potential avenues for application of genomic information to improve clinical care and outcomes in this particularly vulnerable population.

  7. Understanding controls on cirque floor altitudes: Insights from Kamchatka (United States)

    Barr, Iestyn D.; Spagnolo, Matteo


    Glacial cirques reflect former regions of glacier initiation, and are therefore used as indicators of past climate. One specific way in which palaeoclimatic information is obtained from cirques is by analysing their elevations, on the assumption that cirque floor altitudes are a proxy for climatically controlled equilibrium-line altitudes (ELAs) during former periods of small scale (cirque-type) glaciation. However, specific controls on cirque altitudes are rarely assessed, and the validity of using cirque floor altitudes as a source of palaeoclimatic information remains open to question. In order to address this, here we analyse the distribution of 3520 ice-free cirques on the Kamchatka Peninsula (eastern Russia), and assess various controls on their floor altitudes. In addition, we analyse controls on the mid-altitudes of 503 modern glaciers, currently identifiable on the peninsula, and make comparisons with the cirque altitude data. The main study findings are that cirque floor altitudes increase steeply inland from the Pacific, suggesting that moisture availability (i.e., proximity to the coastline) played a key role in regulating the altitudes at which former (cirque-forming) glaciers were able to initiate. Other factors, such as latitude, aspect, topography, geology, and neo-tectonics seem to have played a limited (but not insignificant) role in regulating cirque floor altitudes, though south-facing cirques are typically higher than their north-facing equivalents, potentially reflecting the impact of prevailing wind directions (from the SSE) and/or variations in solar radiation on the altitudes at which former glaciers were able to initiate. Trends in glacier and cirque altitudes across the peninsula are typically comparable (i.e., values typically rise from both the north and south, inland from the Pacific coastline, and where glaciers/cirques are south-facing), yet the relationship with latitude is stronger for modern glaciers, and the relationship with

  8. Kamchatka Peninsula, Russia 3-D Perspective with Landsat Overlay (United States)


    This three-dimensional perspective view, looking up the Tigil River, shows the western side of the volcanically active Kamchatka Peninsula, Russia. The image shows that the Tigil River has eroded down from a higher and differing landscape and now flows through, rather than around the large green-colored bedrock ridge in the foreground. The older surface was likely composed of volcanic ash and debris from eruptions of nearby volcanoes. The green tones indicate that denser vegetation grows on south facing sunlit slopes at the northern latitudes. High resolution SRTM elevation data will be used by geologists to study how rivers shape the landscape, and by ecologists to study the influence of topography on ecosystems.This image shows how data collected by the Shuttle Radar Topography Mission (SRTM) can be used to enhance other satellite images. Color and natural shading are provided by a Landsat 7 image acquired on January 31, 2000. Terrain perspective and shading were derived from SRTM elevation data acquired on February 12, 2000. Topography is exaggerated by about six times vertically. The United States Geological Survey's Earth Resources Observations Systems (EROS) DataCenter, Sioux Falls, South Dakota, provided the Landsat data.The Shuttle Radar Topography Mission (SRTM), launched on February 11,2000, uses the same radar instrument that comprised the Spaceborne Imaging Radar-C/X-Band Synthetic Aperture Radar (SIR-C/X-SAR) that flew twice on the Space Shuttle Endeavour in 1994. The mission is designed to collect three-dimensional measurements of the Earth's surface. To collect the 3-D data, engineers added a 60-meter-long (200-foot) mast, an additional C-band imaging antenna and improved tracking and navigation devices. The mission is a cooperative project between the National Aeronautics and Space Administration (NASA), the National Imagery and Mapping Agency (NIMA) and the German (DLR) and Italian (ASI) space agencies. It is managed by NASA's Jet Propulsion

  9. Protein: Tips for People with Chronic Kidney Disease (CKD) (United States)

    ... grits, cereals l Pasta, noodles, rice l Rice milk (not enriched) Why Is Protein Important for People with CKD? When your body ... Dairy foods: A portion is ½ cup of milk or yogurt, or one slice of cheese. ■ Plant proteins should make up the rest of the protein ...

  10. Glycemic management in ESRD and earlier stages of CKD. (United States)

    Williams, Mark E; Garg, Rajesh


    The management of hyperglycemia in patients with kidney failure is complex, and the goals and methods regarding glycemic control in chronic kidney disease (CKD) are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD (including end-stage renal disease [ESRD]) are lacking. Challenges in the management of such patients include therapeutic inertia, monitoring difficulties, and the complexity of available treatments. In this article, we review the alterations in glucose homeostasis that occur in kidney failure, current views on the value of glycemic control and issues with its determination, and more recent approaches to monitor or measure glycemic control. Hypoglycemia and treatment options for patients with diabetes and ESRD or earlier stages of CKD also are addressed, discussing the insulin and noninsulin agents that currently are available, along with their indications and contraindications. The article provides information to help clinicians in decision making in order to provide individualized glycemic goals and appropriate therapy for patients with ESRD or earlier stages of CKD.

  11. Relating illness complexity to reimbursement in CKD patients

    Directory of Open Access Journals (Sweden)

    Bessette RW


    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  12. Bone mass and microarchitecture in CKD patients with fracture. (United States)

    Nickolas, Thomas L; Stein, Emily; Cohen, Adi; Thomas, Valerie; Staron, Ronald B; McMahon, Donald J; Leonard, Mary B; Shane, Elizabeth


    Patients with predialysis chronic kidney disease (CKD) have increased risk for fracture, but the structural mechanisms underlying this increased skeletal fragility are unknown. We measured areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry at the spine, hip, and radius, and we measured volumetric BMD (vBMD), geometry, and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius and tibia in patients with CKD: 32 with fracture and 59 without fracture. Patients with fracture had lower aBMD at the spine, total hip, femoral neck, and the ultradistal radius, the last having the strongest association with fracture. By HR-pQCT of the radius, patients with fracture had lower cortical area and thickness, total and trabecular vBMD, and trabecular number and greater trabecular separation and network heterogeneity. At the tibia, patients with fracture had significantly lower cortical area, thickness, and total and cortical density. Total vBMD at both radius and tibia most strongly associated with fracture. By receiver operator characteristic curve analysis, patients with longer duration of CKD had area under the curve of >0.75 for aBMD at both hip sites and the ultradistal radius, vBMD and geometry at the radius and tibia, and microarchitecture at the tibia. In summary, patients with predialysis CKD and fractures have lower aBMD by dual-energy x-ray absorptiometry and lower vBMD, thinner cortices, and trabecular loss by HR-pQCT. These density and structural differences may underlie the increased susceptibility to fracture among patients with CKD.

  13. Composition, structure and properties of sediment thermal springs of Kamchatka (United States)

    Shanina, Violetta; Smolyakov, Pavel; Parfenov, Oleg


    The paper deals with the physical and mechanical properties sediment thermal fields Mutnovsky, Lower Koshelevo and Bannyh (Kamchatka). This multi-component soils, mineral and chemical composition of which depends on the formation factors (pH, temperature, salinity of water, composition and structure of the host volcanic rocks). Samples Lower Koshelevo sediment thermal sources differ in the following composition: smectite, kaolinite, kaolinite-smectite mixed-mineral. Samples of sediment thermal springs Mutnovsky volcano in accordance with the X-ray analysis has the following composition: volcanic glass, crystalline sulfur, plagioclase, smectite, illite-smectite mixed, illite, chlorite, quartz, cristobalite, pyrite, melanterite, kaolinite. Natural moisture content samples of sediment thermal springs from 45 to 121%, hygroscopic moisture content of 1.3 to 3.7%. A large amount of native sulfur (up to 92%) and the presence of amorphous material gives low values of density of solid particles (up to 2.1 g/cm3) samples Mutnovskii thermal field. The values of the density of solids sediment Koshelevo and Bannyh hot springs close to those of the main components of mineral densities (up to 2.6-3.0 g/cm3). The results of the particle size distribution and microaggregate analysis of sediment thermal springs Lower Koshelevo field shows that the predominance observed of particles with a diameter from 0.05 mm to 0.25 mm, the coefficient of soil heterogeneity heterogeneous. In the bottom sediments of the thermal springs of the volcano Mutnovsky poorly traced predominance of one faction. Most prevalent fraction with particle size 0.01 - 0.05 mm. When analyzing the content in the soil microaggregates their content is shifted towards particles with a diameter of 0.25 mm. The contents of a large number of large (1-10 mm), porous rock fragments, due to the deposition of pyroclastic material from the eruptions of the last century. Present in large amounts rounded crystals of native sulfur

  14. Progression of CKD form pre-dialysis : natural course, risk factors, and outcomes

    NARCIS (Netherlands)

    Appeldoorn- de Jager, Dina Jezina (Dinanda) van


    Chronic kidney disease (CKD) is a progressive disease associated with increased morbidity and mortality. Different therapeutic interventions in the course of CKD are shown to be effective in slowing or preventing disease progression. This thesis focused on the progression of CKD from pre-dialysis to

  15. Conservation laws and self-consistent sources for a super-CKdV equation hierarchy

    Energy Technology Data Exchange (ETDEWEB)

    Li Li, E-mail: [College of Maths and Systematic Science, Shenyang Normal University, Shenyang 110034 (China)


    From the super-matrix Lie algebras, we consider a super-extension of the CKdV equation hierarchy in the present Letter, and propose the super-CKdV hierarchy with self-consistent sources. Furthermore, we establish the infinitely many conservation laws for the integrable super-CKdV hierarchy.

  16. New stands of species of the Paramecium aurelia complex (Ciliophora, Protista) in Russia (Siberia, Kamchatka). (United States)

    Przyboś, Ewa; Rautian, Maria; Surmacz, Marta; Bieliavskaya, Alexandra


    New stands of P. primaurelia, P. biaurelia, and P. dodecaurelia were found in Russia. P. primaurelia was recorded in Tulun (Siberia, Irkutsk region) and in three stands situated on the Kamchatka peninsula: in Lake Chalaktyrskoye, in the Valley of Geysers, and Petropavlovsk Kamchatski. P. biaurelia was also found in Tulun and in two stands in the vicinity of Lake Baikal and the Buriatia region. P. dodecaurelia was recorded in Cheboksary in European Russia and in other stands situated in Asian Russia: Novosibirsk, the vicinity of Lake Baikal, Buriatia, Kamchatka (Petropavlovsk Kamchatski, Lake Chalaktyrskoye, and Nalychevo). These data extend the ranges of species of the P. aurelia complex in Russia, however, this large territory remains understudied.

  17. Placental Growth Factor as a Predictor of Cardiovascular Events in Patients with CKD from the NARA-CKD Study. (United States)

    Matsui, Masaru; Uemura, Shiro; Takeda, Yukiji; Samejima, Ken-Ichi; Matsumoto, Takaki; Hasegawa, Ayako; Tsushima, Hideo; Hoshino, Ei; Ueda, Tomoya; Morimoto, Katsuhiko; Okamoto, Keisuke; Okada, Sadanori; Onoue, Kenji; Okayama, Satoshi; Kawata, Hiroyuki; Kawakami, Rika; Maruyama, Naoki; Akai, Yasuhiro; Iwano, Masayuki; Shiiki, Hideo; Saito, Yoshihiko


    Placental growth factor (PlGF) contributes to atherogenesis through vascular inflammation and plaque destabilization. High levels of PlGF may be associated with mortality and cardiovascular disease, but the relationship between PlGF level and adverse outcomes in patients with CKD is unclear. We conducted a prospective cohort study of 1351 consecutive participants with CKD enrolled in the Novel Assessment of Risk management for Atherosclerotic diseases in CKD (NARA-CKD) study between April 1, 2004, and December 31, 2011. During a median follow-up of 3 years, 199 participants died and 383 had cardiovascular events, defined as atherosclerotic disease or heart failure requiring hospitalization. In adjusted analyses, mortality and cardiovascular risk increased in each successive quartile of serum PlGF level; hazard ratios (HRs) (95% confidence intervals [95% CIs]) for mortality and cardiovascular risk, respectively, were 1.59 (0.83 to 3.16) and 1.55 (0.92 to 2.66) for the second quartile, 2.97 (1.67 to 5.59) and 3.39 (2.20 to 5.41) for the third quartile, and 3.87 (2.24 to 7.08) and 8.42 (5.54 to 13.3) for the fourth quartile. The composite end point of mortality and cardiovascular events occurred during the study period in 76.4% of patients in both the highest PlGF quartile (≥19.6 pg/ml) and the lowest eGFR tertile (cause mortality and cardiovascular events in patients with CKD.

  18. Late Holocene climate and environmental changes in Kamchatka inferred from the subfossil chironomid record (United States)

    Nazarova, Larisa; de Hoog, Verena; Hoff, Ulrike; Dirksen, Oleg; Diekmann, Bernhard


    This study presents a reconstruction of the Late Holocene climate in Kamchatka based on chironomid remains from a 332 cm long composite sediment core recovered from Dvuyurtochnoe Lake (Two-Yurts Lake, TYL) in central Kamchatka. The oldest recovered sediments date to about 4500 cal years BP. Chironomid head capsules from TYL reflect a rich and diverse fauna. An unknown morphotype of Tanytarsini, Tanytarsus type klein, was found in the lake sediments. Our analysis reveals four chironomid assemblage zones reflecting four different climatic periods in the Late Holocene. Between 4500 and 4000 cal years BP, the chironomid composition indicates a high lake level, well-oxygenated lake water conditions and close to modern temperatures (˜13 °C). From 4000 to 1000 cal years BP, two consecutive warm intervals were recorded, with the highest reconstructed temperature reaching 16.8 °C between 3700 and 2800 cal years BP. Cooling trend, started around 1100 cal years BP led to low temperatures during the last stage of the Holocene. Comparison with other regional studies has shown that termination of cooling at the beginning of late Holocene is relatively synchronous in central Kamchatka, South Kurile, Bering and Japanese Islands and take place around 3700 cal years BP. From ca 3700 cal years BP to the last millennium, a newly strengthened climate continentality accompanied by general warming trend with minor cool excursions led to apparent spatial heterogeneity of climatic patterns in the region. Some timing differences in climatic changes reconstructed from chironomid record of TYL sediments and late Holocene events reconstructed from other sites and other proxies might be linked to differences in local forcing mechanisms or caused by the different degree of dating precision, the different temporal resolution, and the different sensitive responses of climate proxies to the climate variations. Further high-resolution stratigraphic studies in this region are needed to understand

  19. Structural evolution of the Kamchatka - Aleutian arc junction area in the Late Mesozoic and Tertiary (United States)

    Alexeiev, D.; Gaedicke, C.; Tsukanov, N. V.; Freitag, R.; Harbert, W.


    Structural, sedimentological and paleomagnetic studies have been conducted within the Kamchatka - Aleutian junction area aiming to a reconstruction of the tectonic history of the region from the Late Cretaceous to the Miocene. Pre-Pliocene structures of the area are comprised of 1) Achaivayam -Valaginskiy (Olyutorskiy) arc, 2) Vetlovskiy terrane, 3) Kronotskiy arc, and 4) Tyushevka basin, which goes along the boundary between Vetlovskiy and Kronotskiy units. In the Late Cretaceous and Tertiary deformations within the area of study were controlled by the following processes: 1) Northward subduction of the Pacific and Kula plates underneath the Kronotskiy arc and accretion in the fore-arc wedge south of the arc from the Late Cretaceous to the Middle Eocene. 2) Collision of the Achaivayam - Valaginskiy arc against Eurasia during the Early and Middle Eocene. 3) Northwest directed subduction in Proto-Kamchatka subduction zone and development of the accretionary wedge within Vetlovskiy terrane in the Middle and Late Eocene. 4) Collision of the Kronotskiy arc against Kamchatka during the Late Eocene through the Middle Miocene. We reconstruct seven structural complexes with individual structural patterns, which document different episodes of the regional deformation history. Age of the Kronotskiy arc collision is constrained by that 1) the Tyushevka foreland basin developed during the Late Eocene (?), Oligocene, Early and Middle Miocene, and 2) the foreland basin discordantly crosses syn-collisional plunging folds within the Kronotskiy arc. Syn-collisional deformations were controlled by the northwest motion of the Kronotskiy arc as part of the Pacific plate, and by the simultaneous motion of the entire northeast Eurasia margin toward the South. This caused deflection of the western segment of the Kronotskiy arc toward the south; it's rotation up to 90o counterclockwise and the subsequent bent of the arc into a large knee-like structure. The eastern portion of the

  20. Plastic pollution of the Kuril-Kamchatka Trench area (NW pacific) (United States)

    Fischer, Viola; Elsner, Nikolaus O.; Brenke, Nils; Schwabe, Enrico; Brandt, Angelika


    During the German-Russian expedition KuramBio (Kuril-Kamchatka Biodiversity Studies) to the northwest Pacific Kuril-Kamchatka Trench and its adjacent abyssal plain, we found several kinds and sizes of plastic debris ranging from fishing nets and packaging to microplastic in the sediment of the deep-sea floor. Microplastics were ubiquitous in the smaller fractions of the box corer samples from every station from depths between 4869 and 5766 m. They were found on the abyssal plain and in the sediments of the trench slope on both sides. The amount of microplastics differed between the stations, with lowest concentration of 60 pieces per m2 and highest concentrations of more than 2000 pieces per m2. Around 75% of the microplastics (defined here as particles marine fauna (Zenkevich, 1963). Yet we can only guess how these microplastics accumulated in the deep sea of the Kuril-Kamchatka Trench area and what consequences the microplastic itself and its adsorbed chemicals will have on this very special and rich deep-sea fauna. But we herewith present an evaluation of the different kinds of plastic debris we found, as a documentation of human impact into the deep sea of this region of the Northwest Pacific.

  1. A full holocene tephrochronology for the Kamchatsky Peninsula region: Applications from Kamchatka to North America (United States)

    Ponomareva, Vera; Portnyagin, Maxim; Pendea, I. Florin; Zelenin, Egor; Bourgeois, Joanne; Pinegina, Tatiana; Kozhurin, Andrey


    Geochemically fingerprinted widespread tephra layers serve as excellent marker horizons which can directly link and synchronize disparate sedimentary archives and be used for dating various deposits related to climate shifts, faulting events, tsunami, and human occupation. In addition, tephras represent records of explosive volcanic activity and permit assessment of regional ashfall hazard. In this paper we report a detailed Holocene tephrochronological model developed for the Kamchatsky Peninsula region of eastern Kamchatka (NW Pacific) based on ∼2800 new electron microprobe analyses of single glass shards from tephra samples collected in the area as well as on previously published data. Tephra ages are modeled based on a compilation of 223 14C dates, including published dates for Shiveluch proximal tephra sequence and regional marker tephras; new AMS 14C dates; and modeled calibrated ages from the Krutoberegovo key site. The main source volcanoes for tephra in the region are Shiveluch and Kliuchevskoi located 60-100 km to the west. In addition, local tephra sequences contain two tephras from the Plosky volcanic massif and three regional marker tephras from Ksudach and Avachinsky volcanoes located in the Eastern volcanic front of Kamchatka. This tephrochronological framework contributes to the combined history of environmental change, tectonic events, and volcanic impact in the study area and farther afield. This study is another step in the construction of the Kamchatka-wide Holocene tephrochronological framework under the same methodological umbrella. Our dataset provides a research reference for tephra and cryptotephra studies in the northwest Pacific, the Bering Sea, and North America.

  2. Timing of onset of CKD-related metabolic complications. (United States)

    Moranne, Olivier; Froissart, Marc; Rossert, Jerome; Gauci, Cedric; Boffa, Jean-Jacques; Haymann, Jean Philippe; M'rad, Mona Ben; Jacquot, Christian; Houillier, Pascal; Stengel, Benedicte; Fouqueray, Bruno


    Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR acidosis from 2 to 39%, and hyperkalemia from 2 to 42%. Factors most strongly associated with metabolic complications, independent of mGFR, were younger age for acidosis and hyperphosphatemia, presence of diabetes for acidosis, diabetic kidney disease for anemia, and both male gender and the use of inhibitors of the renin-angiotensin system for hyperkalemia. mGFR thresholds for detecting complications with 90% sensitivity were 50, 44, 40, 39, and 37 ml/min per 1.73 m(2) for hyperparathyroidism, anemia, acidosis, hyperkalemia, and hyperphosphatemia, respectively. Analysis using estimated GFR produced similar results. In summary, this study describes the onset of CKD-related complications at different levels of GFR; anemia and hyperparathyroidism occur earlier than acidosis, hyperkalemia, and hyperphosphatemia.

  3. International Volcanological Field School in Kamchatka and Alaska: Experiencing Language, Culture, Environment, and Active Volcanoes (United States)

    Eichelberger, J. C.; Gordeev, E.; Ivanov, B.; Izbekov, P.; Kasahara, M.; Melnikov, D.; Selyangin, O.; Vesna, Y.


    The Kamchatka State University of Education, University of Alaska Fairbanks, and Hokkaido University are developing an international field school focused on explosive volcanism of the North Pacific. An experimental first session was held on Mutnovsky and Gorely Volcanoes in Kamchatka during August 2003. Objectives of the school are to:(1) Acquaint students with the chemical and physical processes of explosive volcanism, through first-hand experience with some of the most spectacular volcanic features on Earth; (2) Expose students to different concepts and approaches to volcanology; (3) Expand students' ability to function in a harsh environment and to bridge barriers in language and culture; (4) Build long-lasting collaborations in research among students and in teaching and research among faculty in the North Pacific region. Both undergraduate and graduate students from Russia, the United States, and Japan participated. The school was based at a mountain hut situated between Gorely and Mutnovsky Volcanoes and accessible by all-terrain truck. Day trips were conducted to summit craters of both volcanoes, flank lava flows, fumarole fields, ignimbrite exposures, and a geothermal area and power plant. During the evenings and on days of bad weather, the school faculty conducted lectures on various topics of volcanology in either Russian or English, with translation. Although subjects were taught at the undergraduate level, lectures led to further discussion with more advanced students. Graduate students participated by describing their research activities to the undergraduates. A final session at a geophysical field station permitted demonstration of instrumentation and presentations requiring sophisticated graphics in more comfortable surroundings. Plans are underway to make this school an annual offering for academic credit in the Valley of Ten Thousand Smokes, Alaska and in Kamchatka. The course will be targeted at undergraduates with a strong interest in and

  4. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD. (United States)

    Navaneethan, Sankar D; Roy, Jason; Tao, Kelvin; Brecklin, Carolyn S; Chen, Jing; Deo, Rajat; Flack, John M; Ojo, Akinlolu O; Plappert, Theodore J; Raj, Dominic S; Saydain, Ghulam; Sondheimer, James H; Sood, Ruchi; Steigerwalt, Susan P; Townsend, Raymond R; Dweik, Raed A; Rahman, Mahboob


    Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings. Copyright © 2016 by the American Society of Nephrology.

  5. Nurse practitioner care improves renal outcome in patients with CKD. (United States)

    Peeters, Mieke J; van Zuilen, Arjan D; van den Brand, Jan A J G; Bots, Michiel L; van Buren, Marjolijn; Ten Dam, Marc A G J; Kaasjager, Karin A H; Ligtenberg, Gerry; Sijpkens, Yvo W J; Sluiter, Henk E; van de Ven, Peter J G; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J; Wetzels, Jack F M


    Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

  6. [Kidney Disease and Laboratory Examinations--Opening Remarks: For Better Understanding of CKD]. (United States)

    Yoshida, Haruyoshi; Wada, Takashi


    Chronic kidney diseases (CKD) have been cited as major risk factors not only for endstage renal failure, but also for the development of cardiovascular diseases and death. In the former criteria for CKD diagnosis (NKF K/DOQI, 2002), estimation of the severity of CKD was simply based on GFR, in order for it to be widely and easily understood by general physicians and patients. Therefore, the use of the CKD guideline without information on the causes and grades of albuminuria was limited for estimation of the prognosis. The revised guideline for CKD diagnosis (KDIGO CKD guideline 2012), with the disease category specified for diabetes mellitus and the different scoring system of microalbuminuria, is presently being effectively utilized by nephrologists as well as general physicians. In this symposium, to advice understanding of the causes and evaluation methods of CKD, speakers were invited to discuss topics in kidney pathology, urine sample examination, urinary biomarkers, and GFR.

  7. Marijuana and Cannabinoids in ESRD and Earlier Stages of CKD. (United States)

    Rein, Joshua L; Wyatt, Christina M


    Marijuana is the most commonly used recreational drug in the United States, and legal recreational and medicinal use has gained public acceptance during the last decade. Twenty-nine US states have established medical marijuana programs, 8 of which have also legalized recreational marijuana, and Canada is expected to legalize recreational marijuana in 2018. Advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) are chronic conditions with significant associated morbidity and mortality. Patients experience substantial symptom burden that is frequently undertreated due to adverse medication side effects. This article reviews the available evidence for the use of medical marijuana to manage chronic pain, nausea/vomiting, anorexia/cachexia, and pruritus, all of which are frequently reported by patients with advanced CKD or ESRD. Potential adverse health effects of medical and recreational marijuana use are also discussed. Regardless of personal, social, and political beliefs, marijuana use is becoming mainstream, and nephrologists should be aware of the potential impact on our patient population. Further research is warranted to investigate the renal endocannabinoid system, the impact of marijuana use on kidney disease outcomes, and the risks and benefits of medical marijuana use on symptoms of advanced CKD and ESRD. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  8. Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD. (United States)

    Schneider, Markus P; Raff, Ulrike; Kopp, Christoph; Scheppach, Johannes B; Toncar, Sebastian; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Floege, Jürgen; Schmid, Matthias; Birukov, Anna; Dahlmann, Anke; Linz, Peter; Janka, Rolf; Uder, Michael; Schmieder, Roland E; Titze, Jens M; Eckardt, Kai-Uwe


    The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using (23)sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, Pskin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients. Copyright © 2017 by the American Society of Nephrology.

  9. CKD-EPI方程估算肾小球滤过率的评价%Assessment of CKD-EPI equation for estimating glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    王宏斌; 夏先考; 吴建华


    Objective To compare the applicability of CKD-EPI equation with MDRD equation in predicting glomerular filtration rate(GFR)in patients with chronic kidney disease(CKD) and healthy controls, and the relative risk factor of the decrease of GFR was analyzed by CKD-EPI equation. Methods GFR of 91 cases of hospitalized patients with CKD and 198 cases of healthy controls were estimated by CKD-FPI and MDRD equation respectively[denoted as GFR( CKD-EPI) and GFR( MDRD) ]. Correlation and consistency between GFR (CKD-FPI) and GFR ( MDRD) were analyzed by Person correlation analysis and Bland-Altman analytic process. CKD stage of subj ects was assessed according to GFR( MDRD) . Scr, GFR( MDRD) and GFR(CKDEPI) of each stage were compared. Correlation between GFR(CKD-FPI) and other items were also analyzed. Results There was no significant difference of age,Scr,GFR(MDRD)and GFR(CKDEPI) between male an female group(P<O. 05). There was fine correlation between GFR ( MDRD) and GFR( CKD-FPI) [GFR( MDRD) = 0. 944×GFR( CKD-FPI) +0. 612 , r2 = 0. 960 ( P<O. 001) ]. BlandAltman analytic process indicated that there was fine consistency between GFR( MDRD) and GFR(CKD-EPI). All subjects were classified into 5 CKD stages according to GFR(MDRD). Compared with GFR( MDRD) ,.mean of GFR(CKD-EPI) in CKD Ⅰ、 Ⅱ、Ⅲ stage increased 0. 15,7. 34 and l. 60 mL. min-1 . (1. 73 m2 )-1 respectively, mean of GFR(CKD-FPI) in CKD Ⅳ、Ⅴ stage decreased 0. 25 and 0. 41 mL. min-1 ( 1. 73 m2) -1 respectively. GFR ( CKD-EPI) was negatively correlative to age , systolic blood pressure ( SBP) , diastolic blood pressure( DBP) ,serum creatinine( Scr) , serum uric acid( SUA) , fasting blood glucose( FBG) , urine protein( UP) and urine protein-to-creatinine ratio( UP/Ucr) , was positively correlative to total cholesterol( TC) and urine uric acid ( P<O. 05) , but was not correlative to gender and triglyceride(P>O. 05). Conclusion The application of CKD-FPI equation to estimate GFR could reduce

  10. The Effects of Exercise Education Intervention on the Exercise Behaviour, Depression, and Fatigue Status of Chronic Kidney Disease Patients (United States)

    Kao, Yu-Hsiu; Huang, Yi-Ching; Chen, Pei-Ying; Wang, Kuo-Ming


    Purpose: The purpose of this paper is to investigate the effects of an exercise education intervention on exercise behavior, depression and fatigue status of chronic kidney disease (CKD) patients. Design/methodology/approach: This was a pilot study using an exercise education program as an intervention for CKD patients. The authors used the…

  11. Historical and paleo-tsunami deposits on Kamchatka, Russia: long-term chronologies and long-distance correlations

    Directory of Open Access Journals (Sweden)

    T. K. Pinegina


    Full Text Available Along the eastern coast of Kamchatka, at a number of localities, we have identified and attempted to assign ages to deposits of both historic and prehistoric (paleo- tsunamis. These deposits are dated and correlated using tephrochronology from Holocene marker tephra and local volcanic ash layers. Because the historical record of earthquakes and tsunamis on Kamchatka is so short, these investigations can make important contributions to evaluating tsunami hazards. Moreover, because even the historical record is spotty, our work helps add to and evaluate tsunami catalogues for Kamchatka. Furthermore, tsunami deposits provide a proxy record for large earthquakes and thus are important paleoseismological tools. The combined, preserved record of tsunami deposits and of numerous marker tephra on Kamchatka offers an unprecedented opportunity to study tsunami frequency. Using combined stratigraphic sections, we can examine both the average frequency of events for each locality, and also changes in frequency through time. Moreover, using key marker tephra as time lines, we can compare tsunami frequency and intensity records along the Kamchatka subduction zone. Preliminary results suggest real variations in frequency on a millennial time scale, with the period from about 0 to 1000 A.D. being particularly active at some localities.

  12. [Kidney and bone update : the 5-year history and future of CKD-MBD. Disorders of musculoskeletal system in CKD ; bone fracture and periarticular calcification]. (United States)

    Yamada, Shunsuke; Taniguchi, Masatomo


    Chronic kidney disease-mineral and bone disorder (CKD-MBD) affects life expectancy through vascular calcification, and impairs patient's activity of daily living (ADL) and quality of life (QOL) through bone fracture and periarticular calcification. In CKD patients, vitamin D deficiency and secondary hyperparathyroidism impairs bone strength, and muscle dysfunction related to vitamin D deficiency also causes easy fall, leading to the high risk of bone fracture. Bone fracture not only aggravates ADL and QOL but increases the risk of mortality. Periarticular calcification such as tumoral calcinosis in relation to CKD-MBD causes restricted range of articular motion, leading to the deterioration of patient's ADL and QOL. Because bone fragility and tumoral calcinosis occurs in relation to CKD-MBD, the appropriate management of CKD-MBD is madatory.

  13. Chronic Kidney Disease Japan Cohort (CKD-JAC) study: design and methods. (United States)

    Imai, Enyu; Matsuo, Seiichi; Makino, Hirofumi; Watanabe, Tsuyoshi; Akizawa, Tadao; Nitta, Kosaku; Iimuro, Satoshi; Ohashi, Yasuo; Hishida, Akira


    The prevalence and incidence of end-stage renal disease (ESRD) in Japan are the highest and the third highest, respectively, in the world, while the incidence of cardiac death in Japan is the lowest among developed countries. A recent study showed that the prevalence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m(2), is extremely high in Japan, about 20% of the adult population. However, the risk of ESRD and cardiovascular disease (CVD) in the CKD population has not been determined nationwide. For this observational study, we will establish a Chronic Kidney Disease Japan Cohort (CKD-JAC) by enrolling 3,000 patients with CKD in 17 clinical centers around Japan, which will be used to determine the incidence of ESRD and CVD in Japanese CKD patients. Risk factors associated with the development of CVD will also be examined. Comorbidity of diabetes in CKD patients will be analyzed to determine whether it is a risk for rapid progression of CKD and high incidence of CVD. In addition, we will study whether the burden of CKD decreases the QOL of patients, and increases hospitalization or health resource utilization. Insights from the CKD-JAC study will provide a basis for future interventional trials focused on reducing the burden of ESRD and CVD in patients with CKD in Japan.

  14. Homocysteine and C-Reactive Protein as Useful Surrogate Markers for Evaluating CKD Risk in Adults

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    Chung-Hsun Chuang


    Full Text Available Background/Aims: This study aimed to evaluate the effectiveness of homocysteine and C-reactive protein (CRP as potential markers for chronic kidney disease (CKD in adults in Taiwan, and to identify associations between these factors and CKD, stratifying by gender. Methods: This cross-sectional study analyzed multi-center data retrospectively. Data were collected from 22,043 adult Taiwanese at Chang-Gung Memorial Hospital from 2005 to 2011. Smoking/drinking history, personal medical/medication history, pregnancy, fasting times as well as laboratory parameters, including homocysteine and CRP were measured and analyzed. Results: Significant differences were observed between four homocysteine and CRP quartiles in eGFR and CKD. For males, only one model showed significant associations between plasma homocysteine and CKD, while in females, all three models showed significant associations with CKD. On the contrary, the gender difference in the case of CRP was opposite. Combined homocysteine and CRP were associated with CKD in males but not in females. Conclusion: Among Taiwanese adults, plasma homocysteine is associated with CKD in females and plasma hsCRP is associated with CKD in males. High hsCRP/high homocysteine is associated with elevated CKD risk in male. Our results suggest that homocysteine and hsCRP may be useful surrogate markers for evaluating CKD risk in adults.

  15. The chronic kidney disease - Mineral bone disorder (CKD-MBD): Advances in pathophysiology. (United States)

    Hruska, Keith A; Sugatani, Toshifumi; Agapova, Olga; Fang, Yifu


    The causes of excess cardiovascular mortality associated with chronic kidney disease (CKD) have been attributed in part to the CKD-mineral bone disorder syndrome (CKD-MBD), wherein, novel cardiovascular risk factors have been identified. New advances in the causes of the CKD-MBD are discussed in this review. They demonstrate that repair and disease processes in the kidneys release factors to the circulation that cause the systemic complications of CKD. The discovery of WNT inhibitors, especially Dickkopf 1 (Dkk1), produced during renal repair as participating in the pathogenesis of the vascular and skeletal components of the CKD-MBD implied that additional pathogenic factors are critical. This lead to the discovery that activin A is a second renal repair factor circulating in increased levels during CKD. Activin A derives from peritubular myofibroblasts of diseased kidneys, wherein it stimulates fibrosis, and decreases tubular klotho expression. Activin A binds to the type 2 activin A receptor, ActRIIA, which is variably affected by CKD in the vasculature. In diabetic/atherosclerotic aortas, specifically in vascular smooth muscle cells (VSMC), ActRIIA signaling is inhibited and contributes to CKD induced VSMC dedifferentiation, osteogenic transition and neointimal atherosclerotic calcification. In nondiabetic/nonatherosclerotic aortas, CKD increases VSMC ActRIIA signaling, and vascular fibroblast signaling causing the latter to undergo osteogenic transition and stimulate vascular calcification. In both vascular situations, a ligand trap for ActRIIA prevented vascular calcification. In the skeleton, activin A is responsible for CKD stimulation of osteoclastogenesis and bone remodeling increasing bone turnover. These studies demonstrate that circulating renal repair and injury factors are causal of the CKD-MBD and CKD associated cardiovascular disease.

  16. CKD hotspots around the world: where, why and what the lessons are. A CKJ review series. (United States)

    Martín-Cleary, Catalina; Ortiz, Alberto


    Chronic kidney disease (CKD) is one of the three causes of death that has had the highest increase in the last 20 years. The increasing CKD burden occurs in the context of lack of access of most of the world population to adequate healthcare and an incomplete understanding of the pathogenesis of CKD. However, CKD is not homogeneously distributed. CKD hotspots are defined as countries, region, communities or ethnicities with higher than average incidence of CKD. Analysis of CKD hotspots has the potential to provide valuable insights into the pathogenesis of kidney disease and to improve the life expectancy of the affected communities. Examples include ethnicities such as African Americans in the USA or Aboriginals in Australia, regions such as certain Balkan valleys or Central America and even groups of people sharing common activities or interests such as young women trying to lose weight in Belgium. The study of these CKD hotspots has identified underlying genetic factors, such as ApoL1 gene variants, environmental toxins, such as aristolochic acid and socioeconomic factors leading to nutritional deprivation and inflammation/infection. The CKD hotspots series of CKJ reviews will explore the epidemiology and causes in CKD hotspots, beginning with Australian Aboriginals in this issue. An online map of CKD hotspots around the world will feature the reviewed hotspots, highlighting known or suspected causes as well as ongoing projects to unravel the cause and providing a directory of public health officials, physicians and basic scientists involved in these efforts. Since the high prevalence of CKD in a particular region or population may only be known to local physicians, we encourage readers to propose further CKD hotspots to be reviewed.

  17. Comparison of seismotomographic and thermogravitational models with distribution of the seismotectonic deformation orientations for Kamchatka region (United States)

    Bushenkova, Natalia; Kuchay, Olga; Chervov, Victor; Koulakov, Ivan


    In this study we reveal the relationships between the structure of the lithosphere, the distribution of convective flows in the upper mantle and the character of seismotectonic deformations (STD) that is especially important for regions of active continental margins. We present a comprehensive analysis of seismotomographic and thermogravitational models together with the distribution of the STD principal axes orientations for the Kamchatka region, where crustal displacements are accompanied with seismic and volcanic activity. Our previous results have shown that: the variations of the lithosphere thickness significantly affect the structure of convective flows in the upper mantle [Chervov, Chernykh, 2014]; the pattern of these flows, in turn, correlate with the distribution and the orientations of STD principal axes (for the Altai-Sayan region with surrounding areas [Bushenkova, at al., 2014]). Based on the upper mantle seismic tomography model beneath Kamchatka and adjacent regions by Koulakov et al. (2011) and taking into account the variations of the lithosphere structure, we have calculated a numerical 3D model of thermal convection in the upper mantle. Also, we have estimated the distribution of orientations of the STD principal axes. We used the focal mechanisms of 511 earthquakes occurred in the period of 1976-2015 [] in the Kamchatka region. These focal mechanisms were transformed to the 3D STD distributions based on the Riznichenko's method (1985). In this case, the STD was determined as an average seismic moment tensor of all earthquakes in a unit volume for the selected time. We found that the STD principal axes distribution is inherited for different depth layers along the entire eastern coast of Kamchatka. Abrupt changes in the orientation of the principal axes of elongation and shortening, and a change of the direction of their dipping are observed in area zone of 53.0- 54.50 N. This zone coincides with an

  18. Integrative biology identifies shared transcriptional networks in CKD. (United States)

    Martini, Sebastian; Nair, Viji; Keller, Benjamin J; Eichinger, Felix; Hawkins, Jennifer J; Randolph, Ann; Böger, Carsten A; Gadegbeku, Crystal A; Fox, Caroline S; Cohen, Clemens D; Kretzler, Matthias


    A previous meta-analysis of genome-wide association data by the Cohorts for Heart and Aging Research in Genomic Epidemiology and CKDGen consortia identified 16 loci associated with eGFR. To define how each of these single-nucleotide polymorphisms (SNPs) could affect renal function, we integrated GFR-associated loci with regulatory pathways, producing a molecular map of CKD. In kidney biopsy specimens from 157 European subjects representing nine different CKDs, renal transcript levels for 18 genes in proximity to the SNPs significantly correlated with GFR. These 18 genes were mapped into their biologic context by testing coregulated transcripts for enriched pathways. A network of 97 pathways linked by shared genes was constructed and characterized. Of these pathways, 56 pathways were reported previously to be associated with CKD; 41 pathways without prior association with CKD were ranked on the basis of the number of candidate genes connected to the respective pathways. All pathways aggregated into a network of two main clusters comprising inflammation- and metabolism-related pathways, with the NRF2-mediated oxidative stress response pathway serving as the hub between the two clusters. In all, 78 pathways and 95% of the connections among those pathways were verified in an independent North American biopsy cohort. Disease-specific analyses showed that most pathways are shared between sets of three diseases, with closest interconnection between lupus nephritis, IgA nephritis, and diabetic nephropathy. Taken together, the network integrates candidate genes from genome-wide association studies into their functional context, revealing interactions and defining established and novel biologic mechanisms of renal impairment in renal diseases.

  19. Medication Adherence and Growth in Children with CKD (United States)

    Schneider, Michael F.; Mulqueen, Lucy; Brooks, Ellen R.; Langman, Craig B.; Greenbaum, Larry A.; Furth, Susan L.; Moxey-Mims, Marva; Warady, Bradley A.; Kaskel, Frederick J.; Skversky, Amy L.


    Background and objectives Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD. Design, setting, participants, & measurements The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age- and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations. Results Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height≤3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score. Conclusions Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and

  20. Volcanic-glacial interactions: GIS applications to the assessment of lahar hazards (case study of Kamchatka)



    On the Kamchatka peninsula, lahars or volcanogenic mudflows arise as a result of intensive snow melting caused by incandescent material ejected by volcanoes onto the surface. Such flows carrying volcanic ash and cinders together with lava fragments and blocks move with a speed up to 70 km/h that can result in significant destructions and even human victims. Formation of such water flows is possible during the whole year.Large-scale GIS «Hazards of lahars (volcanogenic mudflows)» has been deve...

  1. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides (United States)

    Schanstra, Joost P.; Alkhalaf, Alaa; Argiles, Angel; Bakker, Stephan J.L.; Beige, Joachim; Bilo, Henk J.G.; Chatzikyrkou, Christos; Dakna, Mohammed; Dawson, Jesse; Delles, Christian; Haller, Hermann; Haubitz, Marion; Husi, Holger; Jankowski, Joachim; Jerums, George; Kleefstra, Nanne; Kuznetsova, Tatiana; Maahs, David M.; Menne, Jan; Mullen, William; Ortiz, Alberto; Persson, Frederik; Rossing, Peter; Ruggenenti, Piero; Rychlik, Ivan; Serra, Andreas L.; Siwy, Justyna; Snell-Bergeon, Janet; Spasovski, Goce; Staessen, Jan A.; Vlahou, Antonia; Mischak, Harald; Vanholder, Raymond


    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individuals, including 522 with follow-up data, using proteome analysis. We validated that a previously established multipeptide urinary biomarker classifier performed significantly better in detecting and predicting progression of CKD than the current clinical standard, urinary albumin. The classifier was also more sensitive for identifying patients with rapidly progressing CKD. Compared with the combination of baseline eGFR and albuminuria (area under the curve [AUC]=0.758), the addition of the multipeptide biomarker classifier significantly improved CKD risk prediction (AUC=0.831) as assessed by the net reclassification index (0.303±−0.065; P<0.001) and integrated discrimination improvement (0.058±0.014; P<0.001). Correlation of individual urinary peptides with CKD stage and progression showed that the peptides that associated with CKD, irrespective of CKD stage or CKD progression, were either fragments of the major circulating proteins, suggesting failure of the glomerular filtration barrier sieving properties, or different collagen fragments, suggesting accumulation of intrarenal extracellular matrix. Furthermore, protein fragments associated with progression of CKD originated mostly from proteins related to inflammation and tissue repair. Results of this study suggest that urinary proteome analysis might significantly improve the current state of the art of CKD detection and outcome prediction and that identification of the urinary peptides allows insight into various ongoing pathophysiologic processes in CKD. PMID:25589610

  2. Assessing physical function and physical activity in patients with CKD. (United States)

    Painter, Patricia; Marcus, Robin L


    Patients with CKD are characterized by low levels of physical functioning, which, along with low physical activity, predict poor outcomes in those treated with dialysis. The hallmark of clinical care in geriatric practice and geriatric research is the orientation to and assessment of physical function and functional limitations. Although there is increasing interest in physical function and physical activity in patients with CKD, the nephrology field has not focused on this aspect of care. This paper provides an in-depth review of the measurement of physical function and physical activity. It focuses on physiologic impairments and physical performance limitations (impaired mobility and functional limitations). The review is based on established frameworks of physical impairment and functional limitations that have guided research in physical function in the aging population. Definitions and measures for physiologic impairments, physical performance limitations, self-reported function, and physical activity are presented. On the basis of the information presented, recommendations for incorporating routine assessment of physical function and encouragement for physical activity in clinical care are provided.

  3. Genetic variation among major sockeye salmon populations in Kamchatka peninsula inferred from SNP and microsatellite DNA analyses

    DEFF Research Database (Denmark)

    Khrustaleva, A.M.; Limborg, Morten; Seeb, J. E.

    of the two northern Kamchatka rivers (Palana River and Pakhacha River) differed significantly from the other populations studied. We estimated the efficiency for both types of markers for individual assignment of fish taken in mixtures. Accuracy was generally higher for assignment with SNP data; however...

  4. Positive geothermal anomalies in oceanic crust of Cretaceous age offshore Kamchatka

    Directory of Open Access Journals (Sweden)

    G. Delisle


    Full Text Available Heat flow measurements were carried out in 2009 offshore Kamchatka during the German-Russian joint-expedition KALMAR. An area with elevated heat flow in oceanic crust of Cretaceous age – detected ~30 yr ago in the course of several Russian heat flow surveys – was revisited. One previous interpretation postulated anomalous lithospheric conditions or a connection between a postulated mantle plume at great depth (>200 km as the source for the observed high heat flow. However, the positive heat flow anomaly – as our bathymetric data show – is closely associated with the fragmentation of the western flank of the Meiji Seamount into a horst and graben structure initiated during descent of the oceanic crust into the subduction zone offshore Kamchatka. This paper offers an alternative interpretation, which connects high heat flow primarily with natural convection of fluids in the fragmented rock mass and, as a potential additional factor, high rates of erosion, for which evidence is available from our collected bathymetric image. Given high erosion rates, warm rock material at depth rises to nearer the sea floor, where it cools and causes temporary elevated heat flow.

  5. Oceanic, island arc, and back-arc remnants into eastern Kamchatka accretionary complexes

    Energy Technology Data Exchange (ETDEWEB)

    Fedorchuk, A.V.; Vishnevskaya, V.S.; Izvekov, I.N. (Institute of the Lithosphere, Moscow (USSR))


    The Kamchatsky Mts. accretionary complex in the Eastern Kamchatka orogenic belt was studied for identification of the oceanic and suprasubduction components into accretionary wedges. That complex is divided into two tectonic units. The Lower unit is formed sedimentary and tectonic melanges containing arc-related components (Late Senonian volcaniclastics and boninitic gabbro) and oceanic fragments (Fe-Ti-tholeiites, ocean island basalts, and pelagic sediments of Valanginian to Turonian age). The Upper unit consists of ductile deformed oceanic cumulates from troctolites to Fe-Ti-gabbro, 151 to 172 Ma, which are intruded MORB-like diabases with suprasubduction characteristics, 122 to 141 Ma, and are overlain by basalts similar to latter. The Lower and Upper units are separated by a SW-dipping thrust, which is related by an ophiolitoclastic olistostrome of Late Campanian to Early Maestrichtian age. Both units are covered by Paleocene authoclastic deposits. They are all thrusted over the early Neogene island arc complex, 16 to 20 Ma. The Lower unit of the Kamchatsky Mys accretionary complex was originated in a shear zone between a Late Cretaceous island arc and an Early Cretaceous oceanic plate. The Upper unit represents a Jurassic oceanic remnant that formed a basement of Early Cretaceous back-arc or fore-arc basin. Both units were superposed in the latest Cretaceous. The Kamchatsky Mys accretionary complex was emplaced into the Eastern Kamchatka orogenic belt during late Neogene by collision of the early Neogene island arc.

  6. Multiproxy records of climate variability for Kamchatka for the past 400 years

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    O. Solomina


    Full Text Available Tree rings, ice cores and glacial geologic histories for the past several centuries offer an opportunity to characterize climate variability and to identify the key climate parameters forcing glacier expansions. A newly developed larch ring-width chronology is presented for Kamchatka that is sensitive to past summer temperature variability. This record provides the basis to compare with other proxy records of inferred temperature and precipitation change from ice core and glacier records, and to characterize climate for the region over the past 400 years. Individual low growth years in the larch record are associated with several known and proposed volcanic events that have been observed in other proxy records from the Northern Hemisphere. Comparison of the tree-rings with an ice core record of melt feature index for Kamchatka's Ushkovsky volcano confirms a 1–3 year dating accuracy for this ice core series over the late 18th to 20th centuries. Decadal variations of low summer temperatures (tree-ring record and high annual precipitation (ice core record are broadly consistent with intervals of positive mass balance measured and estimated at several glaciers, and with moraine building, provides a basis to interpret geologic glacier records.

  7. Comparative estimates of Kamchatka territory development in the context of northern territories of foreign countries

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    Andrey Gennadyevich Shelomentsev


    Full Text Available The article promotes an approach to assess the prospects of regional development on the basis of the synthesis of comparative and historical methods of research. According to the authors, the comparative analysis of the similar functioning of the socio-economic systems forms deeper understanding what part factors and methods of state regulation play in regional development, and also their place in socio-economic and geopolitical space. The object of the research is Kamchatka territory as the region playing strategically important role in socio-economic development of Russia and also northern territories of the other countries comparable with Kamchatka on the bass if environmental conditions such as Iceland, Greenland, USA (Alaska, Canada (Yukon, and Japan (Hokkaido. On the basis of allocation of the general signs of regional socio-economic systems and creation of the regional development models forming the basis for comparative estimates, the article analyses the territories, which are comparable on the base of climatic, geographic, economic, geopolitical conditions, but thus significantly different due to the level of economic familiarity. The generalization of the extensive statistical material characterizing various spheres of activity at these territories, including branch structure of the economy, its infrastructure security, demographic situation, the budgetary and financial sphere are given. It allows defining the crucial features of the regional economy development models. In the conclusion, the authors emphasize that ignoring of the essential relations among the regional system elements and internal and external factors deprives a research of historical and socio-economic basis.


    Directory of Open Access Journals (Sweden)

    Anna Zavadskaya


    Full Text Available The paper describes assessment and monitoring program which has been designed and initiated for monitoring recreational impacts in some wildernesses areas of Kamchatka. The framework of the recreational assessment was tested through its application in a case study conducted during the summer 2008 in the Kronotsky State Natural Biosphere Preserve (the Kamchatka peninsula, Russia. The overall objective of the case study was to assess the existing campsite and trail recreation impacts and to establish a network of key sites for the subsequent long-term impact monitoring. The detailed assessment of different components of natural complexes of the Kronotsky State Natural Preserve and the obtained maps of their ecological conditions showed that some sites had been highly disturbed. The results of these works have given rise to a concern that the intensive use of these areas would make an unacceptable impact on the nature. Findings of our initial work corroborate the importance of founding wilderness management programs on knowledge about the trail and campsite impacts and emphasize the necessity of adopting the recreational assessment and monitoring framework to the practice of decision-making.

  9. Geophysical Observatory in Kamchatka region for monitoring of phenomena connected with seismic activity

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    S. Uyeda


    Full Text Available Regular monitoring of some geophysical parameters in association with seismicity has been carried out since last year at the Japan-Russian Complex Geophysical Observatory in the Kamchatka region. This observatory was organized in connection with the ISTC project in Russia and was motivated by the results of the FRONTIER/RIKEN and FRONTIER/NASDA research projects in Japan. The main purpose of the observations is to investigate the electromagnetic and acoustic phenomena induced by the lithosphere processes (especially by seismic activity. The seismicity of the Kamchatka area is analyzed and a description of the observatory equipment is presented. At present, the activity of the observatory includes the seismic (frequency range ∆F = 0.5 – 40 Hz and meteorological recordings, together with seismo-acoustic (∆F = 30 – 1000 Hz and electromagnetic observations: three-component magnetic ULF variations ( ∆F = 0.003 – 30 Hz, three-component electric potential variations ( ∆F 1.0 Hz, and VLF transmitter’s signal perturbations ( ∆F ~ 10 – 40 kHz.

  10. Occurrence and genetic typing of infectious hematopoietic necrosis virus in Kamchatka, Russia. (United States)

    Rudakova, Svetlana L; Kurath, Gael; Bochkova, Elena V


    Infectious hematopoietic necrosis virus (IHNV) is a well known rhabdoviral pathogen of salmonid fish in North America that has become established in Asia and Europe. On the Pacific coast of Russia, IHNV was first detected in hatchery sockeye from the Kamchatka Peninsula in 2001. Results of virological examinations of over 10,000 wild and cultured salmonid fish from Kamchatka during 1996 to 2005 revealed IHNV in several sockeye salmon Oncorhynchus nerka populations. The virus was isolated from spawning adults and from juveniles undergoing epidemics in both hatchery and wild sockeye populations from the Bolshaya watershed. No virus was detected in 2 other watersheds, or in species other than sockeye salmon. Genetic typing of 8 virus isolates by sequence analysis of partial glycoprotein and nucleocapsid genes revealed that they were genetically homogeneous and fell within the U genogroup of IHNV. In phylogenetic analyses, the Russian IHNV sequences were indistinguishable from the sequences of North American U genogroup isolates that occur throughout Alaska, British Columbia, Washington, and Oregon. The high similarity, and in some cases identity, between Russian and North American IHNV isolates suggests virus transmission or exposure to a common viral reservoir in the North Pacific Ocean.

  11. Older Patients' Perspectives on Managing Complexity in CKD Self-Management. (United States)

    Bowling, C Barrett; Vandenberg, Ann E; Phillips, Lawrence S; McClellan, William M; Johnson, Theodore M; Echt, Katharina V


    Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens. We conducted an exploratory qualitative study designed to understand the relationship among factors facilitating or impeding CKD self-management in older adults. Six focus groups (n=30) were held in August and September of 2014 with veterans≥70 years old with moderate-to-severe CKD receiving nephrology care at the Atlanta Veterans Affairs Medical Center. Grounded theory with a constant comparative method was used to collect, code, and analyze data. Participants had a mean age (range) of 75.1 (70.1-90.7) years, 60% were black, and 96.7% were men. The central organizing concept that emerged from these data were managing complexity. Participants typically did not have just one chronic condition, CKD, but a number of commonly co-occurring conditions. Recommendations for CKD self-management therefore occurred within a complex regimen of recommendations for managing other diseases. Participants identified overtly discordant treatment recommendations across chronic conditions (e.g., arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity (e.g., focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens (e.g., protein restriction for both gout and CKD). Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be

  12. The influence of volcanic activity on suspended sediment yield of rivers (Kamchatka, Russia) (United States)

    Kuksina, Ludmila


    Kamchatka is specific region of suspended sediment yield formation. This fact is particularly connected with active volcanism in the territory. The influence of volcanism on suspended sediment yield characteristics was studied in various time scales - into-diurnal, seasonal and long-term ones. The study of spatial variability of these characteristics reveals the maximum values characterize river basins in zones of strong impact of volcanic eruptions, especially, rivers draining slopes and flanks of active volcanoes. Into-diurnal fluctuations were studied for rivers in volcanic areas. They are characterized by synchronous changes of water flow and turbidity. It's determined by weak erosion-preventive capacity of friable volcanic deposits and big slopes of channels (2.5 - 6.0 %). The maximum of water flow and turbidity is observed at the period between 12 and 6 pm. The air temperature reaches its maximum by that time, and consequently, the intensity of snow melting is also maximum one. The maximum of turbidity advances diurnal maximum of water flow a little, and it's connected with the features of flood wave moving and consecutive maximums of slopes, turbidity, velocity, water flow, and capacity of stream during flush. Into-diurnal fluctuations are determined by complicated and little-studied processes of mass transfer between stream and channel deposits. These processes are connected with into-diurnal changes of stream capacity and water transfer between channel and underflow. As the result water regime is pulsating. Rivers under the influence of volcanic eruptions transport the main amount of sediments during floods which usually occur in summer-autumn period (in the absence of extreme floods in winter-spring period during volcanic eruptions). Combination of maximum snow supply, significant precipitation in warm part of the year and weak erosion-preventive capacity of friable volcanic deposits on volcanoes slopes is the reason of the most intense erosion in this

  13. The role of bone in CKD-mediated mineral and vascular disease. (United States)

    Khouzam, Nadine M; Wesseling-Perry, Katherine; Salusky, Isidro B


    Cardiovascular disease is the leading cause of death in pediatric patients with chronic kidney disease (CKD), and vascular calcifications start early in the course of CKD. Based on the growing body of evidence that alterations of bone and mineral metabolism and the therapies designed to treat the skeletal consequences of CKD are linked to cardiovascular calcifications, the Kidney Disease, Improving Global Outcomes (KDIGO) working group redefined renal osteodystrophy as a systemic disorder of mineral and bone metabolism due to CKD, and this newly defined disorder is now known as "chronic kidney disease-mineral bone disorder (CKD-MBD)". Elevated fibroblast growth factor 23 (FGF23), a bone-derived protein, is the first biochemical abnormality to be associated with CKD-MBD, and high FGF23 levels correlate with increased cardiovascular morbidity and mortality, suggesting that bone is central to both initiating and perpetuating the abnormal mineral metabolism and vascular disease in CKD. The current standard therapies for CKD-MBD affect FGF23 levels differently; non-calcium-based binders with or without concurrent use of dietary phosphate restriction reduce FGF23 levels, while calcium-based binders seem to either increase or have no effect on FGF23 levels. Active vitamin D sterols increase FGF23 levels, whereas therapy with calcimimetics decreases FGF23 levels. Thus, the appropriate therapy that will minimize the rise in FGF23 and prevent cardiovascular morbidity remains to be defined.

  14. Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study. (United States)

    Vest, Bonnie M; York, Trevor R M; Sand, Jessica; Fox, Chester H; Kahn, Linda S


    Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. © Copyright 2015 by the American Board of Family Medicine.

  15. The lingering dilemma of arterial pressure in CKD : what do we know, where do we go?

    NARCIS (Netherlands)

    Agarwal, Rajiv; Martinez-Castelao, Alberto; Wiecek, Andrzej; Massy, Ziad; Suleymanlar, Gultekin; Ortiz, Alberto; Blankestijn, Peter J.; Covic, Adrian; Dekker, Friedo W.; Jager, Kitty J.; Lindholm, Bengt; Goldsmith, David; Fliser, Danilo; London, Gerard; Zoccali, Carmine


    Despite many advances in the management of hypertensive chronic kidney disease (CKD) patients, both on and off dialysis, there exist several gaps in our knowledge. Although the modern techniques to measure blood pressure (BP) indirectly have been available for a long time, among those with CKD, how

  16. Systematic review of structural and functional neuroimaging findings in children and adults with CKD. (United States)

    Moodalbail, Divya G; Reiser, Kathryn A; Detre, John A; Schultz, Robert T; Herrington, John D; Davatzikos, Christos; Doshi, Jimit J; Erus, Guray; Liu, Hua-Shan; Radcliffe, Jerilynn; Furth, Susan L; Hooper, Stephen R


    CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.

  17. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides

    NARCIS (Netherlands)

    Schanstra, Joost P.; Zuerbig, Petra; Alkhalaf, Alaa; Argiles, Angel; Bakker, Stephan J. L.; Beige, Joachim; Bilo, Henk J. G.; Chatzikyrkou, Christos; Dakna, Mohammed; Dawson, Jesse; Delles, Christian; Haller, Hermann; Haubitz, Marion; Husi, Holger; Jankowski, Joachim; Jerums, George; Kleefstra, Nanne; Kuznetsova, Tatiana; Maahs, David M.; Menne, Jan; Mullen, William; Ortiz, Alberto; Persson, Frederik; Rossing, Peter; Ruggenenti, Piero; Rychlik, Ivan; Serra, Andreas L.; Siwy, Justyna; Snell-Bergeon, Janet; Spasovski, Goce; Staessen, Jan A.; Vlahou, Antonia; Mischak, Harald; Vanholder, Raymond


    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individu

  18. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides

    DEFF Research Database (Denmark)

    Schanstra, Joost P; Zürbig, Petra; Alkhalaf, Alaa


    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 indiv...

  19. Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers. (United States)

    Tuot, Delphine S; Boulware, L Ebony


    CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education.

  20. Volcanic-glacial interactions: GIS applications to the assessment of lahar hazards (case study of Kamchatka

    Directory of Open Access Journals (Sweden)

    Ya. D. Muraviev


    Full Text Available On the Kamchatka peninsula, lahars or volcanogenic mudflows arise as a result of intensive snow melting caused by incandescent material ejected by volcanoes onto the surface. Such flows carrying volcanic ash and cinders together with lava fragments and blocks move with a speed up to 70 km/h that can result in significant destructions and even human victims. Formation of such water flows is possible during the whole year.Large-scale GIS «Hazards of lahars (volcanogenic mudflows» has been developed for some volcano group as well as for individual volcanoes on the peninsula in framework of the GIS «Volcanic hazard of the Kuril-Kamchatka island arc». Main components of this database are the following: physic-geographical information on region of active volcanism and adjacent areas, on human settlements; data on the mudflow activity; data on distribution of the snow and ice reserves. This database is aimed at mapping of surrounding territories and estimating a hazard of lahars.For illustration the paper presents a map of the lahar hazards, results of calculations of the distances of ejects and maximal area of ejected material spreading in dependence on a character and power of an eruption. In future we plan to perform operational calculations of maximal possible volumes of such flows and areas of their spreading. The calculations will be made on the basis of the GIS «Volcanic hazard of the Kuril-Kamchatka island arc».A volume of hard material carried by lahars onto slopes and down to foot of the Kluchevskaya volcanic massif is estimated on the basis of data on the snow and ice reserves on volcano slopes. On the average for many years, the snow accumulation in zones of the mudflow formations their volume often reaches 15–17 millions of cubic meters. Depending on the snowfall activity in different years this value may vary within 50% relative to the norm. Further on, calculations of maximal possible volume of such flows will be performed in a

  1. Depression (Major Depressive Disorder) (United States)

    ... generally miserable or unhappy without really knowing why. Depression symptoms in children and teens Common signs and ... in normal activities, and avoidance of social interaction. Depression symptoms in older adults Depression is not a ...

  2. New insights into the abyssal sponge fauna of the Kurile-Kamchatka plain and Trench region (Northwest Pacific) (United States)

    Downey, Rachel V.; Janussen, Dorte


    The under-explored abyssal depths of the Kurile-Kamchatka region have been re-examined during the KuramBio (Kurile-Kamchatka Biodiversity Study) expedition. Combining new KuramBio data with previous expedition data in this region has enhanced our understanding abyssal sponge fauna, in particular, the patchiness, rarity, and exceptional richness of the Cladorhizidae family. In total, 14 sponge species, from 7 genera, in 5 families, within two classes (Demospongiae and Hexactinellida) were collected. Of the 14 species, 29% (4 spp.) have been found previously in this region, 36% (5 spp.) were new to the regional abyssal fauna, and 21% (3 spp.) were new to science. The number of abyssal species in this region has now been increased by 26% (8 spp.) and genera by nearly 15% (2 genera). Rarity is a prominent feature of this abyssal fauna, with more than half of species only found at one station, and 83% (19 spp.) of species found previously in this region were not re-found during KuramBio. Cladorhizid sponges dominate demosponge species and genera richness in the abyssal Kurile-Kamchatka region; accounting for 87% (20 spp.) of all demosponge species, and accounting for over 60% (5 genera) of all demosponge genera. Sponge richness in this region is potentially aided by the productivity of the ocean waters, the geological age of the Pacific Ocean, low population densities, and the varied topographic features (ridges, trenches, and seamounts) found in this region. Unusually, the dominance of demosponges in the Kurile-Kamchatka sponge faunal composition is not replicated in other well-sampled abyssal regions, which tend to be richer in deep-sea hexactinellid fauna. Broad depth, latitudinal and longitudinal ranges in Kurile-Kamchatka abyssal fauna are a key characteristic of this faunal assemblage. Strong abyssal faunal connectivity is found between the Kurile-Kamchatka region and North Pacific abyssal fauna, with weaker faunal connections found with the adjacent semi

  3. Cross-Correlation Earthquake Precursors in the Hydrogeochemical and Geoacoustic Signals for the Kamchatka Peninsula

    CERN Document Server

    Ryabinin, G V; Polyakov, Yu S; Timashev, S F


    We propose a new type of earthquake precursor based on the analysis of correlation dynamics between geophysical signals of different nature. The precursor is found using a two-parameter cross-correlation function introduced within the framework of flicker-noise spectroscopy, a general statistical physics approach to the analysis of time series. We consider an example of cross-correlation analysis for water salinity time series, an integral characteristic of the chemical composition of groundwater, and geoacoustic emissions recorded at the G-1 borehole on the Kamchatka peninsula in the time frame from 2001 to 2003, which is characterized by a sequence of three groups of significant seismic events. We found that cross-correlation precursors took place 27, 31, and 35 days ahead of the strongest earthquakes for each group of seismic events, respectively. At the same time, precursory anomalies in the signals themselves were observed only in the geoacoustic emissions for one group of earthquakes.

  4. June 03, 2007 Natural Disaster in the Valley of Geysers in Kamchatka (United States)

    Gordeev, E. I.; Pinegina, T. K.; Droznin, V. A.; Dvigalo, V. N.; Melekestsev, I. V.


    The famous Valley of Geysers along with active volcanoes appears to be a beautiful visiting card of Kamchatka. It is well known in Russia and other countries as the most popular tourist place. Annually it is visited by thousands of Russian and foreign tourists. The Valley of Geysers is the most potentially hazardous area in Kamchatka because of intense development of landslides, avalanches and frequent mudflows occurring within its boundaries. June 03, 2007 landslide, followed by a mudflow, resulted in a north - west faced horse-shoe amphitheater consisting of two adjacent circuses. The height of north-eastern sub-vertical wall is 150 m with a length 800 m; the length of a flatly inclined bottom 400 - 600 m. Initially estimated volume of collapse and avalanche made up 8-15 millions cubic meters. Avalanching and formation of a dam at the Geysernaya River caused completion of some geysers and open thermal water discharge at sites blocked off by the avalanche and a dammed lake. However beyond the boundaries of the avalanche and the lake, the geysers are still operating. It is likely that some geysers could be brought back if water level in the lake decreases. Possibly new geysers could appear. Based on results of routine survey we estimated specific areas that nowadays pose a hazard as well as a possibility of new avalanches and landslides that may occur in the future. Estimation and forecast of new avalanches and landslides require continuous observations to be performed in the Valley of Geysers to monitor deformation and seismic processes.

  5. Gold recycling and enrichment beneath volcanoes: A case study of Tolbachik, Kamchatka (United States)

    Zelenski, Michael; Kamenetsky, Vadim S.; Hedenquist, Jeffrey


    Magmas supply metals to hydrothermal ore deposits, although typical arc basalts may be unable to produce a gold-rich ore-forming fluid, as such basalts rarely exceed 5 ppb Au. Consistent with this, the occurrence of native gold of magmatic origin is extremely rare, and only a few finds of micron-sized gold particles in unaltered basalts have been documented. Surprisingly, some lava flows and scoria cones of the historic basaltic eruptions of Tolbachik volcano (Kamchatka) are unusually gold-rich. Tolbachik basalts contain up to 11.6 ppb Au based on whole rock analyses, nuggets of gold (electrum) up to 900 μm in size and native gold droplets up to 200 μm, plus numerous vapor-deposited gold crystals within fumarolic incrustations and directly on surfaces of basaltic lapilli. Our results demonstrate that the gold nuggets in Tolbachik basalt are of hydrothermal origin and were physically scavenged from epithermal veins hosted by country rocks during intrusion of mafic magmas. Depending on the melt temperature and/or time span of the melt-rock interaction, gold was ejected by the erupting volcano either in the form of abraded nuggets or liquid droplets, or was fully assimilated (dissolved) into the shallow long-lived magma chamber to provide a 4-fold increase in gold content over background concentration of 2.7 ppb Au, characteristic of mafic volcanic rocks in Kamchatka. Upon the end of the eruption, the continued discharge of volcanic vapors enriched in gold deposited abundant crystals of gold on cooling lava and scoria. Similar to Tolbachik, recycling of metals from prior accumulations (ore deposits) in the shallow crust may take place in other long-lived magma reservoirs, thus upgrading the gold and other metal contents and contributing to the ore-forming potential of a magma.

  6. Abnormal brain glucose metabolism and depressive mood in patients with pre-dialytic chronic kidney disease: SPM analysis of F-18 FDG positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jun, Sung Min; Song, Sang Heon; Kim, Seong Jang; Kim, Ji Hoon; Kwak, Ihm Soo; Kim, In Ju; Kim, Yong Ki [Pusan National University Hospital, Pusan (Korea, Republic of)


    The aim of this study was to investigate the relationship between depressive mood and pre-dialytic CKD, to localize and quantify depressive mood -related lesions in pre-dialytic CKD patients through statistical parametric mapping (SPM) analysis of brain positron emission tomography (PET), and to examine the usefulness of brain PET for early detection and proper treatment of depressive mood. Twenty one patients with stage 5 CKD and 22 healthy volunteers were analyzed by depressive mood assessment and statistical parametric mapping (SPM) analysis of 18F-FDG PET. Depressive mood assessment was done by Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS). The largest clusters were areas including precentral gyrus, prefrontal cortex, and anterior cingulated cortex of left hemisphere. Other clusters were left transverse temporal gyrus, left superior temporal gyrus, right prefrontal cortex, right dorsolateral prefrontal cortex (BA 46, 44), right inferior frontal gyrus, right inferior parietal lobule, left angular gyrus. In addition, correlation was found between hypometabolized areas and HDRS scores of CKD patients in right prefrontal cortex (BA 11) and right anterior cingulated gyrus (BA 24). In conclusion, this study demonstrated specific depressive mood-related abnormal metabolic lesion. Interestingly, in CKD patients with severe depressive mood, cerebral metabolism was similar to that of MDD.

  7. Filling the gap in CKD: The health care workforce and faculty development. (United States)

    Becker, Bryan N


    Given limited resources, adding another chronic illness to the panoply of chronic disease care is problematic. Nevertheless, chronic kidney disease (CKD) is increasing in recognition and prevalence across the world, and a management strategy for this growing population is necessary. A diverse group of health care professionals interacts with patients with CKD and their family members, including nurses, nurse practitioners, dieticians, social workers, pharmacists, physicians, physical therapists, physician assistants, and public health workers. All these individuals have the opportunity to reinforce CKD management. This potentially would bring a broader health care workforce to bear on CKD, reducing the impact of the nephrology workforce shortage. To realize such a strategy, it is necessary to bolster CKD awareness and knowledge in the diverse health care workforce. A faculty development program that extends CKD awareness to existing health care workers also has the possibility of migrating into the learner curriculum in health professional schools. This approach would expand CKD education, creating a skilled diverse health care workforce. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  8. The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation. (United States)

    Lin, Chiu-Chu; Wu, Chia-Chen; Anderson, Robert M; Chang, Chao-Sung; Chang, Shu-Chen; Hwang, Shang-Jyh; Chen, Hung-Chun


    Self-management has been associated with positive health outcomes among adults with chronic kidney disease (CKD). Perceived disease-related self-efficacy (DSE) is considered a critical component in the successful self-management of chronic disease. A valid and reliable instrument for measuring CKD patients' self-efficacy is needed. This study aims to develop and test a new instrument to measure the DSE of patients with early stage CKD. A total of 594 Taiwanese patients with early stage CKD recruited from two medical centers and one regional hospital in southern Taiwan completed the questionnaire. The CKD self-efficacy (CKD-SE) was evaluated using exploratory factor analyses (EFA) and measures of reliability. EFA identified four distinct factors with loadings ranging from 0.557 to 0.970: autonomy, self-integration, problem solving and seeking social support, accounting for 64.348% of the total variance. Cronbach's alpha coefficients for the subscales ranged from 0.843 to 0.901. This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE.

  9. Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD.

    Directory of Open Access Journals (Sweden)

    Carsten A Böger


    Full Text Available Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD and end stage renal disease (ESRD. Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR <60ml/min/1.73m(2 at follow-up and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls. SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1. SNPs in UMOD (OR = 0.92, p = 0.04 and GCKR (OR = 0.93, p = 0.03 were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.

  10. Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD.

    Directory of Open Access Journals (Sweden)

    Carsten A Böger


    Full Text Available Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD and end stage renal disease (ESRD. Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR <60ml/min/1.73m(2 at follow-up and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls. SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1. SNPs in UMOD (OR = 0.92, p = 0.04 and GCKR (OR = 0.93, p = 0.03 were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.

  11. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. (United States)

    Abdel-Kader, Khaled; Unruh, Mark L; Weisbord, Steven D


    While many patients with end-stage renal disease (ESRD) have impaired physical and psychologic well-being, less is known about these health domains in patients with advanced chronic kidney disease (CKD). The authors sought to compare symptoms, depression, and quality of life in patients with ESRD and those with CKD. Patients with ESRD and subjects with advanced CKD were enrolled. Patients' symptoms, depression, and quality of life were assessed using the Dialysis Symptom Index (DSI), Patient Health Questionnaire-9 (PHQ-9), and Short Form 36 (SF-36), respectively, and these health domains were compared between patient groups. Ninety patients with ESRD and 87 with CKD were enrolled. There were no differences in the overall number of symptoms or in the total DSI symptom-severity score. Median scores on the PHQ-9 were similar, as was the proportion of patients with PHQ-9 scores >9. SF-36 Physical Component Summary scores were comparable, as were SF-36 Mental Component Summary scores. The burden of symptoms, prevalence of depression, and low quality of life are comparable in patients with ESRD and advanced CKD. Given the widely recognized impairments in these domains in ESRD, findings of this study underscore the substantial decrements in the physical and psychologic well-being of patients with CKD.

  12. 2010 Volcanic activity in Alaska, Kamchatka, and the Kurile Islands: summary of events and response of the Alaska Volcano Observatory (United States)

    Neal, Christina A.; Herrick, Julie; Girina, O.A.; Chibisova, Marina; Rybin, Alexander; McGimsey, Robert G.; Dixon, Jim


    The Alaska Volcano Observatory (AVO) responded to eruptions, possible eruptions, volcanic unrest or suspected unrest at 12 volcanic centers in Alaska during 2010. The most notable volcanic activity consisted of intermittent ash emissions from long-active Cleveland volcano in the Aleutian Islands. AVO staff also participated in hazard communication regarding eruptions or unrest at seven volcanoes in Russia as part of an ongoing collaborative role in the Kamchatka and Sakhalin Volcanic Eruption Response Teams.

  13. Magmatic gas flux emissions from Gorelyi volcano, Kamchatka, and implications for volatile recycling in the NW Pacific (United States)

    Aiuppa, A.; Bagnato, E.; Calabrese, S.; Giudice, G.; Liuzzo, M.; Tamburello, G.; Allard, P.; Chaplygin, I.; Taran, Y.


    The Kamchatka peninsula, in the north-western part of the Pacific 'Ring of Fire', is one of the most active volcanic realms on Earth, with 29 historically erupting volcanoes along its ~700 km-long Eastern Volcanic Belt (EVB). This notwithstanding, volatile input and output fluxes along this arc sector have remained poorly characterised until very recently. We here report on the very first assessment of volatile flux emissions from Gorelyi, a large (25 km3, 1830 m high) and most active shield-like Holocene volcano located on the southern segment of the Kamchatka EVB. By combing results from a variety of in situ and remote sensing techniques (MultiGAS, filter packs, and UV camera), we determine the bulk plume molar concentrations of major (H2O 93.5%, CO2 2.6%, SO2 2.2%, HCl 1.1%, HF 0.3%, H2 0.2%) to trace-halogens (Br, I) and trace-element volatile species, and we estimate a total gas release of ~11,000 t/day from Gorelyi during ~900°C non-eruptive degassing. Using this observation, we derive new constraints on the abundances and origins of volatiles in the subduction-modified mantle source feeding magmatism in Kamchatka.

  14. Implication of global nephrology guidelines in Asia and 'Asian CKD Best Practice Guidelines'. (United States)

    Tsukamoto, Yusuke


    By establishing Kidney Diseases: Improving Global Outcome (KDIGO), nephrology has taken an important step towards developing global clinical practice guidelines (CPG). KDIGO published its first CPG on 'Hepatitis C in CKD' in 2008 and has since published two new CPG ('CKD-MBD' and 'Kidney Transplant Recipient') in 2009. A major obstacle to implement CPG is the lack of both high-quality evidence for regionally-specific areas of medicine and a lack of resources in many countries in our region. However, an endeavor by the Asian Forum of CKD Initiative (AFCKDI) may make it possible to overcome these obstacles. By developing regionally-specific CKD guidelines, the AFCKDI might identify relevant evidence gaps and by using specific expertise develop a standard of patient care appropriate to the Asia-Pacific region. This can be accomplished only by engaging a group of international experts who fully represent the Asia-Pacific area.

  15. How to Read a Food Label: Tips for People with Chronic Kidney Disease (CKD) (United States)

    ... How to Read a Tips for People with Chronic Kidney Disease (CKD) National Kidney Disease Education Program If you ... and Human Services National Institutes of Health National Kidney Disease Education Program 2

  16. Study on the E-commerce Ordering Platform of CKD/IKD

    Institute of Scientific and Technical Information of China (English)

    YIN Xiaoqing; LIU Wei


    CKD/IKD is a new technology management method which should be used instead of commerce mode of CBU. In the international trade, as to the products with fast update, complex structure, mass variety, complicated sales states and multimode configuration, when they are exported to enterprises without independent technology of products design from the OEM suppliers in the form of CKD/IKD. The all-around intellectualized management of CKD/IKD customization, purchase and supply will be realized by transforming automatically between CKD/IKD orders and parts orders in ERP systems through KD virtual collaborative center, combining the e-commerce sales system, ERP, SCM, CRM, PDM and export management system.

  17. The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study (United States)

    Stengel, Bénédicte; Combe, Christian; Jacquelinet, Christian; Briançon, Serge; Fouque, Denis; Laville, Maurice; Frimat, Luc; Pascal, Christophe; Herpe, Yves-Edouard; Deleuze, Jean-François; Schanstra, Joost; Pisoni, Ron L.; Robinson, Bruce M.; Massy, Ziad A.


    Background While much has been learned about the epidemiology and treatment of end-stage renal disease (ESRD) in the last 30 years, chronic kidney disease (CKD) before the end-stage has been less investigated. Not enough is known about factors associated with CKD progression and complications, as well as its transition to ESRD. We designed the CKD-renal epidemiology and information network (REIN) cohort to provide a research platform to address these key questions and to assess clinical practices and costs in patients with moderate or advanced CKD. Methods A total of 46 clinic sites and 4 renal care networks participate in the cohort. A stratified selection of clinic sites yields a sample that represents a diversity of settings, e.g. geographic region, and public versus for-profit and non-for-profit private clinics. In each site, 60–90 patients with CKD are enrolled at a routine clinic visit during a 12-month enrolment phase: 3600 total, including 1800 with Stage 3 and 1800 with Stage 4 CKD. Follow-up will continue for 5 years, including after initiation of renal replacement therapy. Data will be collected from medical records at inclusion and at yearly intervals, as well as from self-administered patient questionnaires and provider-level questionnaires. Patients will also be interviewed at baseline, and at 1, 3 and 5 years. Healthcare costs will also be determined. Blood and urine samples will be collected and stored for future studies on all patients at enrolment and at study end, and at 1 and 3 years in a subsample of 1200. Conclusions The CKD-REIN cohort will serve to improve our understanding of the biological, clinical and healthcare system determinants associated with CKD progression and adverse outcomes as well as of international variations in collaboration with the CKD Outcome and Practice Pattern Study (CKDopps). It will foster CKD epidemiology and outcomes research and provide evidence to improve the health and quality of life of patients with CKD and

  18. Pulmonary hypertension: epidemiology in different CKD stages and its association with cardiovascular morbidity.

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    Zhilian Li

    Full Text Available Pulmonary hypertension (PH was recently recognized as a common complication of end-stage renal disease (ESRD that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD and its association with cardiovascular (CV morbidity are scarce.We retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1-4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model.PH was detected in 426 patients (18.1%. Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%. Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI for mild PH: 1.79 (1.30-2.47; moderate PH: 2.75 (1.73-4.37; severe PH: 3.90 (1.46-10.42].Our study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.

  19. Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience. (United States)

    Attini, Rossella; Leone, Filomena; Parisi, Silvia; Fassio, Federica; Capizzi, Irene; Loi, Valentina; Colla, Loredana; Rossetti, Maura; Gerbino, Martina; Maxia, Stefania; Alemanno, Maria Grazia; Minelli, Fosca; Piccoli, Ettore; Versino, Elisabetta; Biolcati, Marilisa; Avagnina, Paolo; Pani, Antonello; Cabiddu, Gianfranca; Todros, Tullia; Piccoli, Giorgina B


    Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited. Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison. January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6-0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1-3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS. Patients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.

  20. Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management. (United States)

    Johnston, Sheila


    Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients.

  1. Estrogen Deficiency Leads to Further Bone Loss in the Mandible of CKD Mice.

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    Yuchen Guo

    Full Text Available Chronic kidney disease (CKD has been regarded as a grave public health problem. Estrogen is a critical factor for both renal protection and bone remodeling. Our previous study demonstrated that CKD impairs the healing of titanium implants. The aim of this study was to investigate the effects of estrogen deficiency on the mandibular bone in CKD mice.Forty eleven-week-old female C57BL mice were used in this study. Uremia and estrogen deficiency were induced by 5/6 nephrectomy and ovariectomy (OVX, respectively. After 8 weeks, the mice were sacrificed, and their mandibles were collected for micro-CT analysis and histological examination.All the mice survived the experimental period. Serum measurements confirmed a significant increase in BUN in the CKD group that was further increased by OVX. OVX led to significant decreases in both the BV/TV and cortical thickness of the mandibular bone in CKD mice.In summary, our findings indicate that estrogen deficiency leads to further mandibular bone loss in CKD mice.

  2. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients. (United States)

    Tang, Wei-Hua; Wang, Chao-Ping; Chung, Fu-Mei; Huang, Lynn L H; Yu, Teng-Hung; Hung, Wei-Chin; Lu, Li-Fen; Chen, Po-Yuan; Luo, Ching-Hsing; Lee, Kun-Tai; Lee, Yau-Jiunn; Lai, Wen-Ter


    Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD). In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS) is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc) prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK) was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD) and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  3. Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control

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    Markus Ketteler


    Full Text Available When compared to the available information for patients on dialysis (CKD stage 5D, data on the epidemiology and appropriate treatment of calcium and phosphate metabolism in the predialysis stages of chronic kidney disease (CKD are quite limited. Perceptible derangements of calcium and phosphate levels start to become apparent when GFR falls below 30 mL/min in some, but not all, patients. However, hyperphosphatemia may be a significant morbidity and mortality risk predictor in predialysis CKD stages. The RIND study, evaluating progression of coronary artery calcification in incident hemodialysis patients, indirectly demonstrated that vascular calcification processes start to manifest in CKD patients prior to the dialysis stage, which may be closely linked to early and invisible derangements in calcium and phosphate homeostasis. Novel insights into the pathophysiology of calcium and phosphate handling such as the discovery of FGF23 and other phosphatonins suggest that a more complex assessment of phosphate balance is warranted, possibly including measurements of fractional phosphate excretion and phosphatonin levels in order to appropriately evaluate disordered metabolism in earlier stages of kidney disease. As a consequence, early and preventive treatment approaches may have to be developed for patients in CKD stages 3-5 to halt progression of CKD-MBD.

  4. First evidence of the Oceanic Anoxic Events in Cenomanian paleoceanic deposits of the Eastern Kamchatka (United States)

    Savelyeva, Olga; Palechek, Tatiana; Savelyev, Dmitry


    They are a few stratigraphical levels corresponding to OAEs in the deep-water drilling sites in the Pacific ocean. Discoveries of ОАЕs evidences in fold-thrust belt of Pacific are important for correlation of Pacific ocean sections with well investigated sections of Europe. We studied Albian-Cenomanian paleoceanic carbonate-siliceous deposits of the Kamchatsky Mys Peninsula (Eastern Kamchatka, Russia). They are deposited in association with pillow-basalts and hyaloclastites. The thickness of the studied section (56°03.353´N, 163°00.376´E) is about 10 m. The deposits are represented mainly by rhythmical intercalation of red-brown radiolarian jaspers, pink nannoplancton limestones as well as siliceous limestones. In the middle and upper parts of the section there are two thin beds enriched by organic carbon. The thickness of the beds is about 2 cm and 5 cm. Such carbon-rich beds were also found in several other exposures. Near the carbonaceous beds jaspers and limestones lose red and pink colours and become gray and black (on the weathered surface almost white). The content of the mineral matter in the carbon-rich beds amounts 27-75%. It consists of biogenic silica and clay minerals (likely altered hyaloclactites). Carbonaceous beds contain pyrite, barite, phosphates in the form of pellets and fish bone detritus. Mo/Mn ratio in the mineral matter of carbon-rich beds corresponds to euxinic conditions. Total organic carbon contents change from 18 to 53%. The calculated values of the hydrogen and oxygen indexes indicate that the organic carbon originated from marine (sapropelic) organic matter. In studied section the curve of d13C (analyzed in limestones) is characterized by a clearly expressed positive shift at the level of the lower carbonaceous bed. Below it and in the overlapping stratum of siliceous limestone (1 cm thickness) d13C has the values of 1.9-2.1 pro mil, and above it d13C increases up to 2.5-3 pro mil. The radiolarian assemblages are dominated by

  5. Depression - resources (United States)

    Resources - depression ... Depression is a medical condition. If you think you may be depressed, see a health care provider. ... following organizations are good sources of information on depression : American Psychological Association -- ...

  6. Constraining recent Shiveluch volcano eruptions (Kamchatka, Russia by means of dendrochronology

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    O. Solomina


    Full Text Available Shiveluch (N 56°38´, E 161°19´; elevation: active dome ~2500 m, summit of Old Shiveluch 3283 m is one of the most active volcanoes in Kamchatka. The eruptions of Shiveluch commonly result in major environmental damage caused by debris avalanches, hot pyroclastic flows, tephra falls and lahars. Constraining these events in time and space is important for the understanding and prediction of these natural hazards. The last major eruption of Shiveluch occurred in 2005; earlier ones, dated by instrumental, historical, 14C and tephrochronological methods, occurred in the last millennium around AD 1030, 1430, 1650, 1739, 1790–1810, 1854, 1879–1883, 1897–1898, 1905, 1927–1929, 1944–1950, and 1964. A lava dome has been growing in the 1964 crater since 1980, occasionally producing tephra falls and pyroclastic flows. Several Shiveluch eruptions (~AD 1050, 1650, 1854, 1964 may have been climatically effective and are probably recorded in the Greenland ice cores.

    Previously, most dates for eruptions before AD 1854 were obtained by tephrochronology and constrained by radiocarbon dating with an accuracy of several decades or centuries. In this paper we report tree-ring dates for a recent pyroclastic flow in Baidarnaia valley. Though the wood buried in these deposits is carbonized, fragile and poorly preserved, we were able to measure ring-width using standard tree-ring equipment or photographs and to cross-date these samples against the regional Kamchatka larch ring-width chronology. The dates of the outer rings indicate the date of the eruptions. In the Baidarnaia valley the eruption occurred shortly after AD 1756, but not later than AD 1758. This date coincides with the decrease of ring-width in trees growing near Shiveluch volcano in 1758–1763 in comparison with the control "non-volcanic" chronology. The pyroclastic flow in Kamenskaia valley, although similar in appearance to the one in Baidarnaia valley, definitively

  7. Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD. (United States)

    Lu, Lu; Huang, Yan-Feng; Wang, Ming-Qing; Chen, De-Xiu; Wan, Heng; Wei, Lian-Bo; Xiao, Wei

    Evidence suggests that dietary fiber benefits patients with chronic kidney disease (CKD); however, this conclusion requires further validation. In this study, we examined the effects of dietary fiber on kidney function, inflammation, indoxyl sulfate, nutritional status, and cardiovascular risk in patients with advanced CKD. We performed linear regressions to assess the association between dietary fiber intake and CKD parameters. The aforementioned parameters were compared over an 18-month follow- up period. Kaplan-Meier analysis was used to investigate the association between fiber intake and Cardiac vascular disease (CVD). In total, 157 patients were included in this study. Dietary fiber and inflammatory indices were associated (interleukin [IL]-6: β=-0.024, p=0.035). The differential estimated glomerular filtration rate (ΔeGFR) as well as levels of C-reactive protein, IL-6, indoxyl sulfate, and serum cholesterol in the higher fiber intake (>=25 g/day) group were lower than those in the lower fiber intake (Dietary fiber intake may be a protective factor associated with CVD (hazard ratio=0.537 and 0.305- 0.947). The protein nutritional status was not different between the two groups (p>0.05). Our results suggest that increasing fiber intake can retard the decrease in the eGFR; can reduce the levels of proinflammatory factors, indoxyl sulfate, and serum cholesterol; and is negatively associated with cardiovascular risk, but does not disrupt the nutritional status of patients with CKD.

  8. Characterization and petrophysical properties of hydrothemally altered lacustrine volcanistic rock in Geyser Valley (Kamchatka) and its transformation by weathering (United States)

    Gvozdeva, Irina; Zerkal, Oleg; Samarin, Evgeny


    Work is devoted to the study of volcano sedimentary hydrothermally altered rocks in Geyser Valley (Kamchatka peninsula, Russia). The Geyser Valley is one of the most unique nature objects in Russia. There are quite large geyser fields. The valley of the river is part of the Uson-Geysernaya depression, where hydrothermal activity is very high. Besides geysers here are hot springs, mud pots and fumarols. In the late Pleistocene (about 45-35 thousand years ago) the lake was located in the site of the modern valley of the Geysernaya river, where sediments accumulated intensively. Sedimentary material came from several sources in the form of pyroclastic flows, ash falls, was supplied by permanent and temporary water streams. The total deposit thickness reached several hundred meters. In the late Pleistocene there was breakthrough of reservoir and further conditions for the lacustrine deposits formation did not arose. Later the rocks were intensively processed by thermal water. In 2007 large landslide was formed in lower part of the Geysernaya River on their left slope. Deposits of Geysernaya (Q34grn) series and Pemsovaya (Q34pmz) series were involved in landslide displacement. The headscarp was formed up to 100 m and a length of 800 m, exposing the volcano-sedimentary section of hydrothermally altered rocks - a unique opportunity for sampling and subsequent laboratory study. Thickness of lake sediments is interbedding of coarse-grain, medium-grain, fine-grain tuffites predominantly acidic composition. The study of thin sections revealed that all samples are lithoclastic and vitroclastic hydrothermally altered tuffits. Currently, the primary minerals and volcanic glass is largely replaced by clay minerals of the smectite group. Pores and cracks are made zeolites (heulandite and clinoptilolite). All this points to the low-temperature (weathered to clayey state tuffites inherit structural and textural features of the primary species. The composition also varies: increased

  9. Practical approach to the diagnosis and treatment of anemia associated with CKD in elderly. (United States)

    Agarwal, Anil K


    Anemia is a frequent complication of chronic kidney disease (CKD). Inadequate production of erythropoietin by the failing kidneys leads to decreased stimulation of the bone marrow to produce red blood cells (RBCs). Anemia of CKD develops early and worsens with progressive renal insufficiency. Although over 40% of patients with CKD are anemic, anemia in this population is under-recognized and undertreated. Of considerable importance, anemia is a risk factor for cardiovascular disease and is associated with higher rates of hospitalization and mortality. Despite the availability of erythropoiesis-stimulating proteins (ESPs) to stimulate RBC production in CKD patients, approximately three fourths of patients initiating dialysis have a hemoglobin CKD begins with an estimation of glomerular filtration rate (GFR), which can be far lower than a normal serum creatinine might suggest, especially in the elderly and in those with poor nutrition and muscle mass. If GFR is cause of anemia should be investigated in these individuals; this can range from erythropoietin deficiency due to CKD, to deficiency of vitamin B(12) and/or folate, iron deficiency, blood loss, inflammation, malignancy, and aluminum intoxication. After other causes of anemia have been excluded, CKD is the most likely etiology, and it should be treated with an ESP. Currently, epoetin alfa and darbepoetin alfa are the only 2 ESPs approved for use in the United States. Extended dosing of ESP has potential advantages for the patient and may also improve resource utilization. Consequently, both agents have been tested for dosing at extended intervals. Adequate iron stores--defined as transferrin saturation >20% and ferritin >100 mg--as well as ESP administration are needed to produce an appropriate increase in hemoglobin. Poor response to treatment with ESP can be due to many factors, including presence of iron deficiency, inflammation, continued blood loss, and hemoglobinopathy.

  10. Myocardial dysfunction occurs prior to changes in ventricular geometry in mice with chronic kidney disease (CKD). (United States)

    Winterberg, Pamela D; Jiang, Rong; Maxwell, Josh T; Wang, Bo; Wagner, Mary B


    Uremic cardiomyopathy is responsible for high morbidity and mortality rates among patients with chronic kidney disease (CKD), but the underlying mechanisms contributing to this complex phenotype are incompletely understood. Myocardial deformation analyses (ventricular strain) of patients with mild CKD have recently been reported to predict adverse clinical outcome. We aimed to determine if early myocardial dysfunction in a mouse model of CKD could be detected using ventricular strain analyses. CKD was induced in 5-week-old male 129X1/SvJ mice through partial nephrectomy (5/6Nx) with age-matched mice undergoing bilateral sham surgeries serving as controls. Serial transthoracic echocardiography was performed over 16 weeks following induction of CKD. Invasive hemodynamic measurements were performed at 8 weeks. Gene expression and histology was performed on hearts at 8 and 16 weeks. CKD mice developed decreased longitudinal strain (-25 ± 4.2% vs. -29 ± 2.3%; P = 0.01) and diastolic dysfunction (E/A ratio 1.2 ± 0.15 vs. 1.9 ± 0.18; P ventricular hypertrophy was not apparent until 4 weeks. Hearts from CKD mice developed progressive fibrosis at 8 and 16 weeks with gene signatures suggestive of evolving heart failure with elevated expression of natriuretic peptides. Uremic cardiomyopathy in this model is characterized by early myocardial dysfunction which preceded observable changes in ventricular geometry. The model ultimately resulted in myocardial fibrosis and increased expression of natriuretic peptides suggestive of progressive heart failure.


    Wheeler, David


    Hypertension is the most prevalent complication of chronic kidney disease (CKD). Lowering high blood pressure slows progressive loss of kidney function and may also reduce the associated risk of cardiovascular complications, a common cause of premature death in CKD patients.Current International Guidelines produced by Kidney Disease: Improving Global Outcomes (KDIGO) acknowledges that no single BP target is optimal for all CKD patients, and encourages individualization of treatment depending on age, the severity of albuminuria and comorbidities. When published in 2012, the available evidence indicated that in CKD patients without albuminuria, the target BP should be ≤140 mmHg systolic and ≤90 mmHg diastolic. However, in most patients with an albumin excretion rate of ≥30 mg/24 h (i.e., those with both micro- and macroalbuminuria), a lower target of ≤130 mmHg systolic and ≤80 mmHg diastolic was suggested. In achieving BP control, the value of lifestyle changes and the need for multiple pharmacological agents was acknowledged. Use of agents that block the renin-angiotensin-aldosterone system was recommended or suggested in all patients with an albumin excretion rate of ≥30 mg/24 h. Recommendations are almost identical in CKD patients with and without diabetes.Recent data from SPRINT (which included CKD patients) and other clinical trials has led nephrologists to ask whether targets lower than those recommend by KDIGO are appropriate and the guidelines are currently undergoing an update. Controversies remain around discontinuation of ACE/ARB in patients with stage 4-5 CKD and dual renin-angiotensin-aldosterone system blockade.

  12. Decreased microRNA is involved in the vascular remodeling abnormalities in chronic kidney disease (CKD.

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    Neal X Chen

    Full Text Available Patients with CKD have abnormal vascular remodeling that is a risk factor for cardiovascular disease. MicroRNAs (miRNAs control mRNA expression intracellularly and are secreted into the circulation; three miRNAs (miR-125b, miR-145 and miR-155 are known to alter vascular smooth muscle cell (VSMC proliferation and differentiation. We measured these vascular miRNAs in blood from 90 patients with CKD and found decreased circulating levels with progressive loss of eGFR by multivariate analyses. Expression of these vascular miRNAs miR-125b, miR-145, and miR-155 was decreased in the thoracic aorta in CKD rats compared to normal rats, with concordant changes in target genes of RUNX2, angiotensin II type I receptor (AT1R, and myocardin. Furthermore, the expression of miR-155 was negatively correlated with the quantity of calcification in the aorta, a process known to be preceded by vascular de-differentiation in these animals. We then examined the mechanisms of miRNA regulation in primary VSMC and found decreased expression of miR-125b, 145, and 155 in VSMC from rats with CKD compared to normal littermates but no alteration in DROSHA or DICER, indicating that the low levels of expression is not due to altered intracellular processing. Finally, overexpression of miR-155 in VSMC from CKD rats inhibited AT1R expression and decreased cellular proliferation supporting a direct effect of miR-155 on VSMC. In conclusion, we have found ex vivo and in vitro evidence for decreased expression of these vascular miRNA in CKD, suggesting that alterations in miRNAs may lead to the synthetic state of VSMC found in CKD. The decreased levels in the circulation may reflect decreased vascular release but more studies are needed to confirm this relationship.

  13. Geochemistry of the Koshelev Volcano-Hydrothermal System, Southern Kamchatka, Russia (United States)

    Taran, Y.; Kalacheva, E.


    Koshelev is the southernmost volcano of the Kamchatkan volcanic front where magmatic plumbing systems of the Kamchatkan subduction zone cross a thick layer of the oil-gas-bearing Neogene sedimentary strata of Western Kamchatka. The volcanic massive hosts a powerful hydrothermal system, which has been drilled in early 1980s. Deep wells tapped a hot (ca. 300ºC) saline solution (up to 40 g/L of Cl), whereas the upper part of the system is a typical steam cap with temperature close to 240ºC. Two hydrothermal fields of the volcano (Upper and Lower) discharge saturated or super-heated (up to 150ºC) steam and are characterized by numerous hot pools and low flow-rate springs of steam-heated waters enriched in boron and ammonia. There is also a small lateral group of warm Na-Ca-Cl-SO4 springs (40ºC). We report here our data and review the literature geochemical data on the chemical and isotopic composition of waters and hydrothermal vapours of the Koshelev system. Data on the gas composition include He and C isotopes, as well as the chemical and isotopic composition of light hydrocarbons. Water geochemistry includes literature data on water isotopes of the deep brine and trace elements and REE of steam-heated waters. A conceptual model of the system is presented and discussed.

  14. 3D Numeric modeling of slab-plume interaction in Kamchatka (United States)

    Constantin Manea, Vlad; Portnyagin, Maxim; Manea, Marina


    Volcanic rocks located in the central segment of the Eastern Volcanic Belt of Kamchatka show a high variability, both in age as well as in the geochemical composition. Three principal groups have been identified, an older group (7-12 my) represented by rich alkaline and transitional basalts, a 7-8 my group exemplified by alkaline basalts of extreme plume type, and a younger group (3-8 my) characterized by calc-alkaline andesites and dacites rocks. Moreover, the younger group shows an adakitic signature. The magmas are assumed to originate from two principle sources: from a subduction modified Pacific MORB-type and from plume-type mantle. In this paper we study the interaction of a cold subducting slab and a hot plume by means of 3D numeric modeling integrated 30 my back in time. Our preliminary modeling results show a short episode of plume material inflowing into the mantle wedge at ~10 my consistent with the second rocks group (plume like). Also our models predict slab edge melting consistent with the youngest group.

  15. The Magma-Hydrothermal System at Mutnovsky Volcano, Kamchatka Peninsula, Russia

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    Alexey Kiryukhin


    Full Text Available What is the relationship between the kinds of volcanoes that ring the Pacific plate and nearby hydrothermal systems? A typical geometry for stratovolcanoes and dome complexes is summit fumaroles and hydrothermal manifestations on and beyond their flanks. Analogous subsurface mineralization is porphyry copper deposits flanked by shallow Cu-As-Au acid-sulfate deposits and base metal veins. Possible reasons for this association are (1 upward and outward flow of magmatic gas and heat from the volcano’s conduit and magma reservoir, mixing with meteoric water; (2 dikes extending from or feeding towards the volcano that extend laterally well beyond the surface edifice, heating a broad region; or (3 peripheral hot intrusions that are remnants of previous volcanic episodes, unrelated to current volcanism. These hypotheses are testable through a Mutnovsky Scientific Drilling Project (MSDP that was discussed in a workshop during the last week of September 2006 at a key example, the Mutnovsky Volcano of Kamchatka. Hypothesis (1 was regarded as the most likely. It is also the most attractive since it could lead to a new understanding of themagma-hydrothermal connection and motivate global geothermal exploration of andesitic arc volcanoes.

  16. Dendrogeomorphic reconstruction of lahar activity and triggers: Shiveluch volcano, Kamchatka Peninsula, Russia (United States)

    Salaorni, E.; Stoffel, M.; Tutubalina, O.; Chernomorets, S.; Seynova, I.; Sorg, A.


    Lahars are highly concentrated, water-saturated volcanic hyperconcentrated flows or debris flows containing pyroclastic material and are a characteristic mass movement process on volcanic slopes. On Kamchatka Peninsula (Russian Federation), lahars are widespread and may affect remote settlements. Historical records of past lahar occurrences are generally sparse and mostly limited to events which damaged infrastructure on the slopes or at the foot of volcanoes. In this study, we present a tree-ring-based reconstruction of spatiotemporal patterns of past lahar activity at Shiveluch volcano. Using increment cores and cross sections from 126 Larix cajanderi trees, we document 34 events covering the period AD 1729-2012. Analyses of the seasonality of damage in trees reveal that 95% of all lahars occurred between October and May and thus point to the predominant role of the sudden melt of the snow cover by volcanic material. These observations suggest that most lahars were likely syn-eruptive and that lahar activity is largely restricted to periods of volcanic activity. By contrast, rainfall events do not seem to play a significant role in lahar triggering.

  17. Rapid glacial retreat on the Kamchatka Peninsula during the early 21st century (United States)

    Lynch, Colleen M.; Barr, Iestyn D.; Mullan, Donal; Ruffell, Alastair


    Monitoring glacier fluctuations provides insights into changing glacial environments and recent climate change. The availability of satellite imagery offers the opportunity to view these changes for remote and inaccessible regions. Gaining an understanding of the ongoing changes in such regions is vital if a complete picture of glacial fluctuations globally is to be established. Here, satellite imagery (Landsat 7, 8 and ASTER) is used to conduct a multi-annual remote sensing survey of glacier fluctuations on the Kamchatka Peninsula (eastern Russia) over the 2000-2014 period. Glacier margins were digitised manually and reveal that, in 2000, the peninsula was occupied by 673 glaciers, with a total glacier surface area of 775.7 ± 27.9 km2. By 2014, the number of glaciers had increased to 738 (reflecting the fragmentation of larger glaciers), but their surface area had decreased to 592.9 ± 20.4 km2. This represents a ˜ 24 % decline in total glacier surface area between 2000 and 2014 and a notable acceleration in the rate of area loss since the late 20th century. Analysis of possible controls indicates that these glacier fluctuations were likely governed by variations in climate (particularly rising summer temperatures), though the response of individual glaciers was modulated by other (non-climatic) factors, principally glacier size, local shading and debris cover.

  18. Thermogladius calderae gen. nov., sp. nov., an anaerobic, hyperthermophilic crenarchaeote from a Kamchatka hot spring. (United States)

    Kochetkova, Tatiana V; Kublanov, Ilya V; Toshchakov, Stepan V; Osburn, Magdalena R; Novikov, Andrei A; Bonch-Osmolovskaya, Elizaveta A; Perevalova, Anna A


    An obligately anaerobic, hyperthermophilic, organoheterotrophic archaeon, strain 1633T, was isolated from a terrestrial hot spring of the Uzon Caldera (Kamchatka Peninsula, Russia). Cells were regular cocci, 0.5-0.9 μm in diameter, with one flagellum. The temperature range for growth was 80-95°C, with an optimum at 84°C. Strain 1633T grew on yeast extract, beef extract, peptone, cellulose and cellobiose. No growth was detected on other sugars or carbohydrates, organic acids, or under autotrophic conditions. The only detected growth products were CO2, acetate, and H2. Growth rate was stimulated by elemental sulfur, which was reduced to hydrogen sulfide. In silico calculated G+C content of strain 1633T genomic DNA was 55.64 mol%. 16S rRNA gene sequence analysis placed the strain 1633T together with the non-validly published "Thermogladius shockii" strain WB1 in a separate genus-level cluster within the Desulfurococcaceae family. ANI results revealed 75.72% identity between 1633T and WB1. Based on these results we propose a novel genus and species, for which the name Thermogladius calderae gen. nov., sp. nov. (type strain 1633T=DSM 22663T=VKM B-2946T) is proposed.

  19. Prevalence and risk factors of CKD in Chinese patients with periodontal disease.

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    Kejin Liu

    Full Text Available BACKGROUND: Periodontal disease is common among adults and is associated with an increasing risk of chronic kidney disease (CKD. We aimed to investigate the prevalence and risk factors of CKD in patients with periodontal disease in China. METHODS: In the current cross-sectional study, patients with periodontal disease were included from Guangdong Provincial Stomatological Hospital between March 2011 and August 2011. CKD was defined as estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m(2, the presence of albuminuria, or hematuria. All patients with periodontal disease underwent a periodontal examination, including periodontal probing pocket depth, gingival recession, and clinical attachment level by Florida Probe. They completed a questionnaire and had blood and urine samples taken. The adjusted prevalence of indicators of kidney damage was calculated and risk factors associated with CKD were analyzed. RESULTS: A total of 1392 patients with periodontal disease were invited to participate this study and 1268 completed the survey and examination. After adjusting for age and sex, the prevalence of reduced eGFR, albuminuria, and hematuria was 2.7% (95% CI 1.7-3.7, 6.7% (95% CI 5.5-8.1 and 10.9% (95% CI 9.2-12.5, respectively. The adjusted prevalence of CKD was 18.2% (95% CI 16.2-20.3. Age, male, diabetes, hypertension, history of CKD, hyperuricemia, and interleukin-6 levels (≥7.54 ng/L were independent risk factors for reduced eGFR. Female, diabetes, hypertension, history of CKD, hyperuricemia, high level of cholesterol, and high sensitivity C-reactive protein (hsCRP (≥ 1.03 mg/L and TNF-α levels (≥ 1.12 ng/L were independently associated with an increased risk of albuminuria. Female, lower education (CKD were independent risk factors for hematuria. CONCLUSIONS: 18.2% of Chinese patients with periodontal disease have proteinuria, hematuria, or reduced eGFR, indicating the presence of kidney damage

  20. Postpartum depression (United States)

    Depression - postpartum; Postnatal depression; Postpartum psychological reactions ... behavioral therapy (CBT) and interpersonal therapy (IPT) are types of talk therapy that often help postpartum depression. ...

  1. Sleep quality, mood, alertness and their variability in CKD and ESRD. (United States)

    Roumelioti, Maria-Eleni; Argyropoulos, Christos; Buysse, Daniel J; Nayar, Harry; Weisbord, Steven D; Unruh, Mark L


    Little is known about the association of chronic kidney disease (CKD) with sleep quality, mood, and alertness. In this report, we assessed these symptoms among patients with advanced CKD (stages 4-5) and those with end-stage renal disease (ESRD) and compared them to healthy controls without known kidney disease. Patients were recruited from local dialysis units, outpatient nephrology clinics and the Thomas E. Starzl Transplant Institute. Healthy control subjects matched for age, gender and race were drawn from an archival database. Daily symptoms of sleep quality, mood, and alertness were assessed by visual analogue scales of the Pittsburgh Sleep Diary. Health-related quality of life was assessed by the Short Form-36 instrument. Sixty-nine dialysis patients and 23patients with advanced CKD demonstrated worse scores in sleep quality, mood, and alertness (p < 0.001) than controls. In adjusted analyses, European-American race, dialysis dependency, younger age, and physical performance SF-36 components were significantly associated with poor sleep quality, mood and alertness (p < 0.05). The dialysis population demonstrated higher day-to-day variability in scores than either the advanced CKD patients or the controls. Advanced CKD and dialysis dependency are associated with impaired and highly variable sleep quality, mood, and alertness. Copyright 2010 S. Karger AG, Basel.

  2. What Would You Like to Eat, Mr CKD Microbiota? A Mediterranean Diet, please!

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    Eustacchio Montemurno


    Full Text Available In this review we elucidate the role of gut microbiota as the plausible missing link between food and health, focusing on chronic kidney disease (CKD. Microbiota, the microbial community harboured in the large intestine, is considered a symbiotic “supplementary organ”. It contributes to digestion, mainly through two catabolic pathways: saccharolytic (fermentation or proteolytic (putrefaction. It also interacts with host influencing immunity, metabolism, and health status. It is believed that a balanced healthy microbiota is primarily saccharolytic and diet has a deep effect on its composition. Mediterranean Diet, UNESCO “Intangible Cultural Heritage of Humanity”, prevents cardiovascular and metabolic systemic diseases, thanks to the high supply of fibres and antioxidants. Mediterranean Diet also favours the prevalence of saccharolytic species, while Western Diet promotes the shift towards a proteolytic profile (dysbiosis. Emerging evidences highlight the association between a wide range of diseases and dysbiosis. In CKD a vicious circle exists, in which proteolytic-derived microbial metabolites (p-cresol and indoxyl sulphate, represent the main circulating uremic toxins: their accumulation worsens dysbiosis and promotes CKD progression. Gut microbiota shaping through non-pharmacologic nutritional treatments, based on Mediterranean Diet, represents an innovative approach in CKD, potentially restoring microbiota balance, ameliorating CKD conditions and slowing down disease progression.

  3. What would you like to eat, Mr CKD Microbiota? A Mediterranean Diet, please! (United States)

    Montemurno, Eustacchio; Cosola, Carmela; Dalfino, Giuseppe; Daidone, Giuseppe; De Angelis, Maria; Gobbetti, Marco; Gesualdo, Loreto


    In this review we elucidate the role of gut microbiota as the plausible missing link between food and health, focusing on chronic kidney disease (CKD). Microbiota, the microbial community harboured in the large intestine, is considered a symbiotic "supplementary organ". It contributes to digestion, mainly through two catabolic pathways: saccharolytic (fermentation) or proteolytic (putrefaction). It also interacts with host influencing immunity, metabolism, and health status. It is believed that a balanced healthy microbiota is primarily saccharolytic and diet has a deep effect on its composition. Mediterranean Diet, UNESCO "Intangible Cultural Heritage of Humanity", prevents cardiovascular and metabolic systemic diseases, thanks to the high supply of fibres and antioxidants. Mediterranean Diet also favours the prevalence of saccharolytic species, while Western Diet promotes the shift towards a proteolytic profile (dysbiosis). Emerging evidences highlight the association between a wide range of diseases and dysbiosis. In CKD a vicious circle exists, in which proteolytic-derived microbial metabolites (p-cresol and indoxyl sulphate), represent the main circulating uremic toxins: their accumulation worsens dysbiosis and promotes CKD progression. Gut microbiota shaping through non-pharmacologic nutritional treatments, based on Mediterranean Diet, represents an innovative approach in CKD, potentially restoring microbiota balance, ameliorating CKD conditions and slowing down disease progression.

  4. Longitudinal changes of cardiac structure and function in CKD (CASCADE study). (United States)

    Cai, Qi-Zhe; Lu, Xiu-Zhang; Lu, Ye; Wang, Angela Yee-Moon


    Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (Pcardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.

  5. Research Priorities in CKD: Report of a National Workshop Conducted in Australia. (United States)

    Tong, Allison; Crowe, Sally; Chando, Shingisai; Cass, Alan; Chadban, Steve J; Chapman, Jeremy R; Gallagher, Martin; Hawley, Carmel M; Hill, Sophie; Howard, Kirsten; Johnson, David W; Kerr, Peter G; McKenzie, Anne; Parker, David; Perkovic, Vlado; Polkinghorne, Kevan R; Pollock, Carol; Strippoli, Giovanni F M; Tugwell, Peter; Walker, Rowan G; Webster, Angela C; Wong, Germaine; Craig, Jonathan C


    Research aims to improve health outcomes for patients. However, the setting of research priorities is usually performed by clinicians, academics, and funders, with little involvement of patients or caregivers and using processes that lack transparency. A national workshop was convened in Australia to generate and prioritize research questions in chronic kidney disease (CKD) among diverse stakeholder groups. Patients with CKD (n=23), nephrologists/surgeons (n=16), nurses (n=8), caregivers (n=7), and allied health professionals and researchers (n=4) generated and voted on intervention questions across 4 treatment categories: CKD stages 1 to 5 (non-dialysis dependent), peritoneal dialysis, hemodialysis, and kidney transplantation. The 5 highest ranking questions (in descending order) were as follows: How effective are lifestyle programs for preventing deteriorating kidney function in early CKD? What strategies will improve family consent for deceased donor kidney donation, taking different cultural groups into account? What interventions can improve long-term post-transplant outcomes? What are effective interventions for post hemodialysis fatigue? How can we improve and individualize drug therapy to control post-transplant side effects? Priority questions were focused on prevention, lifestyle, quality of life, and long-term impact. These prioritized research questions can inform funding agencies, patient/consumer organizations, policy makers, and researchers in developing a CKD research agenda that is relevant to key stakeholders.

  6. HDL Cholesterol, LDL Cholesterol, and Triglycerides as Risk Factors for CKD: A Mendelian Randomization Study. (United States)

    Lanktree, Matthew B; Thériault, Sébastien; Walsh, Michael; Paré, Guillaume


    High-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride concentrations are heritable risk factors for vascular disease, but their role in the progression of chronic kidney disease (CKD) is unclear. 2-sample Mendelian randomization analysis of data derived from the largest published lipid and CKD studies. Effect of independent genetic variants significantly associated with lipid concentrations was obtained from the Global Lipids Genetics Consortium (n=188,577), and the effect of these same variants on estimated glomerular filtration rate (eGFR), CKD (defined as eGFRGenetics Consortium (n=133,814). Using conventional, multivariable, and Egger Mendelian randomization approaches, we assessed the causal association between genetically determined lipid concentrations and kidney traits. eGFR, dichotomous eGFRGenetically higher triglyceride concentrations appeared associated with higher eGFRs, but this finding was driven by a single pleiotropic variant in the glucokinase regulator gene (GCKR). After exclusion, genetically higher triglyceride concentration was not associated with any kidney trait. Individual patient-level phenotype and genotype information were unavailable. 2-sample Mendelian randomization analysis of data from the largest lipid and CKD cohorts supports genetically higher HDL cholesterol concentration as causally associated with better kidney function. There was no association between genetically altered LDL cholesterol or triglyceride concentration and kidney function. Further analysis of CKD outcomes in HDL cholesterol intervention trials is warranted. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  7. Curcumin and Chronic Kidney Disease (CKD: Major Mode of Action through Stimulating Endogenous Intestinal Alkaline Phosphatase

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    Siddhartha S. Ghosh


    Full Text Available Curcumin, an active ingredient in the traditional herbal remedy and dietary spice turmeric (Curcuma longa, has significant anti-inflammatory properties. Chronic kidney disease (CKD, an inflammatory disease, can lead to end stage renal disease resulting in dialysis and transplant. Furthermore, it is frequently associated with other inflammatory disease such as diabetes and cardiovascular disorders. This review will focus on the clinically relevant inflammatory molecules that play a role in CKD and associated diseases. Various enzymes, transcription factors, growth factors modulate production and action of inflammatory molecules; curcumin can blunt the generation and action of these inflammatory molecules and ameliorate CKD as well as associated inflammatory disorders. Recent studies have shown that increased intestinal permeability results in the leakage of pro-inflammatory molecules (cytokines and lipopolysaccharides from gut into the circulation in diseases such as CKD, diabetes and atherosclerosis. This change in intestinal permeability is due to decreased expression of tight junction proteins and intestinal alkaline phosphatase (IAP. Curcumin increases the expression of IAP and tight junction proteins and corrects gut permeability. This action reduces the levels of circulatory inflammatory biomolecules. This effect of curcumin on intestine can explain why, despite poor bioavailability, curcumin has potential anti-inflammatory effects in vivo and beneficial effects on CKD.

  8. FGF23 signaling impairs neutrophil recruitment and host defense during CKD. (United States)

    Rossaint, Jan; Oehmichen, Jessica; Van Aken, Hugo; Reuter, Stefan; Pavenstädt, Hermann J; Meersch, Melanie; Unruh, Mark; Zarbock, Alexander


    Chronic kidney disease (CKD) has been associated with impaired host response and increased susceptibility to infections. Leukocyte recruitment during inflammation must be tightly regulated to protect the host against pathogens. FGF23 levels are increased in blood during CKD, and levels of this hormone have been associated with a variety of adverse effects in CKD patients. Here, we have shown that CKD impairs leukocyte recruitment into inflamed tissue and host defense in mice and humans. FGF23 neutralization during CKD in murine models restored leukocyte recruitment and host defense. Intravital microscopy of animals with chronic kidney failure showed that FGF23 inhibits chemokine-activated leukocyte arrest on the endothelium, and downregulation of FGF receptor 2 (FGFR2) on PMNs rescued host defense in these mice. In vitro, FGF23 inhibited PMN adhesion, arrest under flow, and transendothelial migration. Mechanistically, FGF23 binding to FGFR2 counteracted selectin- and chemokine-triggered β2 integrin activation on PMNs by activating protein kinase A (PKA) and inhibiting activation of the small GTPase Rap1. Moreover, knockdown of PKA abolished the inhibitory effect of FGF23 on integrin activation. Together, our data reveal that FGF23 acts directly on PMNs and dampens host defense by direct interference with chemokine signaling and integrin activation.

  9. 2009 Volcanic activity in Alaska, Kamchatka, and the Kurile Islands: summary of events and response of the Alaska Volcano Observatory (United States)

    McGimsey, Robert G.; Neal, Christina A.; Girina, Olga A.; Chibisova, Marina; Rybin, Alexander


    The Alaska Volcano Observatory (AVO) responded to eruptions, possible eruptions, volcanic unrest, and reports of unusual activity at or near eight separate volcanic centers in Alaska during 2009. The year was highlighted by the eruption of Redoubt Volcano, one of three active volcanoes on the western side of Cook Inlet and near south-central Alaska's population and commerce centers, which comprise about 62 percent of the State's population of 710,213 (2010 census). AVO staff also participated in hazard communication and monitoring of multiple eruptions at ten volcanoes in Russia as part of its collaborative role in the Kamchatka and Sakhalin Volcanic Eruption Response Teams.

  10. Association between absolute blood eosinophil count and CKD stages among cardiac patients. (United States)

    Ishii, Rui; Fujita, Shu-Ichi; Kizawa, Shun; Sakane, Kazushi; Morita, Hideaki; Ozeki, Michishige; Sohmiya, Koichi; Hoshiga, Masaaki; Ishizaka, Nobukazu


    Elevated eosinophil count was shown to be associated with the development of cholesterol embolization syndrome, a potentially life-threatening condition, after catheter-based procedures. We investigated the association between stages of chronic kidney disease (CKD) and the absolute eosinophil count (AEC) among cardiac patients. CKD stages were determined solely on the estimated glomerular filtration rate or requirement for hemodialysis. Eosinophilia is defined as an eosinophil count exceeding 500/μL. A total of 1022 patients were enrolled in the current study, and eosinophil counts (/μL) in the first through fourth eosinophil count quartiles were blood pressure, and total white blood cell count. Similarly, after adjustment for the same variables, eosinophilia was associated with severe renal dysfunction with an odds ratio of 2.60 (95 % confidence interval, 1.08-6.26, P count was positively associated with higher CKD stages among cardiology patients, some fraction of which might be related to subclinical cholesterol embolization.

  11. IκB Kinase Inhibitor Attenuates Sepsis-Induced Cardiac Dysfunction in CKD. (United States)

    Chen, Jianmin; Kieswich, Julius E; Chiazza, Fausto; Moyes, Amie J; Gobbetti, Thomas; Purvis, Gareth S D; Salvatori, Daniela C F; Patel, Nimesh S A; Perretti, Mauro; Hobbs, Adrian J; Collino, Massimo; Yaqoob, Muhammad M; Thiemermann, Christoph


    Patients with CKD requiring dialysis have a higher risk of sepsis and a 100-fold higher mortality rate than the general population with sepsis. The severity of cardiac dysfunction predicts mortality in patients with sepsis. Here, we investigated the effect of preexisting CKD on cardiac function in mice with sepsis and whether inhibition of IκB kinase (IKK) reduces the cardiac dysfunction in CKD sepsis. Male C57BL/6 mice underwent 5/6 nephrectomy, and 8 weeks later, they were subjected to LPS (2 mg/kg) or sepsis by cecal ligation and puncture (CLP). Compared with sham operation, nephrectomy resulted in significant increases in urea and creatinine levels, a small (Psepsis or endotoxemia in mice; this effect may be caused by increased cardiac NF-κB activation and iNOS expression. Copyright © 2016 by the American Society of Nephrology.

  12. The effect of sodium bicarbonate on cytokine secretion in CKD patients with metabolic acidosis. (United States)

    Ori, Yaacov; Zingerman, Boris; Bergman, Michael; Bessler, Hanna; Salman, Hertzel


    The incidence of acidosis increases with the progression of chronic kidney disease (CKD). Correction of acidosis by sodium bicarbonate may slow CKD deterioration. Inflammation, which is common in CKD, may be related to acidosis. Whether the slower rate of GFR decline following the correction of acidosis is related to changes in inflammatory markers is unknown. The current study examined whether correcting CKD-acidosis affected inflammatory cytokines secretion. Thirteen patients with CKD 4-5 and acidosis were tested for cytokines secretion from peripheral-blood mononuclear cells at baseline and after one month of oral sodium bicarbonate. Following treatment with sodium bicarbonate there was no change in weight, blood pressure, serum creatinine, albumin, sodium, calcium, phosphate, PTH, hemoglobin and CRP. Serum urea decreased (134±10-116±8 mg/dl, P=0.002), potassium decreased (5.1±0.4-4.8±0.1 mequiv./l, P=0.064), pH increased (7.29±0.01-7.33±0.01, P=0.008), and serum bicarbonate increased (18.6±0.4 mequiv./l to 21.3±0.3 mequiv./l, P=0.001). The secretion of the anti-inflammatory cytokine IL-10 decreased (2.75±0.25 ng/ml to 2.29±0.21 ng/ml, P=0.041). There was no significant change in the secretion of the other pro-inflammatory and anti-inflammatory cytokines, including IL-1β, IL-2, IL-6, TNFα, IFNγ, IL-1ra. Thus, correcting acidosis in CKD with bicarbonate decreases IL-10 secretion. Its significance needs to be further investigated.

  13. Genome-Wide Association of CKD Progression: The Chronic Renal Insufficiency Cohort Study. (United States)

    Parsa, Afshin; Kanetsky, Peter A; Xiao, Rui; Gupta, Jayanta; Mitra, Nandita; Limou, Sophie; Xie, Dawei; Xu, Huichun; Anderson, Amanda Hyre; Ojo, Akinlolu; Kusek, John W; Lora, Claudia M; Hamm, L Lee; He, Jiang; Sandholm, Niina; Jeff, Janina; Raj, Dominic E; Böger, Carsten A; Bottinger, Erwin; Salimi, Shabnam; Parekh, Rulan S; Adler, Sharon G; Langefeld, Carl D; Bowden, Donald W; Groop, Per-Henrik; Forsblom, Carol; Freedman, Barry I; Lipkowitz, Michael; Fox, Caroline S; Winkler, Cheryl A; Feldman, Harold I


    The rate of decline of renal function varies significantly among individuals with CKD. To understand better the contribution of genetics to CKD progression, we performed a genome-wide association study among participants in the Chronic Renal Insufficiency Cohort Study. Our outcome of interest was CKD progression measured as change in eGFR over time among 1331 blacks and 1476 whites with CKD. We stratified all analyses by race and subsequently, diabetes status. Single-nucleotide polymorphisms (SNPs) that surpassed a significance threshold of P<1×10(-6) for association with eGFR slope were selected as candidates for follow-up and secondarily tested for association with proteinuria and time to ESRD. We identified 12 such SNPs among black patients and six such SNPs among white patients. We were able to conduct follow-up analyses of three candidate SNPs in similar (replication) cohorts and eight candidate SNPs in phenotype-related (validation) cohorts. Among blacks without diabetes, rs653747 in LINC00923 replicated in the African American Study of Kidney Disease and Hypertension cohort (discovery P=5.42×10(-7); replication P=0.039; combined P=7.42×10(-9)). This SNP also associated with ESRD (hazard ratio, 2.0 (95% confidence interval, 1.5 to 2.7); P=4.90×10(-6)). Similarly, rs931891 in LINC00923 associated with eGFR decline (P=1.44×10(-4)) in white patients without diabetes. In summary, SNPs in LINC00923, an RNA gene expressed in the kidney, significantly associated with CKD progression in individuals with nondiabetic CKD. However, the lack of equivalent cohorts hampered replication for most discovery loci. Further replication of our findings in comparable study populations is warranted.

  14. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

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    Marie Ludlow


    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  15. A new modified CKD-EPI equation for Chinese patients with type 2 diabetes.

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    Xun Liu

    Full Text Available OBJECTIVE: To improve the performance of glomerular filtration rate (GFR estimating equation in Chinese type 2 diabetic patients by modification of the CKD-EPI equation. DESIGN AND PATIENTS: A total of 1196 subjects were enrolled. Measured GFR was calibrated to the dual plasma sample 99mTc-DTPA-GFR. GFRs estimated by the re-expressed 4-variable MDRD equation, the CKD-EPI equation and the Asian modified CKD-EPI equation were compared in 351 diabetic/non-diabetic pairs. And a new modified CKD-EPI equation was reconstructed in a total of 589 type 2 diabetic patients. RESULTS: In terms of both precision and accuracy, GFR estimating equations all achieved better results in the non-diabetic cohort comparing with those in the type 2 diabetic cohort (30% accuracy, P≤0.01 for all comparisons. In the validation data set, the new modified equation showed less bias (median difference, 2.3 ml/min/1.73 m2 for the new modified equation vs. ranged from -3.8 to -7.9 ml/min/1.73 m2 for the other 3 equations [P<0.001 for all comparisons], as was precision (IQR of the difference, 24.5 ml/min/1.73 m2 vs. ranged from 27.3 to 30.7 ml/min/1.73 m2, leading to a greater accuracy (30% accuracy, 71.4% vs. 55.2% for the re-expressed 4 variable MDRD equation and 61.0% for the Asian modified CKD-EPI equation [P = 0.001 and P = 0.02]. CONCLUSION: A new modified CKD-EPI equation for type 2 diabetic patients was developed and validated. The new modified equation improves the performance of GFR estimation.

  16. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

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    Wei-Hua Tang

    Full Text Available Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD. In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  17. Homotopic Approximate Solutions for the Perturbed CKdV Equation with Variable Coefficients

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    Dianchen Lu


    Full Text Available This work concerns how to find the double periodic form of approximate solutions of the perturbed combined KdV (CKdV equation with variable coefficients by using the homotopic mapping method. The obtained solutions may degenerate into the approximate solutions of hyperbolic function form and the approximate solutions of trigonometric function form in the limit cases. Moreover, the first order approximate solutions and the second order approximate solutions of the variable coefficients CKdV equation in perturbation εun are also induced.

  18. High Mobility Group Box Protein-1 correlates with renal function in chronic kidney disease (CKD). (United States)

    Bruchfeld, Annette; Qureshi, Abdul Rashid; Lindholm, Bengt; Barany, Peter; Yang, Lihong; Stenvinkel, Peter; Tracey, Kevin J


    Chronic kidney disease (CKD) is associated with inflammation and malnutrition and carries a markedly increased risk of cardiovascular disease (CVD). High Mobility Group Box Protein-1 (HMGB-1) is a 30-kDa nuclear and cytosolic protein known as a transcription and growth factor, recently identified as a proinflammatory mediator of tissue injury. Recent data implicates HMGB-1 in endotoxin lethality, rheumatoid arthritis, and atherosclerosis. The aim of this post-hoc, cross-sectional study was to determine whether HMGB-1 serum levels are elevated in CKD patients. The study groups were categorized as follows: 110 patients starting dialysis defined as CKD 5; 67 patients with moderately to severely reduced renal function or CKD 3-4; and 48 healthy controls. High-sensitivity C-reactive-protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF), serum-albumin (S-albumin), hemoglobin A(1c) (HbA(1c)), hemoglobin, subjective global nutritional assessment (SGA), and glomerular filtration rate (GFR) were analyzed. Kruskal-Wallis test was used to compare groups and Spearman's rank correlation test was used for continuous variables. HMGB-1, measured by Western blot, was significantly (P < 0.001) elevated in CKD 5 (146.7 +/- 58.6 ng/mL) and CKD 3-4 (85.6 +/- 31.8) compared with controls (10.9 +/- 10.5). HMGB-1 levels were correlated positively with TNF (Rho = 0.52; P < 0.001), hs-CRP (Rho = 0.38; P < 0.001), IL-6 (Rho = 0.30; P < 0.001), HbA(1c) (Rho = 0.14; P = 0.02) and SGA (Rho = 0.21; P = 0.002) and negatively correlated with GFR (Rho = -0.69; P = 0.0001), Hb (Rho = -0.60; P < 0.001), S-albumin (Rho = -0.31; P < 0.001). The current study has revealed that HMGB-1 is elevated significantly in CKD patients and correlates with GFR as well as markers of inflammation and malnutrition. Future studies may delineate whether HMGB-1 is also a marker of disease activity and severity as well as a predictor of outcome in CKD.

  19. Effects of Vitamin D Receptor Activation and Dietary Sodium Restriction on Residual Albuminuria in CKD: The ViRTUE-CKD Trial. (United States)

    Keyzer, Charlotte A; van Breda, G Fenna; Vervloet, Marc G; de Jong, Maarten A; Laverman, Gozewijn D; Hemmelder, Marc H; Janssen, Wilbert M T; Lambers Heerspink, Hiddo J; Kwakernaak, Arjan J; Bakker, Stephan J L; Navis, Gerjan; de Borst, Martin H


    Reduction of residual albuminuria during single-agent renin-angiotensin-aldosterone blockade is accompanied by improved cardiorenal outcomes in CKD. We studied the individual and combined effects of the vitamin D receptor activator paricalcitol (PARI) and dietary sodium restriction on residual albuminuria in CKD. In a multicenter, randomized, placebo (PLAC)-controlled, crossover trial, 45 patients with nondiabetic CKD stages 1-3 and albuminuria >300 mg/24 h despite ramipril at 10 mg/d and BPsodium (LS) or regular sodium (RS) diet. We analyzed the treatment effect by linear mixed effect models for repeated measurements. In the intention-to-treat analysis, albuminuria (geometric mean) was 1060 (95% confidence interval, 778 to 1443) mg/24 h during RS + PLAC and 990 (95% confidence interval, 755 to 1299) mg/24 h during RS + PARI (P=0.20 versus RS + PLAC). LS + PLAC reduced albuminuria to 717 (95% confidence interval, 512 to 1005) mg/24 h (Psodium restriction substantially reduced residual albuminuria during fixed dose angiotensin-converting enzyme inhibition. The additional effect of PARI was small and nonsignificant.

  20. Sediment transport in headwaters of a volcanic catchment—Kamchatka Peninsula case study (United States)

    Chalov, Sergey R.; Tsyplenkov, Anatolii S.; Pietron, Jan; Chalova, Aleksandra S.; Shkolnyi, Danila I.; Jarsjö, Jerker; Maerker, Michael


    Due to specific environmental conditions, headwater catchments located on volcanic slopes and valleys are characterized by distinctive hydrology and sediment transport patterns. However, lack of sufficient monitoring causes that the governing processes and patterns in these areas are rarely well understood. In this study, spatiotemporal water discharge and sediment transport from upstream sources was investigated in one of the numerous headwater catchments located in the lahar valleys of the Kamchatka Peninsula Sukhaya Elizovskaya River near Avachinskii and Koryakskii volcanoes. Three different subcatchments and corresponding channel types (wandering rivers within lahar valleys, mountain rivers within volcanic slopes and rivers within submountain terrains) were identified in the studied area. Our measurements from different periods of observations between years 2012-2014 showed that the studied catchment was characterized by extreme diurnal fluctuation of water discharges and sediment loads that were influenced by snowmelt patterns and high infiltration rates of the easily erodible lahar deposits. The highest recorded sediment loads were up to 9•104 mg/L which was related to an increase of two orders of magnitude within a one day of observations. Additionally, to get a quantitative estimate of the spatial distribution of the eroded material in the volcanic substrates we applied an empirical soil erosion and sediment yield model-modified universal soil loss equation (MUSLE). The modeling results showed that even if the applications of the universal erosion model to different non-agricultural areas (e.g., volcanic catchments) can lead to irrelevant results, the MUSLE model delivered might be acceptable for non-lahar areas of the studied volcanic catchment. Overall the results of our study increase our understanding of the hydrology and associated sediment transport for prediction of risk management within headwater volcanic catchments.

  1. Abrupt transition from fractional crystallization to magma mixing at Gorely volcano (Kamchatka) after caldera collapse (United States)

    Gavrilenko, Maxim; Ozerov, Alexey; Kyle, Philip R.; Carr, Michael J.; Nikulin, Alex; Vidito, Christopher; Danyushevsky, Leonid


    A series of large caldera-forming eruptions (361-38 ka) transformed Gorely volcano, southern Kamchatka Peninsula, from a shield-type system dominated by fractional crystallization processes to a composite volcanic center, exhibiting geochemical evidence of magma mixing. Old Gorely, an early shield volcano (700-361 ka), was followed by Young Gorely eruptions. Calc-alkaline high magnesium basalt to rhyolite lavas have been erupted from Gorely volcano since the Pleistocene. Fractional crystallization dominated evolution of the Old Gorely magmas, whereas magma mixing is more prominent in the Young Gorely eruptive products. The role of recharge-evacuation processes in Gorely magma evolution is negligible (a closed magmatic system); however, crustal rock assimilation plays a significant role for the evolved magmas. Most Gorely magmas differentiate in a shallow magmatic system at pressures up to 300 MPa, ˜3 wt% H2O, and oxygen fugacity of ˜QFM + 1.5 log units. Magma temperatures of 1123-1218 °C were measured using aluminum distribution between olivine and spinel in Old and Young Gorely basalts. The crystallization sequence of major minerals for Old Gorely was as follows: olivine and spinel (Ol + Sp) for mafic compositions (more than 5 wt% of MgO); clinopyroxene and plagioclase crystallized at ˜5 wt% of MgO (Ol + Cpx + Plag) and magnetite at ˜3.5 wt% of MgO (Ol + Cpx + Plag + Mt). We show that the shallow magma chamber evolution of Old Gorely occurs under conditions of decompression and degassing. We find that the caldera-forming eruption(s) modified the magma plumbing geometry. This led to a change in the dominant magma evolution process from fractional crystallization to magma mixing. We further suggest that disruption of the magma chamber and accompanying change in differentiation process have the potential to transform a shield volcanic system to that of composite cone on a global scale.

  2. Anaerobic transformation of carbon monoxide by microbial communities of Kamchatka hot springs. (United States)

    Kochetkova, Tatiana V; Rusanov, Igor I; Pimenov, Nikolay V; Kolganova, Tatyana V; Lebedinsky, Alexander V; Bonch-Osmolovskaya, Elizaveta A; Sokolova, Tatyana G


    Carbon monoxide (CO) is one of the common gaseous compounds found in hot volcanic environments. It is known to serve as the growth substrate for a number of thermophilic prokaryotes, both aerobic and anaerobic. The goal of this work was to study the process of anaerobic transformation of CO by microbial communities inhabiting natural thermal environments: hot springs of Uzon Caldera, Kamchatka. The anaerobic microbial community of Treshchinny Spring (80°C, pH 6.5) was found to exhibit two peaks of affinity for CO (K (S1) = 54 nM and K (S2) = 1 μM). The actual rate of anaerobic CO transformation by the microbial community of this spring, calculated after obtaining the concentration dependence curve and extrapolated to the natural concentration of CO dissolved in the hot spring water (20 nM), was found to be 120 μmol l(-1) of sediment day(-1). In all the hot springs studied, more than 90% of the carbon of (14)CO upon anaerobic incubation was recovered as (14)CO(2). From 1 to 5% of (14)CO was transformed to volatile fatty acids (VFA). The number of microorganisms capable of anaerobic CO oxidation determined by dilution-to-extinction method reached 10(6) cells ml(-1) of sediment. CO-transforming anaerobic thermophilic microorganisms isolated from the springs under study exhibited hydrogenogenic type of CO oxidation and belonged to the bacterial genera Carboxydocella and Dictyoglomus. These data suggest a significant role of hydrogenogenic carboxydotrophic prokaryotes in anaerobic CO transformation in Uzon Caldera hot springs.

  3. Sediment transport in headwaters of a volcanic catchment—Kamchatka Peninsula case study (United States)

    Chalov, Sergey R.; Tsyplenkov, Anatolii S.; Pietron, Jan; Chalova, Aleksandra S.; Shkolnyi, Danila I.; Jarsjö, Jerker; Maerker, Michael


    Due to specific environmental conditions, headwater catchments located on volcanic slopes and valleys are characterized by distinctive hydrology and sediment transport patterns. However, lack of sufficient monitoring causes that the governing processes and patterns in these areas are rarely well understood. In this study, spatiotemporal water discharge and sediment transport from upstream sources was investigated in one of the numerous headwater catchments located in the lahar valleys of the Kamchatka Peninsula Sukhaya Elizovskaya River near Avachinskii and Koryakskii volcanoes. Three different subcatchments and corresponding channel types (wandering rivers within lahar valleys, mountain rivers within volcanic slopes and rivers within submountain terrains) were identified in the studied area. Our measurements from different periods of observations between years 2012-2014 showed that the studied catchment was characterized by extreme diurnal fluctuation of water discharges and sediment loads that were influenced by snowmelt patterns and high infiltration rates of the easily erodible lahar deposits. The highest recorded sediment loads were up to 9•104 mg/L which was related to an increase of two orders of magnitude within a one day of observations. Additionally, to get a quantitative estimate of the spatial distribution of the eroded material in the volcanic substrates we applied an empirical soil erosion and sediment yield model-modified universal soil loss equation (MUSLE). The modeling results showed that even if the applications of the universal erosion model to different non-agricultural areas (e.g., volcanic catchments) can lead to irrelevant results, the MUSLE model delivered might be acceptable for non-lahar areas of the studied volcanic catchment. Overall the results of our study increase our understanding of the hydrology and associated sediment transport for prediction of risk management within headwater volcanic catchments.

  4. Is chronic kidney disease-mineral bone disorder (CKD-MBD) really a syndrome? (United States)

    Cozzolino, Mario; Ureña-Torres, Pablo; Vervloet, Marc G; Brandenburg, Vincent; Bover, Jordi; Goldsmith, David; Larsson, Tobias E; Massy, Ziad A; Mazzaferro, Sandro


    The concept of chronic kidney disease-mineral bone disorder (CKD-MBD) does not appear to fulfil the requirements for a syndrome at first glance, but its definition has brought some clear-cut benefits for clinicians and patients, including wider and more complex diagnostic and therapeutic approaches to the management of this challenging set of issues. Admittedly, not all components of CKD-MBD are present in all patients at all times, but these are highly interrelated, involving mineral and bone laboratory abnormalities, clinical and histological bone disease and finally, cardiovascular disease. The presence of typical biological bone ossification processes in an ectopic anatomical location in CKD has helped to define the existence of an unprecedented bone-vascular relationship, extending its interest even to other medical specialities. For now, we believe that CKD-MBD does not reach full criteria to be defined as a syndrome. However, this novel concept has clearly influenced current clinical guidelines. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) guidelines in 2003 for instance recommended that calcium-based phosphate binders should be avoided to treat hyperphosphataemia in the presence of cardiovascular calcifications. In 2009, the KDIGO and other guidelines reinforced and extended this recommendation by stating that it is reasonable to choose oral phosphate binder therapy by taking into consideration other components of CKD-MBD. Similarly, it is also considered reasonable to use information on vascular/valvular calcification to guide the management of CKD-MBD. Our current assumption as a working group 'CKD-MBD' is that CKD-MBD has the potential to be defined a true syndrome, such as a constellation of concurrent signs and symptoms that suggest a common underlying mechanism for these components as opposed to the term disease. The term 'syndrome' also implies that in any patient at risk due to the presence of one or a few

  5. CKD and hypertension during long-term follow-up in children and adolescents previously treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    A.J.M. Zwiers (Alexandra); H. IJsselstijn (Hanneke); J.M. van Rosmalen (Joost); S.J. Gischler (Saskia); S.N. de Wildt (Saskia); D. Tibboel (Dick); K. Cransberg (Karlien)


    markdownabstract__Abstract__ Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term foll

  6. Multiparameter monitoring of short-term earthquake precursors and its physical basis. Implementation in the Kamchatka region

    Directory of Open Access Journals (Sweden)

    Pulinets Sergey


    Full Text Available We apply experimental approach of the multiparameter monitoring of short-term earthquake precursors which reliability was confirmed by the Lithosphere-Atmosphere-Ionosphere Coupling (LAIC model created recently [1]. A key element of the model is the process of Ion induced Nucleation (IIN and formation of cluster ions occurring as a result of the ionization of near surface air layer by radon emanating from the Earth's crust within the earthquake preparation zone. This process is similar to the formation of droplet’s embryos for cloud formation under action of galactic cosmic rays. The consequence of this process is the generation of a number of precursors that can be divided into two groups: a thermal and meteorological, and b electromagnetic and ionospheric. We demonstrate elements of prospective monitoring of some strong earthquakes in Kamchatka region and statistical results for the Chemical potential correction parameter for more than 10 years of observations for earthquakes with M≥6. As some experimental attempt, the data of Kamchatka volcanoes monitoring will be demonstrated.

  7. Satellite thermal monitoring of the 2010 - 2013 eruption of Kizimen volcano (Kamchatka) using MIROVA hot-spot detection system (United States)

    Massimetti, Francesco; Coppola, Diego; Laiolo, Marco; Cigolini, Corrado


    After 81 years of rest, the Holocenic stratovolcano of Kizimen (Kamchatka, Russia) began a new eruptive phase on December 2010. The eruption was preceded by a year-long seismic unrest and fumarole activity, and persisted for 3 years showing a transition from explosive to effusive style. The initial explosive phase caused the partial disruption of the volcano summit and was followed by the effusion of andesitic lava flow along the eastern side of the edifice. Here we used an automatic hot-spot detection system named MIROVA (Middle InfraRed Observation of Volcanic Activity), in order to track the thermal evolution of the eruption and to understand the eruptive dynamic. MIROVA is based on the analysis IR images acquired by the MODIS sensor (Moderate Resolution Imaging Spectroradiometer) and is able to provide thermal maps (1 km resolution) and Volcanic Radiative Power (VRP, in Watt) time series in near real time (1-4 hours from satellite overpass). Each image with a thermal alert has been classified, distinguishing different quality level of the data based on cloud cover, viewing geometry and coherence with the VRP trend. The analysis of VRP variation show different thermal phases that have been correlated with independent observations of KVERT (Kamchatka Volcanic Eruption Response Team). Finally, we show that the relation between total thermal energy radiated (VRE, in Joule) and erupted lava volume is consistent with the typical radiant density of an intermediate-silicic lava flow (Coppola et al., 2013).

  8. Obesity, smoking, and physical inactivity as risk factors for CKD: Are men more vulnerable?

    NARCIS (Netherlands)

    S. Hallan; R. de Mutsert; S. Carlsen; F.W. Dekker; K. Aasarod; J. Holmen


    Background: The incidence of end-stage renal disease is especially high in men, and some studies indicated that smoking is a risk factor for men only. We investigated associations between obesity, smoking, and physical inactivity and chronic kidney disease (CKD) in the general population and whether

  9. Starting together: a focus group for the organization of a CKD outpatient care unit. (United States)

    Piccoli, Giorgina Barbara; Consiglio, Valentina; Deagostini, Maria Chiara; Manente, Elisa; Scarpa, Roberto Mario


    The growing interest in patient empowerment in chronic diseases underlines the importance of assessing patients' opinions in planning healthcare strategies. Focus groups are flexible tools for investigating innovative aspects of care. The aim of the study was to use a focus group to define the main requirements for a chronic kidney disease (CKD) outpatient care unit. The focus group met during the opening of a new CKD outpatient facility. It consisted of 12 patients with long-term experience of CKD, dialysis and transplantation; they had been followed previously by the senior physician, who moderated the discussion. The discussion was tape-recorded and the results were summarized and approved by all participants. The group made 10 major suggestions: 1. Therapeutic continuity in all disease phases, from pre-dialysis to transplantation; 2. Possibility to choose the reference physician; 3. Strict integration with the nursing activities; 4. Organizational flexibility, to adapt to the needs of daily life; 5. To be "fully" taken care of, with organizational support for blood tests, imaging and consultations; 6. Need for time with the reference physician in critical phases of the disease; 7. Identification of a network of consultants, in keeping with the need for continuity of care; 8. Educational sessions; 9. Meetings for critical discussion of organizational performances; 10. As a setting: a home for the disease and not a disease to take home. Continuity of care and flexibility of organization, allowing time for education and discussion, are the quality requirements of our CKD patients.

  10. A resistant starch fiber diet ameliorates oxidative stress, inflammation, and progression of chronic kidney disease (CKD) (United States)

    Inflammation is a constant feature and a major mediator of CKD progression. It is, in part, driven by altered gut microbiome and disruption of intestinal epithelial barrier, events which are primarily caused by: 1- urea influx in the intestine resulting in dominance of urease-possessing bacteria; 2-...

  11. High amylose resistant starch diet ameliorates oxidative stress, inflammation, and progression of chronic kidney disease (CKD) (United States)

    Patients with advanced CKD exhibit profound changes in the composition and function of the gut microbiome. This is, in part, mediated by: I- heavy influx of urea in the intestinal tract leading to the dominance of urease-possessing bacteria and II- dietary restriction of potassium-rich fruits and ve...

  12. Intravenous Iron Repletion Does Not Significantly Decrease Platelet Counts in CKD Patients with Iron Deficiency Anemia

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    Neville R. Dossabhoy


    Full Text Available Purpose. We sought to investigate the effect of IV iron repletion on platelet (PLT counts in CKD patients with iron deficiency anemia (IDA. Methods. We conducted a retrospective chart review, including all patients with CKD and IDA who were treated with iron dextran total dose infusion (TDI between 2002 and 2007. Patient demographics were noted, and laboratory values for creatinine, hemoglobin (Hgb, iron stores and PLT were recorded pre- and post-dose. Results. 153 patients received a total of 251 doses of TDI (mean ± SD = 971 ± 175 mg; age years and Creatinine  mg/dL. All CKD stages were represented (stage 4 commonest. Hgb and Fe stores improved post-TDI (. There was a very mild decrease in PLT (pre-TDI 255 versus post-TDI 244, . The mild reduction in PLT after TDI remained non-significant ( when data was stratified by molecular weight (MW of iron dextran used (low versus high, as well as by dose administered (<1000 versus ≥1000 mg. Linear regression analysis between pre-dose PLT and Tsat and Fe showed R2 of 0.01 and 0.04, respectively. Conclusion. Correction of iron deficiency did not significantly lower PLT in CKD patients, regardless of MW or dose used. Correlation of PLT to severity of iron deficiency was very weak.

  13. Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care. (United States)

    Narva, Andrew S; Norton, Jenna M; Boulware, L Ebony


    Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD. Copyright © 2016 by the American Society of Nephrology.

  14. Tempol, a Superoxide Dismutase-Mimetic Drug, Ameliorates Progression of Renal Disease in CKD Mice

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    Wei Ding


    Full Text Available Background: Oxidative stress has been implicated in the pathogenesis of chronic kidney disease (CKD and antioxidants may ameliorate disease progression. We investigate the beneficial effect of Tempol, a superoxide dismutase-mimetic drug, on progression of disease in a mouse model of CKD. Methods: CKD was surgically induced in c57BL/6 mice by 5/6 nephrectomy. Mice were randomly divided into 3 groups: sham group, 5/6 nephrectomized group (Nx and Nx+Tempol (2 mmol/l in drinking water. Mice were sacrificed at the end of 12 weeks. Renal function, structure as well as expression of key molecules involved in the pathogenesis of inflammation, fibrosis and progression in mice were measured. Results: Reduced body weight and impaired renal function (elevation on serum creatinine, blood urea nitrogen, urine albumin, segmental sclerosis and tubulointerstitial damage was demonstrated in Nx mice but was significantly improved by Tempol administration. Nx animals exhibited significantly elevated proinflammatory and profibrotic factors, activation of NF-κB, increased expression of NADPH oxidase related subunits (p47phox, p67phox, gp91phox, and elevated activation of TGF-ß/Smad3, EGFR, MAPK signaling pathway. Tempol inhibited NF-κB mediated inflammation, TGF-ß/Smad3-induced renal fibrosis as well as EGFR and MAPK signaling pathway activation. Conclusions: Tempol administration attenuated renal injury in CKD mice through NF-κB, TGF-ß/Smad3, redox-senstive EGFR activation and c-Raf/MEK/ERK pathways.

  15. Hepcidin Response to Iron Therapy in Patients with Non-Dialysis Dependent CKD

    NARCIS (Netherlands)

    Gaillard, Carlo A.; Bock, Andreas H.; Carrera, Fernando; Eckardt, Kai-Uwe; Van Wyck, David B.; Bansal, Sukhvinder S.; Cronin, Maureen; Meier, Yvonne; Larroque, Sylvain; Roger, Simon D.; Macdougall, Iain C.


    Hepcidin is the key regulator of iron homeostasis but data are limited regarding its temporal response to iron therapy, and response to intravenous versus oral iron. In the 56-week, open-label, multicenter, prospective, randomized FIND-CKD study, 626 anemic patients with non-dialysis dependent

  16. Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care

    NARCIS (Netherlands)

    Verhave, J.C.; Troyanov, S.; Mongeau, F.; Fradette, L.; Bouchard, J.; Awadalla, P.; Madore, F.


    BACKGROUND AND OBJECTIVES: It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The CARTaGENE study evaluated B

  17. The community health promotion plan: a CKD prevention and management strategy. (United States)

    Sinasac, Lisa


    Chronic kidney disease (CKD) is one of the top 10 causes of death. CKD is often caused by diabetes mellitus (DM) and hypertension (HTN). Both DM Type 2 and HTN are treatable and preventable and, yet, the population of individuals diagnosed with these two diseases is increasing. Millions of dollars are spent every year providing dialysis treatments for patients with CKD. This money only accounts for dialysis and does not include the millions spent on complications such as infections, medications, tests and procedures. The burden to society is tremendous and the quality of life for these people is often poor. Health promotion and early detection is a key factor in reducing the risk for and incidence of DM and HTN, thus reducing the incidence of CKD. Three-quarters of health problems are preventable. Educating and providing the community with resources about diet, exercise, regular physical examinations, medication, and smoking cessation can empower the population with the necessary knowledge to help prevent these diseases. Health promotion and access to health promotion activities can, therefore, provide an active and healthier life.


    Directory of Open Access Journals (Sweden)

    Min-Yu Chang


    Inadequate calories intake will induce excessive protein catabolism, which can cause accumulation of uremic toxins and acceleration of renal failure. Increasing fats intake is an easy way to achieve adequate calories acquirement and may stabilize the progression of CKD especially in low-fat intake patients.

  19. LDL cholesterol in CKD-to treat or not to treat?

    NARCIS (Netherlands)

    Massy, Ziad A.; de Zeeuw, Dick


    In the majority of patients with chronic kidney disease (CKD) the total and low-density lipoprotein (LDL) cholesterol are usually normal, with the exception of patients with nephrotic-range proteinuria and in peritoneal dialysis patients. Moreover, epidemiological evidence shows that the link betwee

  20. The effect of some medications given to CKD patients on vitamin D levels

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    Claudia Yuste


    Conclusions: CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25-OH-D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings.

  1. Assessment of the anti-obesity effects of the TNP-470 analog, CKD-732. (United States)

    Kim, Yoo Mee; An, Juan Ji; Jin, Yong-Jun; Rhee, Yumie; Cha, Bong Soo; Lee, Hyun Chul; Lim, Sung-Kil


    The systemic treatment with angiogenesis inhibitor has been shown to result in weight reduction and adipose tissue loss in various models of obesity. To verify the mechanism of CKD-732 (TNP-470 analog) against obesity, we evaluated CKD-732's peripheral and central anti-obesity effects. CKD-732 was injected subcutaneously (s.c.) for 7 days in various animal models and intracerebroventricularly (i.c.v.) in arcuate nucleus (ARC) lesion mice, ob/ob mice, and normal littermates. Modulation of the hypothalamic neuropeptide mRNAs after i.c.v. injection was evaluated in ARC lesion mice and normal littermates. A conditioned taste aversion (CTA) was performed using lithium chloride (LiCl) as a positive control agent in Long-Evans Tokushima Otsuka and Otsuka Long-Evans Tokushima fatty (OLETF) rats. As a result, 7 days of CKD-732 s.c. injection reduced the cumulative food intake and the body weight significantly in both treated obese (e.g. 114.8 +/- 13.4 g vs 170.7 +/- 20.6 g, 7.9 +/- 0.5% decrease vs 0.3 +/- 2.2% decrease; in treated OLETF rat versus control OLETF rat, P obese models. Epididymal and mesenteric fat pads, and the size of adipocytes were significantly decreased in treated rats. A single i.c.v. injection decreased food intake and body weight in ARC lesion mice and ob/ob mice but not in normal littermates. Unexpectedly, the hypothalamic neuropeptide mRNAs were not altered by single i.c.v. injection. CKD-732 also induced a dose-dependent CTA comparable with LiCl injection, which is a commonly used agent to produce a CTA. In conclusion, CKD-732 causes significant body weight and appetite reduction, possibly by decreasing adiposity directly and inducing central anorexia, which is partly explained by a CTA. These results should be carefully verified to assess the utility of CKD-732 as an anti-obesity drug.

  2. KDOQI US commentary on the 2013 KDIGO Clinical Practice Guideline for Lipid Management in CKD. (United States)

    Sarnak, Mark J; Bloom, Roy; Muntner, Paul; Rahman, Mahboob; Saland, Jeffrey M; Wilson, Peter W F; Fried, Linda


    The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

  3. Measured GFR Does Not Outperform Estimated GFR in Predicting CKD-related Complications (United States)

    Propert, Kathleen; Xie, Dawei; Hamm, Lee; He, Jiang; Miller, Edgar; Ojo, Akinlolu; Shlipak, Michael; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wilson, Jillian; Feldman, Harold


    Although many assume that measurement of glomerular filtration rate (GFR) using a marker such as iothalamate (iGFR) is superior to equation-estimated GFR (eGFR), each of these methods has distinct disadvantages. Because physicians often use renal function to guide the screening for various CKD-associated complications, one method to compare the clinical utility of iGFR and eGFR is to determine the strength of their association with CKD-associated comorbidities. Using a subset of 1214 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, we determined the cross-sectional associations between known complications of CKD and iGFR, eGFR estimated from serum creatinine (eGFR_Cr), and eGFR estimated from cystatin C (eGFR_cysC). We found that none of the measures of renal function strongly associated with CKD complications and that the relative strengths of associations varied according to the outcome of interest. For example, iGFR demonstrated better discrimination than eGFR_Cr and eGFR_cysC for outcomes of anemia and hemoglobin concentration; however, both eGFR_Cr and eGFR_cysC demonstrated better discrimination than iGFR for outcomes of hyperphosphatemia and phosphorus level. iGFR and eGFR had similar strengths of association with hyperkalemia/potassium level and with metabolic acidosis/bicarbonate level. In conclusion, iothalamate measurement of GFR is not consistently superior to equation-based estimations of GFR in explaining CKD-related comorbidities. These results raise questions regarding the conventional view that iGFR is the “gold standard” measure of kidney function. PMID:21921144

  4. Geochemical evolution of Bolshaya Udina, Malaya Udina, and Gorny Zub Volcanoes, Klyuchevskaya Group (Kamchatka) (United States)

    Churikova, Tatiana; Gordeychik, Boris; Wörner, Gerhard; Flerov, Gleb; Hartmann, Gerald; Simon, Klaus


    The Klyuchevskaya group of volcanoes (KGV) located in the northern part of Kamchatka has the highest magma production rate for any arc worldwide and several of its volcanoes have been studied in considerable detail [e.g. Kersting & Arculus, 1995; Pineau et al., 1999; Dorendorf et al., 2000; Ozerov, 2000; Churikova et al., 2001, 2012, 2015; Mironov et al., 2001; Portnyagin et al., 2007, 2015; Turner et al., 2007]. However, some volcanoes of the KGV including Late-Pleistocene volcanoes Bolshaya Udina, Malaya Udina, Ostraya Zimina, Ovalnaya Zimina, and Gorny Zub were studied only on a reconnaissance basis [Timerbaeva, 1967; Ermakov, 1977] and the modern geochemical studies have not been carried out at all. Among the volcanoes of KGV these volcanoes are closest to the arc trench and may hold information on geochemical zonation with respect to across arc source variations. We present the first major and trace element data on rocks from these volcanoes as well as on their basement. All rocks are medium-calc-alkaline basaltic andesites to dacites except few low-Mg basalts from Malaya Udina volcano. Phenocrysts are mainly olivine, pyroxene, plagioclase and magnetite, Hb-bearing andesites and dacites are rarely found only in subvolcanic intrusions at Bolshaya Udina volcano. Lavas are geochemically similar to the active Bezymianny volcano, however, individual variations for each volcano exist in both major and trace elements. Trace element geochemistry is typical of island arc volcanism. Compared to KGV lavas all studied rocks form very narrow trends in all major element diagrams, which almost do not overlap with the fields of other KGV volcanoes. The lavas are relatively poor in alkalis, TiO2, P2O5, FeO, Ni, Zr, and enriched in SiO2 compared to other KGV volcanics and show greater geochemical and petrological evidence of magmatic differentiation during shallow crustal processing. Basement samples of the Udinskoe plateau lavas to the east of Bolshaya Udina volcano have

  5. Gas flux measurements of episodic bimodal eruptive activity at Karymsky volcano (Kamchatka, Russia) (United States)

    Arellano, S.; Galle, B.; Melnikov, D.


    Volcanoes of intermediate magmatic composition commonly exhibit episodes of intermittent gas and ash emission of variable duration. Due to the multiple conditions present at each system, different mechanisms have been proposed to account for the observed activity, and without key measurements at hand, a definite understanding of the situation might not be singled out. Karymsky, the most active volcano of Central Kamchatka, has presented a remarkably stable pattern of bimodal eruption since a few weeks after its violent reactivation in 1996. Periods of quasi-periodic explosive emissions with typical recurrence intervals of 3-10 min are alternated with episodes of semi-continuous discharge which intensity has a typical modulation at a frequency of 1 Hz. Geophysical studies at Karymsky have identified the main visual, seismic and acoustic features of these two eruption modalities. From these observations, the time scales of the processes have been defined and relevant models have been formulated, according to which the two modes are controlled by the rheological properties of an intruding gas-saturated magma batch and a shallow gas-depleted magma plug. Explosions are explained as the consequence of the formation of temporary sealing, overpressure buildup and vent clearance. Clearly, direct measurements of the gas emission rate are the key parameter to test such models. In this work, we report on the results of a field campaign for SO2 gas measurements carried out at Karymsky during 10-14 September 2011. We deployed 2 NOVAC-type, scanning DOAS systems as well as 1 rapid wide-Field of View mini-DOAS plume tracker. With this setup, we derived time-resolved SO2 flux, plume height, direction and speed, and detected pulses of increasing emission with high temporal resolution. We observed phases of explosive and quiescent degassing with variable amounts of ash emission and detected intensity changes of the associated acoustic signals. The repose time intervals between these

  6. Petrological and geochemical evolution of the Tolbachik volcanic massif, Kamchatka, Russia (United States)

    Churikova, Tatiana G.; Gordeychik, Boris N.; Iwamori, Hikaru; Nakamura, Hitomi; Ishizuka, Osamu; Nishizawa, Tatsuji; Haraguchi, Satoru; Miyazaki, Takashi; Vaglarov, Bogdan S.


    Data on the geology, petrography, and geochemistry of Middle-Late-Pleistocene rocks from the Tolbachik volcanic massif (Kamchatka, Klyuchevskaya group of volcanoes) are presented and compared with rocks from the neighboring Mount Povorotnaya, Klyuchevskaya group basement, and Holocene-historical Tolbachik monogenetic cones. Two volcanic series of lavas, middle-K and high-K, are found in the Tolbachik massif. The results of our data analysis and computer modeling of crystallization at different P-T-H2O-fO2 conditions allow us to reconstruct the geochemical history of the massif. The Tolbachik volcanic massif started to form earlier than 86 ka based on K-Ar dating. During the formation of the pedestal and the lower parts of the stratovolcanoes, the middle-K melts, depleted relative to NMORB, fractionated in water-rich conditions (about 3% of H2O). At the Late Pleistocene-Holocene boundary, a large fissure zone was initiated and the geodynamical regime changed. Upwelling associated with intra-arc rifting generated melting from the same mantle source that produced magmas more enriched in incompatible trace elements and subduction components; these magmas are high-K, not depleted relative to N-MORB melts with island arc signatures and rift-like characteristics. The fissure opening caused degassing during magma ascent, and the high-K melts fractionated at anhydrous conditions. These high-K rocks contributed to the formation of the upper parts of stratovolcanoes. At the beginning of Holocene, the high-K rocks became prevalent and formed cinder cones and associated lava fields along the fissure zone. However, some features, including 1975-1976 Northern Breakthrough, are represented by middle-K high-Mg rocks, suggesting that both middle-K and high-K melts still exist in the Tolbachik system. Our results show that fractional crystallization at different water conditions and a variably depleted upper mantle source are responsible for all observed variations in rocks within

  7. The Holocene environmental history of a small coastal lake on the north-eastern Kamchatka Peninsula (United States)

    Solovieva, N.; Klimaschewski, A.; Self, A. E.; Jones, V. J.; Andrén, E.; Andreev, A. A.; Hammarlund., D.; Lepskaya, E. V.; Nazarova, L.


    A radiocarbon and tephra-dated sediment core from Lifebuoy Lake, located on the north-east coast of Kamchatka Peninsula, was analysed for pollen, spores, diatoms, chironomids and tephra in order to uncover regional environmental history. The 6500-year environmental history of Lifebuoy Lake correlates with the broad regional patterns of vegetation development and climate dynamics with both diatoms and chironomids showing near-synchronous changes. Between ca. 6300 and 3900 cal yr BP, the lake ecosystem was naturally enriched, with several Stephanodiscus species dominating the diatom plankton. This natural eutrophication state is likely to be due to a combination of the base-rich catchment geology, the fertilisation effect of several fires in the catchment, silica input from tephra layers and, possibly, nitrogen input from seabirds. The substantial tephra deposit at about 3850 cal yr BP might have stopped sedimentary phosphorus from entering the lake water thus decreasing the trophic state of the lake and facilitating the shift in diatom composition to a benthic Fragiliariaceae complex. Both diatoms and chironomids showed simultaneous compositional changes, which are also reflected by statistically significant changes in their rates of change 300-400 years after the arrival of Pinus pumila in the lake catchment. The rapid increase in both total diatom concentration and the percentage abundance of the large heavy species, Aulacoseira subarctica might be a response to the change in timing and intensity of lake spring turn-over due to the changes in the patterns of North Pacific atmospheric circulation, most notably westward shift of the Aleutian Low. The two highest peaks in A. subarctica abundance at Lifebouy Lake occurred during opposite summer temperature inferences: the earlier peak (3500-2900 cal yr BP) coincided with warm summers and the latter peak (300 cal yr BP-present) occurred during the cold summer period. These imply that A. subarctica shows no direct

  8. Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD). (United States)

    Fujii, Naohiko; Hamano, Takayuki; Mikami, Satoshi; Nagasawa, Yasuyuki; Isaka, Yoshitaka; Moriyama, Toshiki; Horio, Masaru; Imai, Enyu; Hori, Masatsugu; Ito, Takahito


    Recent post hoc analysis proved the efficacy and tolerability of risedronate in osteoporotic patients with renal impairment, but the combination of active vitamin D in chronic kidney disease (CKD) patients taking glucocorticoids remains unknown. We conducted a prospective study enrolling 114 CKD patients (creatinine clearance > or =30 ml/min/1.73 m(2)) receiving glucocorticoid therapy for > or =6 months. Eighty-eight subjects who had received active vitamin D (aVD) were randomly assigned to either a group treated with aVD only (group A), or to a group also receiving risedronate 2.5 mg/day (group B). The remaining patients (group C) received risedronate only. After 1 year 100 subjects were analysed. Risedronate was effective on the lumbar spine, but not on the femoral neck. The lumbar bone mineral density (BMD) significantly increased by 2.8 and 2.5% in groups B and C, respectively, but decreased by 1.0% in group A. Serum N-terminal telopeptides of type I collagen (S-NTX) and bone alkaline phosphatase (ALP) fell significantly in groups B and C at 3 and 6 months, respectively, while in group A S-NTX remained unchanged and bone ALP significantly increased. There was no significant difference between groups B and C regarding BMD and bone markers. The reduction rate of S-NTX (bone ALP) at 6 months predicted the increase in lumbar BMD at 1 year with a sensitivity of 73% (34%) and a specificity of 46.2% (100%). Risedronate is effective in increasing BMD with or without aVD in CKD patients receiving long-term glucocorticoid therapy. Bone markers are of some use in predicting the response to anti-resorptive therapy.

  9. Postpartum Depression (United States)

    ... starts about 1–3 weeks after childbirth. What causes postpartum depression? Postpartum depression probably is caused by a combination ... better. Can antidepressants cause side effects? Antidepressants can ... If your depression worsens soon after starting medication or if you ...

  10. Caregiver Depression (United States)

    ... will not sell or share your name. Caregiver Depression Tweet Bookmark this page | Email | Print Many caregivers ... depression See your doctor Treatment Coping Symptoms of depression Caregiving is hard — and can lead to feelings ...

  11. High-Mg# andesitic lavas of the Shisheisky Complex, Northern Kamchatka: implications for primitive calc-alkaline magmatism (United States)

    Bryant, J. A.; Yogodzinski, G. M.; Churikova, T. G.


    Primitive arc magmatism and mantle wedge processes are investigated through a petrologic and geochemical study of high-Mg# (Mg/Mg + Fe > 0.65) basalts, basaltic andesites and andesites from the Kurile-Kamchatka subduction system. Primitive andesitic samples are from the Shisheisky Complex, a field of Quaternary-age, monogenetic cones located in the Aleutian-Kamchatka junction, north of Shiveluch Volcano, the northernmost active composite volcano in Kamchatka. The Shisheisky lavas have Mg# of 0.66-0.73 at intermediate SiO2 (54-58 wt%) with low CaO (3.0 wt%) and K2O (>1.0 wt%). Olivine phenocryst core compositions of Fo90 appear to be in equilibrium with whole-rock `melts', consistent with the sparsely phyric nature of the lavas. Compared to the Shisheisky andesites, primitive basalts from the region (Kuriles, Tolbachik, Kharchinsky) have higher CaO (>9.9 wt%) and CaO/Al2O3 (>0.60), and lower whole-rock Na2O (andesites. The absence of plagioclase phenocrysts from the primitive andesitic lavas contrasts the plagioclase-phyric basalts, indicating relatively high pre-eruptive water contents for the primitive andesitic magmas compared to basalts. Estimated temperature and water contents for primitive basaltic andesites and andesites are 984-1,143°C and 4-7 wt% H2O. For primitive basalts they are 1,149-1,227°C and 2 wt% H2O. Petrographic and mineral compositions suggest that the primitive andesitic lavas were liquids in equilibrium with mantle peridotite and were not produced by mixing between basalts and felsic crustal melts, contamination by xenocrystic olivine, or crystal fractionation of basalt. Key geochemical features of the Shisheisky primitive lavas (high Ni/MgO, Na2O, Ni/Yb and Mg# at intermediate SiO2) combined with the location of the volcanic field above the edge of the subducting Pacific Plate support a genetic model that involves melting of eclogite or pyroxenite at or near the surface of the subducting plate, followed by interaction of that melt with

  12. Holocene environmental changes in southern Kamchatka, Far Eastern Russia, inferred from a pollen and testate amoebae peat succession record (United States)

    Klimaschewski, A.; Barnekow, L.; Bennett, K. D.; Andreev, A. A.; Andrén, E.; Bobrov, A. A.; Hammarlund, D.


    High resolution palaeoenvironmental records in Far-Eastern Russia are rare, and the Kamchatka Peninsula is among the least studied areas of the region. This paper describes a record spanning the last ca. 11,000 yr, obtained from a bog in the southern part of Kamchatka. The radiocarbon dated core was analysed for pollen, testate amoebae, charcoal and loss-on-ignition (LOI). The vegetation during the early Holocene was dominated by grasses (Poaceae), birch (Betula) and heath (Ericaceae p. p.). Around 10,300 cal yr BP there was a substantial change in the vegetation cover to shrub alder (Alnus viridis s.l.) stands with sedges and ferns (Polypodiophyta) as well as herbs such as meadow rue (Thalictrum) in the understory. In the surroundings of Utka peatlands started to form. The variations in the vegetation cover were most probably caused by climatic changes. At the beginning of sediment accumulation, before 10,300 cal yr BP, the composition of the vegetation points to cooler summers and/or decreased annual precipitation. Around 10,300 cal yr BP, changes in vegetation occurred due to rising temperatures and/or changed water regimes. Increased abundancies of dry indicating testate amoebae after 9100 cal yr BP point to intermediate to dry soil conditions. Between 8600 and 7700 cal yr BP tree alder (Alnus incana) was widely spread at the site which probably indicates optimal environmental conditions. The tephra layer at 381-384.5 cm (ca. 8500 cal yr BP) produces a strong impact on the testate amoebae assemblages. At 7700 cal yr BP there was a sudden drop of A. incana in the local vegetation. From this time on, A. incana and also A. viridis decrease continuously whereas Betula gradually increases. The upper part of the sequence (after 6300 cal yr BP) shows higher abundancies of meadowsweet (Filipendula) and sweet gale (Myrica) pollen. After 6300 cal yr BP, changes in testate amoebae demonstrate variable soil moisture conditions at the site. Between 3700 and 1800 cal yr BP

  13. Association between Urine Creatinine Excretion and Arterial Stiffness in Chronic Kidney Disease: Data from the KNOW-CKD Study

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    Young Youl Hyun


    Full Text Available Background/Aims: Previous studies have shown that low muscle mass is associated with arterial stiffness, as measured by pulse wave velocity (PWV, in a population without chronic kidney disease (CKD. This link between low muscle mass and arterial stiffness may explain why patients with CKD have poor cardiovascular outcomes. However, the association between muscle mass and arterial stiffness in CKD patients is not well known. Methods: Between 2011 and 2013, 1,529 CKD patients were enrolled in the prospective Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD. We analyzed 888 participants from this cohort who underwent measurements of 24-hr urinary creatinine excretion (UCr and brachial-ankle PWV (baPWV at baseline examination. The mean of the right and left baPWV (mPWV was used as a marker of arterial stiffness. Results: The baPWV values varied according to the UCr quartile (1,630±412, 1,544±387, 1,527±282 and 1,406±246 for the 1st to 4th quartiles of UCr, respectively, PConclusion: Low muscle mass estimated by low UCr was associated high baPWV in pre-dialysis CKD patients in Korea. Further studies are needed to confirm the causal relationship between UCR and baPWV, and the role of muscle mass in the development of cardiovascular disease in CKD.

  14. Nonapnea Sleep Disorders in Patients Younger than 65 Years Are Significantly Associated with CKD: A Nationwide Population-Based Study.

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    Hugo You-Hsien Lin

    Full Text Available Nonapnea sleep disorders (NASD and sleep-related problems are associated with poor health outcomes. However, the association between NASD and the development and prognosis of chronic kidney disease (CKD has not been investigated thoroughly. We explored the association between CKD and NASD in Taiwan.We conducted a population-based study using the Taiwan National Health Insurance database with1,000,000 representative data for the period from January 1, 2000 to December 31, 2009. We investigated the incidence and risk of CKD in 7,006 newly diagnosed NASD cases compared with 21,018 people without NASD matched according to age, sex, index year, urbanization, region, and monthly income at a 1:3 ratio.The subsequent risk of CKD was 1.48-foldhigher in the NASD cohort than in the control cohort (95% confidence interval [CI] = 1.26-1.73, p< 0.001. Men, older age, type 2 diabetes mellitus, and gout were significant factors associated with the increased risk of CKD (p< 0.001. Among different types of NASDs, patients with insomnia had a 52% increased risk of developing CKD (95%CI = 1.23-1.84; P<0.01, whereas patients with sleep disturbance had a 49%increased risk of subsequent CKD (95% CI = 1.19-1.87; P<0.001. Younger women (aged < 65 years were at a high risk of CKD with NASD (adjusted hazard ratio, [HR] = 1.81; 95% CI = 1.35-2.40, p< 0.001.In this nationwide population-based cohort study, patients with NASD, particularly men of all ages and women aged younger than 65 years, were at high risk of CKD.

  15. MDRD or CKD-EPI for glomerular filtration rate estimation in living kidney donors. (United States)

    Burballa, Carla; Crespo, Marta; Redondo-Pachón, Dolores; Pérez-Sáez, María José; Mir, Marisa; Arias-Cabrales, Carlos; Francés, Albert; Fumadó, Lluis; Cecchini, Lluis; Pascual, Julio


    The evaluation of the measured Glomerular Filtration Rate (mGFR) or estimated Glomerular Filtration Rate (eGFR) is key in the proper assessment of the renal function of potential kidney donors. We aim to study the correlation between glomerular filtration rate estimation equations and the measured methods for determining renal function. We analysed the relationship between baseline GFR values measured by Tc-(99)m-DTPA (diethylene-triamine-pentaacetate) and those estimated by the four-variable Modification of Diet in Renal Disease (MDRD4) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in a series of living donors at our institution. We included 64 donors (70.6% females; mean age 48.3±11 years). Baseline creatinine was 0.8±0.1 mg/dl and it was 1.1±0.2 mg/dl one year after donation. The equations underestimated GFR when measured by Tc(99)m-DTPA (MDRD4-9.4 ± 25ml/min, P<.05, and CKD-EPI-4.4 ± 21ml/min). The correlation between estimation equations and the measured method was superior for CKD-EPI (r=.41; P<.004) than for MDRD4 (r=.27; P<.05). eGFR decreased to 59.6±11 (MDRD4) and 66.2±14ml/min (CKD-EPI) one year after donation. This means a mean eGFR reduction of 28.2±16.7 ml/min (MDRD4) and 27.31±14.4 ml/min (CKD-EPI) at one year. In our experience, CKD-EPI is the equation that better correlates with mGFR-Tc(99)m-DTPA when assessing renal function for donor screening purposes. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Can we delay the progression of chronic kidney disease (CKD) by improving collaboration between renal units and primary care teams? (United States)

    Thomas, N


    This paper will discuss why nephrology teams should collaborate with primary care teams in delaying the progression of chronic kidney disease (CKD), and explain how they can collaborate to improve the outcomes for patients who eventually need dialysis. The paper will describe the staging of CKD and will discuss evidence-based guidelines for the management of CKD in the community. Practical examples of how a specialist renal nurse can improve communication with primary care and can improve the outcome of patients with early kidney disease will be described.

  17. 2008 Volcanic activity in Alaska, Kamchatka, and the Kurile Islands: Summary of events and response of the Alaska Volcano Observatory (United States)

    Neal, Christina A.; McGimsey, Robert G.; Dixon, James P.; Cameron, Cheryl E.; Nuzhdaev, Anton A.; Chibisova, Marina


    The Alaska Volcano Observatory (AVO) responded to eruptions, possible eruptions, and volcanic unrest or suspected unrest at seven separate volcanic centers in Alaska during 2008. Significant explosive eruptions at Okmok and Kasatochi Volcanoes in July and August dominated Observatory operations in the summer and autumn. AVO maintained 24-hour staffing at the Anchorage facility from July 12 through August 28. Minor eruptive activity continued at Veniaminof and Cleveland Volcanoes. Observed volcanic unrest at Cook Inlet's Redoubt Volcano presaged a significant eruption in the spring of 2009. AVO staff also participated in hazard communication regarding eruptions or unrest at nine volcanoes in Russia as part of a collaborative role in the Kamchatka and Sakhalin Volcanic Eruption Response Teams.

  18. International Studies of Hazardous Groundwater/Surface Water Exchange in the Volcanic Eruption and Tsunami Affected Areas of Kamchatka (United States)

    Kontar, Y. A.; Gusiakov, V. K.; Izbekov, P. E.; Gordeev, E.; Titov, V. V.; Verstraeten, I. M.; Pinegina, T. K.; Tsadikovsky, E. I.; Heilweil, V. M.; Gingerich, S. B.


    During the US-Russia Geohazards Workshop held July 17-19, 2012 in Moscow, Russia the international research effort was asked to identify cooperative actions for disaster risk reduction, focusing on extreme geophysical events. As a part of this recommendation the PIRE project was developed to understand, quantify, forecast and protect the coastal zone aquifers and inland water resources of Kamchatka (Russia) and its ecosystems affected by the November 4, 1952 Kamchatka tsunami (Khalatyrka Beach near Petropavlovsk-Kamchatskiy) and the January 2, 1996 Karymskiy volcano eruption and the lake tsunami. This project brings together teams from U.S. universities and research institutions located in Russia. The research consortium was briefed on recent technical developments and will utilize samples secured via major international volcanic and tsunami programs for the purpose of advancing the study of submarine groundwater discharge (SGD) in the volcanic eruption and tsunami affected coastal areas and inland lakes of Kamchatka. We plan to accomplish this project by developing and applying the next generation of field sampling, remote sensing, laboratory techniques and mathematical tools to study groundwater-surface water interaction processes and SGD. We will develop a field and modeling approach to define SGD environment, key controls, and influence of volcano eruption and tsunami, which will provide a framework for making recommendations to combat contamination. This is valuable for politicians, water resource managers and decision-makers and for the volcano eruption and tsunami affected region water supply and water quality of Kamchatka. Data mining and results of our field work will be compiled for spatial modeling by Geo-Information System (GIS) using 3-D Earth Systems Visualization Lab. The field and model results will be communicated to interested stakeholders via an interactive web site. This will allow computation of SGD spatial patterns. In addition, thanks to the

  19. Isolation, characterization and molecular cloning of Duplex-Specific Nuclease from the hepatopancreas of the Kamchatka crab

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    Vagner Laura L


    Full Text Available Abstract Background Nucleases, which are key components of biologically diverse processes such as DNA replication, repair and recombination, antiviral defense, apoptosis and digestion, have revolutionized the field of molecular biology. Indeed many standard molecular strategies, including molecular cloning, studies of DNA-protein interactions, and analysis of nucleic acid structures, would be virtually impossible without these versatile enzymes. The discovery of nucleases with unique properties has often served as the basis for the development of modern molecular biology methods. Thus, the search for novel nucleases with potentially exploitable functions remains an important scientific undertaking. Results Using degenerative primers and the rapid amplification of cDNA ends (RACE procedure, we cloned the Duplex-Specific Nuclease (DSN gene from the hepatopancreas of the Kamchatka crab and determined its full primary structure. We also developed an effective method for purifying functional DSN from the crab hepatopancreas. The isolated enzyme was highly thermostable, exhibited a broad pH optimum (5.5 – 7.5 and required divalent cations for activity, with manganese and cobalt being especially effective. The enzyme was highly specific, cleaving double-stranded DNA or DNA in DNA-RNA hybrids, but not single-stranded DNA or single- or double-stranded RNA. Moreover, only DNA duplexes containing at least 9 base pairs were effectively cleaved by DSN; shorter DNA duplexes were left intact. Conclusion We describe a new DSN from Kamchatka crab hepatopancreas, determining its primary structure and developing a preparative method for its purification. We found that DSN had unique substrate specificity, cleaving only DNA duplexes longer than 8 base pairs, or DNA in DNA-RNA hybrids. Interestingly, the DSN primary structure is homologous to well-known Serratia-like non-specific nucleases structures, but the properties of DSN are distinct. The unique substrate

  20. Hepatitis B Virus Infection and Anti-HBc (Total Positivity in CKD Patients before Dialysis

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    Fareha Jesmin Rabbi


    Full Text Available Background: CKD patients are associated with HBV infection both as a cause and complication of treatment. CKD patients before starting dialysis therapy are considered as a high risk group because of impaired immune response compared with healthy individuals and also other risk factors related with treatment and management. Only HBsAg marker does not always follow the presence or absence of HBV infection. Anti-HBc (total alone positivity indicates previous exposure to HBV infection, window period and even after reactivation of resolved HBV infection. In some cases only anti-HBc positivity is interpreted as possible chronic low dose HBV infection (chronic carriage. Predialytic CKD patients were tested with three serological markers [HBsAg, anti-HBc (total and anti-HBs] for screening HBV infection. Proper diagnosis before dialysis and knowing the infection status would help both the patient and doctor to choose proper treatment approach. Objective: This cross-sectional study was done in the CKD patients before starting dialysis therapy to find out the HBV infection and to evaluate the infection by minimal serological markers as for screening. Materials and Methods: A total of 211 patients with chronic kidney disease stage five (CKD-V before starting dialysis therapy were included as subjects of this cross-sectional study. Among the CKD patients HBsAg was tested to see the prevalence. Other serological markers, i.e., anti-HBc (total and anti-HBs were tested in combination with HBsAg in 89 randomly selected patients among the subjects. The patients were also tested for anti-HCV to assess co-infection. After collecting all the data of different test results analyses were done by SPSS version 15.0. Results: Among total study population 10 (4.7% patients were found HBsAg positive. No patient was found positive for both HBsAg and anti-HCV. Among the 89 CKD patients only 2 (2.2% patients were HBsAg positive, and only one patient (0.9% was found positive

  1. Relation of Serum Lipids and Lipoproteins with Progression of CKD: The CRIC Study (United States)

    Yang, Wei; Akkina, Sanjeev; Alper, Arnold; Anderson, Amanda Hyre; Appel, Lawrence J.; He, Jiang; Raj, Dominic S.; Schelling, Jeffrey; Strauss, Louise; Teal, Valerie; Rader, Daniel J.


    Background and objectives Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD. Design, setting, participants, & measurements Prospective cohort study in adults (n=3939) with CKD aged 21–74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR). Results Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m2; 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories. Conclusions In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria. PMID:24832097

  2. The effect of some medications given to CKD patients on vitamin D levels. (United States)

    Yuste, Claudia; Quiroga, Borja; de Vinuesa, Soledad García; Goicoechea, Maria Angeles; Barraca, Daniel; Verdalles, Ursula; Luño, Jose


    Vitamin D deficiency and polypharmacy is a common problem over chronic kidney disease (CKD) population. To assess the clinical and analytical characteristics of CKD patients with 25-OH-D3 deficiency (<15 ng/mL), including the possible role of associated drugs. A single center observational review of 137 incident patients referred to our outpatient clinic with different stages of CKD and 25-OH-D3<15ng/mL (male gender 53.3%, mean age 70.8 [±16.1] years, mean GFR (MDRD-4) 43.6 [±25.5] ml/min/1.73 m²). 25-OH-D3 levels were collected in spring. Clinical and biochemical data and associated medications were recorded. Mean 25-OH-D3 levels were 8.23 [±4.03] ng/ml. Eighty-eight patients (64.7%) had 3 or more concomitant drugs. Only 7 patients (5.1%) were not receiving any medication. Patients were divided in three groups according the therapies into none (n=26), RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30); with the aim to study the influence of statin therapy. Patients under renin angiotensin (RAS) inhibitors or Allopurinol treatment presented significantly higher 25-OH-D3 levels (p=0.001 and p=0.01 respectively), however patients with Statins treatment had lower 25-OH-D3 level (p=0.039). Personal history of diabetes, cardiovascular events or other therapies did not modify 25-OH-D3 levels, adjusted by age and eGFR. CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25-OH-D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings. Copyright © 2015. Published by Elsevier España, S.L.U.

  3. Phytoextraction of chloride from a cement kiln dust (CKD) contaminated landfill with Phragmites australis. (United States)

    McSorley, Kaitlin; Rutter, Allison; Cumming, Robert; Zeeb, Barbara A


    Cement kiln dust (CKD) is a globally produced by-product from cement manufacturing that is stockpiled or landfilled. Elevated concentrations of chloride pose toxic threats to plants and aquatic communities, as the anion is highly mobile in water and can leach into surrounding water sources. Re-vegetation and in situ phytoextraction of chloride from a CKD landfill in Bath, ON, Canada, was investigated with the resident invasive species Phragmites australis (haplotype M). Existing stands of P. australis were transplanted from the perimeter of the site into the highest areas of contamination (5.9×10(3)μg/g). Accumulation in the shoots of P. australis was quantified over one growing season by collecting samples from the site on a bi-weekly basis and analyzing for chloride. Concentrations decreased significantly from early May (24±2.2×10(3)μg/g) until mid-June (15±2.5×10(3)μg/g), and then remained stable from June to August. Shoot chloride accumulation was not significantly affected by water level fluctuations at the site, however elevated potassium concentrations in the soil may have contributed to uptake. Based on shoot chloride accumulation and total biomass, it was determined that phytoextraction from the CKD landfill can remove 65±4kg/km(2) of chloride per season. Based on this extraction rate, removal of chloride present in the highly contaminated top 10cm of soil can be achieved in 3-9years. This is the first study to apply phytotechnologies at a CKD landfill, and to successfully demonstrate in situ phytoextraction of chloride.

  4. Clinical features of CKD-MBD in Japan: cohort studies and registry. (United States)

    Hamano, Takayuki; Sakaguchi, Yusuke; Fujii, Naohiko; Isaka, Yoshitaka


    Randomized controlled trials (RCTs) are essential for evidence-based medicine; however, cohort studies and registries provide an important information about risk factors and, hence, shed light on the target of laboratory parameters. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target range of intact parathyroid hormone levels than those used in other countries, which is based on analyses of the nationwide Japan Renal Data Registry. Cohort studies were also useful in exploring risk factors of renal outcome in predialysis patients. It was revealed that low vitamin D status (very prevalent in Japan) and high fibroblast growth factor 23 (FGF23) levels predict poor renal outcome. The reported association of FGF23 levels with left ventricular hypertrophy (LVH) and heart failure observed in cohort studies may support the idea of adding the 4th component of CKD-MBD, namely, "LVH" to the three original components. When it is not feasible to conduct RCTs regarding intervention, we have no choice but to rely on observational studies with sophisticated analysis methods, such as facility-level analysis and marginal structural model minimizing indication bias. Observational studies conducted in Japan revealed that the side effects of medications for CKD-MBD, resultant compliance, and effective doses in terms of hard outcome in Japanese patients were found to be different from those in other countries. For example, the MBD-5D study confirmed the benefit of cinacalcet in terms of mortality despite its median dose of only 25 mg/day. These data are very helpful for future guidelines specific to Japanese patients with CKD.

  5. High Mobility Group Box Protein-1 Correlates with Renal Function in Chronic Kidney Disease (CKD)


    Bruchfeld, Annette; Qureshi, Abdul Rashid; Lindholm, Bengt; Barany, Peter; Yang, Lihong; Stenvinkel, Peter; Tracey, Kevin J.


    Chronic kidney disease (CKD) is associated with inflammation and malnutrition and carries a markedly increased risk of cardiovascular disease (CVD). High Mobility Group Box Protein-1 (HMGB-1) is a 30-kDa nuclear and cytosolic protein known as a transcription and growth factor, recently identified as a proinflammatory mediator of tissue injury. Recent data implicates HMGB-1 in endotoxin lethality, rheumatoid arthritis, and atherosclerosis. The aim of this post-hoc, cross-sectional study was to...

  6. Use of administrative databases for health-care planning in CKD. (United States)

    Bello, Aminu; Hemmelgarn, Brenda; Manns, Braden; Tonelli, Marcello


    Good-quality information is required to plan healthcare services for patients with chronic diseases. Such information includes measures of disease burden, current care patterns and gaps in care based on quality-of-care indicators and clinical outcomes. Administrative data have long been used as a source of information for policy decisions related to the management of chronic diseases including cardiovascular disease, diabetes and hypertension. More recently, chronic kidney disease (CKD) has been acknowledged as a significant public health issue. Administrative data, particularly when supplemented by the use of routine laboratory data, have the potential to inform the development of optimal CKD care strategies, generate hypotheses about how to slow disease progression and identify risk factors for adverse outcomes. Available data may allow case identification and assessment of rates and patterns of disease progression, evaluation of risk and complications, including current gaps in care, and an estimation of associated costs. In this article, we use the example of the Alberta Kidney Disease Network to describe how researchers and policy makers can collaborate, using administrative data sources to guide health policy for the care of CKD patients.

  7. Alteration of the Intestinal Environment by Lubiprostone Is Associated with Amelioration of Adenine-Induced CKD. (United States)

    Mishima, Eikan; Fukuda, Shinji; Shima, Hisato; Hirayama, Akiyoshi; Akiyama, Yasutoshi; Takeuchi, Yoichi; Fukuda, Noriko N; Suzuki, Takehiro; Suzuki, Chitose; Yuri, Akinori; Kikuchi, Koichi; Tomioka, Yoshihisa; Ito, Sadayoshi; Soga, Tomoyoshi; Abe, Takaaki


    The accumulation of uremic toxins is involved in the progression of CKD. Various uremic toxins are derived from gut microbiota, and an imbalance of gut microbiota or dysbiosis is related to renal failure. However, the pathophysiologic mechanisms underlying the relationship between the gut microbiota and renal failure are still obscure. Using an adenine-induced renal failure mouse model, we evaluated the effects of the ClC-2 chloride channel activator lubiprostone (commonly used for the treatment of constipation) on CKD. Oral administration of lubiprostone (500 µg/kg per day) changed the fecal and intestinal properties in mice with renal failure. Additionally, lubiprostone treatment reduced the elevated BUN and protected against tubulointerstitial damage, renal fibrosis, and inflammation. Gut microbiome analysis of 16S rRNA genes in the renal failure mice showed that lubiprostone treatment altered their microbial composition, especially the recovery of the levels of the Lactobacillaceae family and Prevotella genus, which were significantly reduced in the renal failure mice. Furthermore, capillary electrophoresis-mass spectrometry-based metabolome analysis showed that lubiprostone treatment decreased the plasma level of uremic toxins, such as indoxyl sulfate and hippurate, which are derived from gut microbiota, and a more recently discovered uremic toxin, trans-aconitate. These results suggest that lubiprostone ameliorates the progression of CKD and the accumulation of uremic toxins by improving the gut microbiota and intestinal environment.

  8. The "phosphorus pyramid": a visual tool for dietary phosphate management in dialysis and CKD patients. (United States)

    D'Alessandro, Claudia; Piccoli, Giorgina B; Cupisti, Adamasco


    Phosphorus retention plays a pivotal role in the onset of mineral and bone disorders (MBD) in chronic kidney disease (CKD). Phosphorus retention commonly occurs as a result of net intestinal absorption exceeding renal excretion or dialysis removal. The dietary phosphorus load is crucial since the early stages of CKD, throughout the whole course of the disease, up to dialysis-dependent end-stage renal disease.Agreement exits regarding the need for dietary phosphate control, but it is quite challenging in the real-life setting. Effective strategies to control dietary phosphorus intake include restricting phosphorus-rich foods, preferring phosphorus sourced from plant origin, boiling as the preferred cooking procedure and avoiding foods with phosphorus-containing additives. Nutritional education is crucial in this regard.Based on the existing literature, we developed the "phosphorus pyramid", namely a novel, visual, user-friendly tool for the nutritional education of patients and health-care professionals. The pyramid consists of six levels in which foods are arranged on the basis of their phosphorus content, phosphorus to protein ratio and phosphorus bioavailability. Each has a colored edge (from green to red) that corresponds to recommended intake frequency, ranging from "unrestricted" to "avoid as much as possible".The aim of the phosphorus pyramid is to support dietary counseling in order to reduce the phosphorus load, a crucial aspect of integrated CKD-MBD management.

  9. Chronotherapy improves blood pressure control and reduces vascular risk in CKD. (United States)

    Hermida, Ramón C; Ayala, Diana E; Smolensky, Michael H; Mojón, Artemio; Fernández, José R; Crespo, Juan J; Moyá, Ana; Ríos, María T; Portaluppi, Francesco


    In patients with chronic kidney disease (CKD), the prevalence of increased blood pressure during sleep and blunted sleep-time-relative blood pressure decline (a nondipper pattern) is very high and increases substantially with disease severity. Elevated blood pressure during sleep is the major criterion for the diagnoses of hypertension and inadequate therapeutic ambulatory blood pressure control in these patients. Substantial, clinically meaningful ingestion-time-dependent differences in the safety, efficacy, duration of action and/or effects on the 24 h blood pressure pattern of six different classes of hypertension medications and their combinations have been substantiated. For example, bedtime ingestion of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers is more effective than morning ingestion in reducing blood pressure during sleep and converting the 24 h blood pressure profile into a dipper pattern. We have identified a progressive reduction in blood pressure during sleep--a novel therapeutic target best achieved by ingestion of one or more hypertension medications at bedtime--as the most significant predictor of decreased cardiovascular risk in patients with and without CKD. Recent findings suggest that in patients with CKD, ambulatory blood pressure monitoring should be used for the diagnosis of hypertension and assessment of cardiovascular disease risk, and that therapeutic strategies given at bedtime rather than on awakening are preferable for the management of hypertension.

  10. The First Result of the Precursors Observation in Karymshina Observatory (Kamchatka, Russia) for Moderate Earthquakes (United States)

    Gordeev, E.; Uyeda, S.; Nagao, T.; Molchanov, O.; Hattori, K.; Lutikov, A.; Gladyshev, V.; Schekotov, A.; Chebrov, V.


    In 1999 the complex geophysical observatory was created in Kamchatka, Russia under mutual Russian-Japanese scientific project. The main purpose of this project is to investigate electromagnetic and other phenomena in connection with earthquakes. The observatory is sited in the place without any sources of industrial noise. The seismic waveforms, acoustic emission, telluric currents, magnetic pulsation and chemical composition of underground water are measured continuously. The measurements of three components of ground displacement velocity is realized by seismometer in the frequency band 0.5-40 Hz with sensitivity threshold 10-8 m/s and dynamic range of 90 dB. Triaxial induction magnetometer measures geomagnetic pulsations in the frequency range 0.003-30 Hz with sensitivity threshold 20 pT/Hz1/2 at frequency 0.01 Hz and 0.02 pT/Hz1/2 at frequencies higher than 10 Hz. Dynamic range of the magnetometer is 90 dB. Measurements of NS and EW components of telluric currents with maximum distance between electrodes of about 500 m are carried out. The acoustic emission receiver (high-frequency seismometer) based on mechanical pendulum with ceramic transducer is installed in 30 m borehole. The output signals are filtered by 4 filters with central frequencies equal to 30, 160, 500 and 1000 Hz. In the same borehole was installed high-frequency seismic noise (HFSN) piezoceramic sensor with very narrow band around 30 Hz and sensitivity threshold 10-12 m. The chemical components Cl, HCO3, SO4, Na, K, Ca, H3BO3, H4SiO4, gases CH4, N2, O2, CO2, Ar, He, H2 and hydrocarbonates C2H6, C2H4, C3H8, C3H6, C4H10, C4H10i are analysed in a few wells nearby the observatory. The atmospheric pressure, direction and velocity of the wind, humidity, precipitation, air and ground temperature are measured using meteorological station installed at observatory. Since June 2000 CGO Karymshina has started regular simultaneous monitoring of the above-mentioned parameters. Processing and analysis of the

  11. Microbial metabolism and the geochemistry of bioactive gases in Kamchatka and Lassen hot springs (United States)

    He, B.; Robb, F. T.; Colman, A. S.


    Thermophilic and hyperthermophilic metabolisms include several pathways that involve dissolved gases as carbon sources, energy sources, and/or waste products. In hot springs, dissolved gas concentrations are often compared with concentrations predicted based upon equilibration with free phase gases bubbling up in the same springs. This comparison guides the inference of metabolic modes in the subsurface, spring vents, and outflow channels. Supersaturation is invoked as a signal of a biogenic source for the gas, while undersaturation is interpreted to indicate microbial consumption. However, these conventional interpretations of disequilibria between dissolved and free phase gases can be misleading. They ignore the decoupling of water and free phase gas transport in terrestrial hot springs and the effects on gas solubility of thermal and pressure gradients that exist as fluids travel from depth to vent. We have surveyed two significant geothermal regions: Lassen Volcanic National Park (LVNP), California, USA (July, 2009), and Uzon Caldera, Kamchatka, Russia (August, 2010) in past years. We collected and analyzed both free phase and dissolved gas composition from a number of hot springs in each region. We used Henry's Law to calculate apparent saturation state of the dissolved gases with respect to the free phases gases bubbling up in the springs. We then constructed a 1-D gas exchange-transport model to examine the thermodynamic drivers and potential kinetic hindrances to gas exchange and equilibration in water and gases ascending continental hot spring systems. Specifically, this model takes into account: (1) the vertical gradient in temperature and pressure, (2) interaction between the bioactive gases via water gas shift reaction, and (3) fluid transport from subsurface to vent. We have modeled several end-member transport-exchange scenarios: (1) gas and spring water co-ascend in a closed system, with instantaneous equilibration between free phase and dissolved

  12. Pre-eruption deformation and seismic anomalies in 2012 in Tolbachik volcanic zone, Kamchatka (United States)

    Kugaenko, Yulia; Saltykov, Vadim; Titkov, Nikolay


    Tolbachik volcanic zone (active volcano Plosky Tolbachik, dormant volcano Ostry Tolbachik and Tolbachik zone of cinder cones) is situated in the south part of Klyuchevskaya group of volcanoes in Kamchatka. All historical fissure eruptions of Tolbachik volcanic zone (1740, 1941, 1975-76 and 2012-13) were connected with one or another activity of Plosky Tolbachik volcano. In 1941 the fissure vent was occurred during the completion of 1939-41 terminal eruption of Plosky Tolbachik. In 1975 the Large Tolbachik Fissure Eruption (LTFE) was forestalled by Plosky Tolbachik terminal activity of the Hawaiian type and then was accompanied by the catastrophic collapse in the crater of Plosky Tolbachik. What events took place in the vicinity of Plosky Tolbachik in 2012 before the 2012-13 fissure eruption? In contrast of the 1975-76 LTFE the eruption 2012-13 was not preceded by intensive seismic preparation. Nowadays Klyuchevskaya group of volcanoes is under monitoring by 12 seismic stations, so we can investigate seismicity in details on the lower energy level then forty years ago. We analyzed seismicity of Plosky Tolbachik using regional catalogue 1999-2012. Anomalies of low-energy (M≥1.5) seismicity parameters (increase of seismicity rate and seismic energy) were discovered. This is evidence of seismic activization covered the whole Plosky Tolbachik volcano. The significance of this anomaly was estimated by distribution function of emitted seismic energy. Statistically significant transition of seismicity from background level to high and extremely high levels was revealed. It corresponds to multiple growth of earthquake number and seismic energy in 2012, July-November (five months before the eruption). The seismicity transition from background level to high level was happen in August 2012. During last three weeks before fissure eruption seismicity of analyzed seismoactive volume was on extremely high level. Earthquakes from fissure site directly appeared only on November 27

  13. Initial H2O content and conditions of parent magma origin for Gorely volcano (Southern Kamchatka) estimated by trace element thermobarometry (United States)

    Nazarova, D. P.; Portnyagin, M. V.; Krasheninnikov, S. P.; Mironov, N. L.; Sobolev, A. V.


    The formation conditions of the parental magmas of Gorely volcano, which is located behind a volcanic front in Southern Kamchatka, have been evaluated using the modern methods of micro-element thermobarometry. These magmas contained 1.7 ± 0.8 (2σ) wt % of H2O, the majority (82%) of which has been lost from inclusions. They crystallized at 1121 ± 17°C and an oxygen fugacity of ΔQFM 1.2 ± 0.2, and could have been produced by about 11% melting of an enriched MORB source (E-DMM) at a temperature of about 1270°C, and a pressure of about 1.5 GPa. A distinctive feature of Gorely volcano, compared with frontal volcanoes of Kamchatka, is the unusually high temperature (925 ± 20°C) of formation of the subduction component corresponding to the region of existence of water-bearing melts.

  14. Preoperative Hemoglobin and Outcomes in Patients with CKD Undergoing Cardiac Surgery (United States)

    Hitti, Sharbel; Silberman, Shuli; Tauber, Rachel; Merin, Ofer; Lifschitz, Meyer; Slotki, Itzchak; Bitran, Daniel; Fink, Daniel


    Background and objectives Preoperative anemia adversely affects outcomes of cardiothoracic surgery. However, in patients with CKD, treating anemia to a target of normal hemoglobin has been associated with increased risk of adverse cardiac and cerebrovascular events. We investigated the association between preoperative hemoglobin and outcomes of cardiac surgery in patients with CKD and assessed whether there was a level of preoperative hemoglobin below which the incidence of adverse surgical outcomes increases. Design, setting, participants, & measurements This prospective observational study included adult patients with CKD stages 3–5 (eGFR<60 ml/min per 1.73 m2) undergoing cardiac surgery from February 2000 to January 2010. Patients were classified into four groups stratified by preoperative hemoglobin level: <10, 10–11.9, 12–13.9, and ≥14 g/dl. The outcomes were postoperative AKI requiring dialysis, sepsis, cerebrovascular accident, and mortality. Results In total, 788 patients with a mean eGFR of 43.5±13.7 ml/min per 1.73 m2 were evaluated, of whom 22.5% had preoperative hemoglobin within the normal range (men: 14–18 g/dl; women: 12–16 g/dl). Univariate analysis revealed an inverse relationship between the incidence of all adverse postoperative outcomes and hemoglobin level. Using hemoglobin as a continuous variable, multivariate logistic regression analysis showed a proportionally greater frequency of all adverse postoperative outcomes per 1-g/dl decrement of preoperative hemoglobin (mortality: odds ratio, 1.38; 95% confidence interval, 1.23 to 1.57; P<0.001; sepsis: odds ratio, 1.31; 95% confidence interval, 1.14 to 1.49; P<0.001; cerebrovascular accident: odds ratio, 1.31; 95% confidence interval, 1.00 to 1.67; P=0.03; postoperative hemodialysis: odds ratio, 1.38; 95% confidence interval, 1.11 to 1.75; P<0.01). Moreover, preoperative hemoglobin<12 g/dl was an independent risk factor for postoperative mortality (odds ratio, 2.6; 95% confidence

  15. Soluble TWEAK and Major Adverse Cardiovascular Events in Patients with CKD (United States)

    Fernández-Laso, Valvanera; Sastre, Cristina; Valdivielso, Jose M.; Betriu, Angels; Fernández, Elvira; Egido, Jesús; Martín-Ventura, Jose L.


    Background and objectives Soluble TNF–like weak inducer of apoptosis (sTWEAK) is a proinflammatory cytokine belonging to the TNF superfamily. sTWEAK concentrations have been associated with the presence of CKD and cardiovascular disease (CVD). We hypothesized that sTWEAK levels may relate to a higher prevalence of atherosclerotic plaques, vascular calcification, and cardiovascular outcomes observed in patients with CKD. Design, setting, participants, & measurements A 4-year prospective, multicenter, longitudinal study was conducted in 1058 patients with CKD stages 3–5D (mean age =58±13 years old; 665 men) but without any history of CVD from the NEFRONA Study (a study design on the prevalence of surrogate markers of CVD). Ankle-brachial index and B-mode ultrasound were performed to detect the presence of carotid and/or femoral atherosclerotic plaques together with biochemical measurements and sTWEAK assessment. Patients were followed for cardiovascular outcomes (follow-up of 3.13±1.15 years). Results Patients with more advanced CKD had lower sTWEAK levels. sTWEAK concentrations were independently and negatively associated with carotid intima-media thickness. sTWEAK levels were lower in patients with carotid atherosclerotic plaques but not in those with femoral plaques. After adjustment by confounders, the odds ratio (OR) for presenting carotid atherosclerotic plaques in patients in the lowest versus highest tertile of sTWEAK was 4.18 (95% confidence interval [95% CI], 2.89 to 6.08; P<0.001). Furthermore, sTWEAK levels were lower in patients with calcified carotid atherosclerotic plaques. The OR for presenting calcified carotid plaques was 1.77 (95% CI, 1.06 to 2.93; P=0.02) after multivariable adjustment. After the follow-up, 41 fatal and 68 nonfatal cardiovascular events occurred. In a Cox model, after controlling for potential confounding factors, patients in the lowest tertile of sTWEAK concentrations had a higher risk of fatal and nonfatal cardiovascular

  16. The influence of creatinine versus GFR on NSAID prescriptions in CKD (United States)

    Patel, Krupa; Diamantidis, Clarissa; Zhan, Min; Hsu, Van Doren; Walker, Loreen D.; Gardner, James; Weir, Matthew R.; Fink, Jeffrey C.


    Background Non-steroidal anti-inflammatory drugs (NSAIDs), including cyclo-oxygenase-2 (COX-2) inhibitors, are generally contraindicated in chronic kidney disease (CKD). This investigation sought to identify the frequency of NSAID/COX2 prescription and determine the influence of serum Cr versus estimated GFR on this practice pattern. Methods An established Veterans Health Administration (VHA) CKD safety cohort (n = 70,154) was examined to determine the frequency of NSAID/COX2 in fiscal year 2005 (FY05) for up to 30 days preceding the index hospitalization and as many as 365 days during that year. Binomial regression was used to determine adjusted prevalence ratios for prescription of NSAID/COX2 with respect to continuous eGFR measurement and serum creatinine (Cr) categories. CKD was defined as eGFR < 60 ml/min/1.73m2. Results 15.4% of subjects had an NSAID/COX2 prescription during the observation period with the proportion prescribed these agents decreasing with declining renal function, but remained significant at any stage of CKD given the renal harm related to these medications. At specific GFR estimates, serum creatinine (Cr) remained a significant predictor of NSAID/COX prescription. At GFR set at 42 ml/min/1.73, the predicted proportion prescribed NSAID/COX2 was 0.29 (95% CI: 0.24,0.36); 0.23 (95% CI: 0.22,0.26); 0.20 (95%: 0.19,0,22); 0.12 (95% CI: 0.10,0.14) for Cr strata of ≤ 1.3 mg/dl, 1.4 – 1.6 mg/dl, 1.7 –2.1 mg/dl, ≥ 2.2 mg/dl, respectively (all p < 0.05). Conclusion A significant proportion of individuals with CKD continue to be prescribed NSAID/COX2 and serum Cr remains an influential guide to NSAID/COX2 prescription, even in GFR ranges where these agents are ill-advised. PMID:22699456

  17. Draft Genome Sequence of Geobacillus icigianus Strain G1w1T Isolated from Hot Springs in the Valley of Geysers, Kamchatka (Russian Federation). (United States)

    Bryanskaya, Alla V; Rozanov, Aleksey S; Logacheva, Maria D; Kotenko, Anastasia V; Peltek, Sergey E


    The Geobacillus icigianus G1w1(T) strain was isolated from sludge samples of unnamed vaporing hydrothermal (97°С) outlets situated in a geyser in the Troinoy region (Valley of Geysers, Kronotsky Nature Reserve, Kamchatka, Russian Federation; 54°25'51.40″N, 160°7'41.40″E). The sequenced and annotated genome is 3,457,810 bp and encodes 3,342 genes.

  18. Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question). (United States)

    Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Loi, Valentina; Gerbino, Martina; Biolcati, Marilisa; Pani, Antonello; Todros, Tullia


    Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3%, while the prevalence of chronic hypertension is about 5-8%. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.

  19. Predicted radionuclide release from reactor-related unenclosed solid objects dumped in the Sea of Japan and the Pacific Ocean, east coast of Kamchatka

    Energy Technology Data Exchange (ETDEWEB)

    Mount, M.E. [Lawrence Livermore National Lab., CA (United States); Lynn, N.M.; Warden, J.M. [Royal Naval Coll., Greenwich (United Kingdom)


    Between 1978 and 1991 reactor-related solid radioactive waste was dumped by the former Soviet Union as unenclosed objects in the Pacific Ocean, east coast of Kamchatka, and the Sea of Japan. This paper presented estimates for the current (1994) inventory of activation and corrosion products contained in the reactor-related unenclosed solid objects. In addition, simple models derived for prediction of radionuclide release from marine reactors dumped in the Kara Sea are applied to certain of the dumped objects to provide estimates of radionuclide release to the Pacific Ocean, east coast of Kamchatka, and Sea of Japan environments. For the Pacific Ocean, east coast of Kamchatka, total release rates start below 0.01 GBq yr{sup -1} and over 1,000 years, fall to 100 Bq yr{sup -1}. In the Sea of Japan, the total release rate starts just above 1 GBq yr{sup - 1}, dropping off to a level less than 0.1 GBq yr{sup -1}, extending past the year 4,000.

  20. Taxonomy of the early life stages of arrowtooth flounder (Atheresthes stomias) and Kamchatka flounder (A. evermanni) in the eastern Bering Sea, with notes on distribution and condition (United States)

    De Forest, Lisa; Duffy-Anderson, J. T.; Heintz, R. A.; Matarese, A. C.; Siddon, E. C.; Smart, T. I.; Spies, I. B.


    Arrowtooth flounder (Atheresthes stomias) and Kamchatka flounder (A. evermanni) are closely related flatfish species that co-occur in the eastern Bering Sea. As adults, arrowtooth flounder can be distinguished from Kamchatka flounder; however, larvae and early juveniles can only be indentified to the genus level due to morphological similarities. This has precluded studies of ecology for the early life stages of both species in the eastern Bering Sea. In this study, we developed a genetic technique to identify the larvae and early juveniles of the two species using mtDNA cytochrome oxidase subunit I (COI). Genetically identified specimens were then examined to determine a visual identification method based on pigment patterns and morphology. Specimens 6.0-12.0 mm SL and≥18.0 mm SL can be identified to the species level, but species identification of individuals 12.1-17.9 mm SL by visual means alone remains elusive. The distribution of larvae (larvae and juveniles of each species by analyzing lipid content (%) and energy density (kJ/g dry mass). Kamchatka flounder larvae on average had higher lipid content than arrowtooth flounder larvae, but were also larger on average than arrowtooth flounder larvae in the summer. When corrected for length, both species had similar lipid content in the larval and juvenile stages.

  1. CKD8S型内燃机车柴油机发电机组设计%CKD8S Diesel Locomotive Diesel Engine-generator Set Design

    Institute of Scientific and Technical Information of China (English)




  2. Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology. (United States)

    Bellizzi, Vincenzo; Conte, Giuseppe; Borrelli, Silvio; Cupisti, Adamasco; De Nicola, Luca; Di Iorio, Biagio R; Cabiddu, Gianfranca; Mandreoli, Marcora; Paoletti, Ernesto; Piccoli, Giorgina B; Quintaliani, Giuseppe; Ravera, Maura; Santoro, Domenico; Torraca, Serena; Minutolo, Roberto


    This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs. dialysis. For each topic synthetic statements, guideline-style, are reported.

  3. Kidney Disease Population Health Management in the Era of Accountable Care: A Conceptual Framework for Optimizing Care Across the CKD Spectrum. (United States)

    Mendu, Mallika L; Waikar, Sushrut S; Rao, Sandhya K


    Since its passage in 2010, the Affordable Care Act has led to the creation of numerous accountable care organizations that face the challenge of transforming the traditional care delivery model to provide more patient-centered, high-quality, and low-cost care. Complex patients, including those with chronic kidney disease (CKD), present the most challenges and opportunities. CKD is a condition with significant morbidity, mortality, and cost and thought to be partly secondary to known gaps in care delivery. Successful population management for CKD requires consideration of the needs of patients at all phases of the disease. In this article, we offer a comprehensive framework for a population-based approach to CKD and examples of programs we are implementing in each area. These initiatives include the development and implementation of an electronic nephrology consult (e-consult) platform, CKD quality metrics, CKD registry, CKD collaborative care agreement, multidisciplinary care clinic for advanced CKD, end-stage renal disease care coordinator program, shared decision-making tools for renal replacement, CKD education videos, and a tablet-based CKD patient-reported outcome measures tool.

  4. Composition, volatile components, and trace elements in andesitic melts of the Kurile-Kamchatka region%俄罗斯Kurile-Kamchatka地区安山质熔体的成分、挥发分组成和微量元素

    Institute of Scientific and Technical Information of China (English)

    M.L.Tolstykh; V.B.Naumov; A.D.Babansky


    Melt inclusions in minerals from some volcanoes of the Kurile-Kamchatka region were examined. The studied basaltic andesites and andesites were sampled from volcanoes of the Central Kamchatka depression ( Shiveluch and Bezymyannyi), Eastern Kamchatka volcanic belt (Avachinskii and Karymskii), and Iturup Island, Southern Kuriles (Kudryavyi). Basalts of the 1996 eruption of the Karymskii volcanic center and dacites of Dikii Greben' volcano, Southern Kamchatka were also studied. More than 260 melt inclusions from 31 rock samples were homogenized, and quenched glasses were analyzed using electron and ion microprobes. The compositions of melt inclusions in andesitic phenocrysts vary in silica contents from 56 to 80wt%. Al2O3 , FeO, MgO, CaO decrease and Na2O and K2O increase with increasing SiO2. Many inclusions ( about 80% ) are dacitic or rhyolitic. However, the compositions of silicic glasses ( >65wt% SiO2 ) in andesites significantly differ in TiO2 , FeO, MgO, CaO, and K2O contents from those in dacites and rhyolites. High-potassium melts (K2O 3.8 ~6.8wt% ) with various SiO2 from 51.4 to 77.2wt% were found in minerals of all volcanoes studied. This indicates a contribution of a component selectively enriched in potassium to magmas of the whole region. A great compositional diversity of melt inclusions in plagioclase phenocrysts from the Bezymyannyi andesites suggests a complex history of plagioclase crystallization and magma evolution in the andesite formation. Melts from different volcanoes strongly vary in volatile contents. The highest H2O contents are found in the melts from Shiveluch (3.0 ~7.2wt%, 4.7wt% on average) and Avachinskii (4.7 ~4.8wt% ); while those are lower in melts of Kudryavyi (0.1 ~ 2.6wt% ), Dikii Greben' (0.4 ~ 1.8wt% ), and Bezymyannyi ( < 1wt% ). Chlorine contents are also variable. The lowest values are found in the Bezymyannyi melts (0.09wt% on average), the highest Cl contents are typical of melt inclusions in minerals from

  5. Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis. (United States)

    Lee, Mei-Chen; Wu, Shu-Fang Vivienne; Hsieh, Nan-Chen; Tsai, Juin-Ming


    Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time. Self-management programs have been widely applied to chronic disease education programs, which are designed to delay deteriorating kidney functions, preclude depression, and improve quality of life. This study aims to analyze effectiveness of self-management programs in bettering CKD patients' eGFR, mitigating depression symptoms and improving quality of life in randomized control or clinical trials. Using key terms, a search was conducted in English-language, peer-reviewed journals on CKD that were published between 2002 and 2014 on databases including CINAHL, Cochrane Library, MEDLINE. The measurable variables included CKD patients' eGFR, depression, and quality of life. Random and fixed effects meta analysis were applied with standard error and correlation based measure of effect size. Eight studies met the inclusion criteria. A self-management program significantly impacted CKD patients' depression and mental quality-of-life dimensions, with an effect size of .29 [95% confidence interval (CI) (0.07, 0.53)] and -.42 [95% CI (-0.75, -0.10)]. However, the intervention of a self-management program had no significant effect on patients' eGFR as well as physical quality-of-life dimensions, with effect sizes of .06 [95% CI (-0.69, 0.81)] and -.16 [95% CI (-0.81, 0.50)]. Self-management programs of patients with chronic kidney disease can improve the depression and mental quality of life. Aside from providing more objective evidence-based results, this study provides a reference for clinical health care personnel who tend to patients with CKD. Copyright © 2016. Published by Elsevier B.V.

  6. Uzon-Geysernaya volcano-tectonic depression: geodynamics phenomena last years (United States)

    Kugaenko, Yulia


    One of the most active volcanic arcs in the Pacific Rim, Kamchatka is also one with poor geophysical constraints on its shallow magma plumbing systems. Uzon calderas lie within a graben approximately 20 km wide running beneath the eastern Kamchatka volcanic group. Cross sections of the shallow crustal graben show that it steps WNW from its southeasterly bounding fault beneath Kikhpinych volcano, deepening toward Uzon caldera. Uzon Caldera Summary (by Global Volcanism Program, ): Country, Subregion Name: Russia; Kamchatka Peninsula Volcano Number: 1000-17 Volcano Type: Calderas Last Known Eruption: 200 AD +/- 300 years Summit Elevation: 1617 m (5,305 feet) Coordinates: 54.50°N, 159.97°E Kikhpinych volcano Summary (by Global Volcanism Program, ): Country, Subregion Name: Russia, Kamchatka Peninsula Volcano Number: 1000-18 Volcano Type: Stratovolcanoes Last Known Eruption: 1550 (?) Summit Elevation: 1552 m (5,092 feet) Coordinates: 160.253°N, 160.253°E The twin Uzon and Geysernaya calderas, containing Kamchatka's largest geothermal area, from a 7x18 km Uzon-Geysernaya volcano-tectonic depression that originated during multiple eruptions during the mid-Pleistocene. Post-caldera activity was largely Pleistocene in age and consisted of the extrusion of small silicic lava domes and flows, maar formation and several Holocene phreatic eruptions. The extensive high-temperature hydrothermal system includes the many hot springs, mudpots, and geysers of the Valley of the Geysers on the SE margin of the Uzon-Geysernaya depression. Hydrothermal explosions took place in the western part of caldera in 1986 and 1989. The Valley of the Geysers in the far eastern portion of Uzon caldera is considered derived from shallow meteoric water in contact with a heat source associated with Kikhpinych volcano The general structure places a deep aquifer shallower than a depth of about 2 km with the top of a cooling magma chamber at depths

  7. [Recited depression]. (United States)

    Barucci, M; Cossio, M


    Several subjects who tell their depression and play a part of it in front of the doctor without being really depressed are reported. Some of them try to hide the symptoms (irritability or erethism, ceremonials of obsessive neurosis, shunning of phobia) which, in their opinion, might be detrimental to their reputation. Others neglect to describe some of the symptoms of their polymorphous clinical picture only underlining the depressive signs. Some others play a part of depression because they have believed to recognize themselves in persons presented by mass media, because it seems to them a duty to show an adequate depression in case of mournful event, or because they "convert" their problem into a depression. Some others use depression as a blackmail, or to obtain an advantage from doctor's conviction about their illness. The reason for the high frequency of similar cases in the present time are examined: the scientific divulgation and the acceptance of depression by the modern society are among the most important ones. The peculiar semantic vicissitudes of the word depression are also reviewed. A widening of the boundaries of depression has contributed to an increase in the number of the cases. Finally, in addition to patients who are depressed without being aware of it, the authors focus the inverse possibility: patients who believed or try to make their doctor believe (playing the part of depression in front of them) that they are depressed.

  8. Kamchatka and North Kurile Volcano Explosive Eruptions in 2015 and Danger to Aviation (United States)

    Girina, Olga; Melnikov, Dmitry; Manevich, Alexander; Demyanchuk, Yury; Nuzhdaev, Anton; Petrova, Elena


    There are 36 active volcanoes in the Kamchatka and North Kurile, and several of them are continuously active. In 2015, four of the Kamchatkan volcanoes (Sheveluch, Klyuchevskoy, Karymsky and Zhupanovsky) and two volcanoes of North Kurile (Alaid and Chikurachki) had strong and moderate explosive eruptions. Moderate gas-steam activity was observing of Bezymianny, Kizimen, Avachinsky, Koryaksky, Gorely, Mutnovsky and other volcanoes. Strong explosive eruptions of volcanoes are the most dangerous for aircraft because they can produce in a few hours or days to the atmosphere and the stratosphere till several cubic kilometers of volcanic ash and aerosols. Ash plumes and the clouds, depending on the power of the eruption, the strength and wind speed, can travel thousands of kilometers from the volcano for several days, remaining hazardous to aircraft, as the melting temperature of small particles of ash below the operating temperature of jet engines. The eruptive activity of Sheveluch volcano began since 1980 (growth of the lava dome) and is continuing at present. Strong explosive events of the volcano occurred in 2015: on 07, 12, and 15 January, 01, 17, and 28 February, 04, 08, 16, 21-22, and 26 March, 07 and 12 April: ash plumes rose up to 7-12 km a.s.l. and extended more 900 km to the different directions of the volcano. Ashfalls occurred at Ust'-Kamchatsk on 16 March, and Klyuchi on 30 October. Strong and moderate hot avalanches from the lava dome were observing more often in the second half of the year. Aviation color code of Sheveluch was Orange during the year. Activity of the volcano was dangerous to international and local aviation. Explosive-effusive eruption of Klyuchevskoy volcano lasted from 01 January till 24 March. Strombolian explosive volcanic activity began from 01 January, and on 08-09 January a lava flow was detected at the Apakhonchich chute on the southeastern flank of the volcano. Vulcanian activity of the volcano began from 10 January. Ashfalls

  9. Atypical Depression (United States)

    ... satisfaction and control in your life Help ease depression symptoms such as hopelessness and anger As part of your treatment, it's important to also address other conditions that often accompany atypical depression, in particular anxiety and drug or alcohol use, ...

  10. Teen Depression (United States)

    ... Depression is a real, treatable brain illness, or health problem. Depression can be caused by big transitions in life, stress, or changes in your body’s chemicals that affect your thoughts and moods. Even if you feel ...

  11. Postpartum Depression (United States)

    ... do not need treatment. The symptoms of postpartum depression last longer and are more severe. You may ... treatment right away, often in the hospital. Postpartum depression can begin anytime within the first year after ...

  12. Depression Treatment (United States)

    ... 3286 After hours (404) 639-2888 Contact Media Depression Treatment Recommend on Facebook Tweet Share Compartir On ... How Do I Know if I Am Experiencing Depression? The following questions may help you determine if ...

  13. Depression Screening (United States)

    ... Centers Diseases + Condition Centers Mental Health Medical Library Depression Screening (PHQ-9) - Instructions The following questions are ... this tool, there is also text-only version . Depression Screening - Manual Instructions The following questions are a ...

  14. Association between periodontal disease and mortality in people with CKD: a meta-analysis of cohort studies. (United States)

    Zhang, Jian; Jiang, Hong; Sun, Min; Chen, Jianghua


    Periodontal disease occurs relatively prevalently in people with chronic kidney disease (CKD), but it remains indeterminate whether periodontal disease is an independent risk factor for premature death in this population. Interventions to reduce mortality in CKD population consistently yield to unsatisfactory results and new targets are necessitated. So this meta-analysis aimed to evaluate the association between periodontal disease and mortality in the CKD population. Pubmed, Embase, Web of Science, Scopus and abstracts from recent relevant meeting were searched by two authors independently. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for overall and subgroup meta-analyses. Statistical heterogeneity was explored by chi-square test and quantified by the I(2) statistic. Eight cohort studies comprising 5477 individuals with CKD were incorporated. The overall pooled data demonstrated that periodontal disease was associated with all-cause death in CKD population (RR, 1.254; 95% CI 1.046-1.503; P = 0.005), with a moderate heterogeneity, I(2) = 52.2%. However, no evident association was observed between periodontal disease and cardiovascular mortality (RR, 1.30, 95% CI, 0.82-2.06; P = 0.259). Besides, statistical heterogeneity was substantial (I(2) = 72.5%; P = 0.012). Associations for mortality were similar between subgroups, such as the different stages of CKD, adjustment for confounding factors. Specific to all-cause death, sensitivity and cumulative analyses both suggested that our results were robust. As for cardiovascular mortality, the association with periodontal disease needs to be further strengthened. We demonstrated that periodontal disease was associated with an increased risk of all-cause death in CKD people. Yet no adequate evidence suggested periodontal disease was also at elevated risk for cardiovascular death.

  15. Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial. (United States)

    Wang, Angela Yee-Moon; Fang, Fang; Chan, John; Wen, Yue-Yi; Qing, Shang; Chan, Iris Hiu-Shuen; Lo, Gladys; Lai, Kar-Neng; Lo, Wai-Kei; Lam, Christopher Wai-Kei; Yu, Cheuk-Man


    Vitamin D seems to protect against cardiovascular disease, but the reported effects of vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebo-controlled trial to determine whether oral activated vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV hypertrophy. Subjects with echocardiographic criteria of LV hypertrophy were randomly assigned to receive either oral paricalcitol (1 μg) one time daily (n=30) or matching placebo (n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volume, echocardiographic measures of systolic and diastolic function, biochemical parameters of mineral bone disease, and measures of renal function. Change in LV mass index did not differ significantly between groups (median [interquartile range], -2.59 [-6.13 to 0.32] g/m(2) with paricalcitol versus -4.85 [-9.89 to 1.10] g/m(2) with placebo). Changes in LV volume, ejection fraction, tissue Doppler-derived measures of early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However, paricalcitol treatment significantly reduced intact parathyroid hormone (P<0.001) and alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral paricalcitol (1 μg one time daily) significantly improved secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.

  16. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. (United States)

    Lepage, Laurence; Dufour, Anne-Claude; Doiron, Jessica; Handfield, Katia; Desforges, Katherine; Bell, Robert; Vallée, Michel; Savoie, Michel; Perreault, Sylvie; Laurin, Louis-Philippe; Pichette, Vincent; Lafrance, Jean-Philippe


    Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. In total, 33 outpatients with CKD and mild hyperkalemia (5.0-5.9 mEq/L) in a single teaching hospital were included in this double-blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, -1.04 mEq/L; 95% confidence interval, -1.37 to -0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD. Copyright © 2015 by the American Society of Nephrology.

  17. Explosive eruptions at Bezymianny Volcano (Kamchatka, Russia) from 2000-2009: warning system, prediction and risk assessment (United States)

    Senyukov, S.


    for population centers, were released to the Kamchatka Branch of the Russian Advisory Council. The copies of these documents were sent to participants of the KVERT (Kamchatka Volcano Eruption Response Team) project, uniting scientists Alaska Volcano Observatory, Institute of Volcanology and Seismology and KBGS. One explosive eruption was missed and only one false prediction (due to incorrect data) was made during this time period. Seismic precursors of sixteen explosive eruptions of Bezymianny were investigated using seismic data from both Bezymianny and nearby Kluchevskoy Volcano to improve risk assessment. It was determined that the successful prediction of a Bezymianny eruption depends strongly on the activity at Kluchevskoy.

  18. Assessment of geomorphic risks and attractiveness to recreational systems: a case of Nalychevo Nature Park (Kamchatka, Russia). (United States)

    Blinova, I.; Bredikhin, A.


    Attractiveness of relief, diversity and rareness were always the basic features of overall recreational attractiveness of a territory. Mountainous regions with high geomorphic diversity served as model for first recreation and tourism researches. The above features often favoured sustainability of touristic system. Unique relief forms are commonly referred to natural sites. They differ from the others in structure or have some morphological and morphometric characteristics not found in other forms of the earth's surface. Such monuments form the main natural functional kernel for a recreation system which is created and exists around them. In general, functions of geomorphological sites in recreation can be divided into socio-cultural and economic. Socio-cultural function is the principal function of recreation. It responds to the cultural or spiritual needs of people such as the knowledge in the broader sense, knowledge of the world and their place in it. The economic function is to create consumer demand for goods and services, and sometimes an entire economy sector. Natural sites are particularly vulnerable to dangerous occurrence of endogenous and exogenous processes as guarantee of environmental stability is an essential condition for a proper system functioning. This requires a comprehensive study of relief dynamics, monitoring and forecasting its evolution in recreation areas. Nowadays educational and environmental tourism in Russia develop rapidly. The unique tectonic position of Kamchatka Peninsula (the active geodynamic area dedicated to the subduction zone) formed a variety of landscapes, attracting visitors from all over the world. Recreational development of this region is slow due to remoteness and poor transport accessibility. However, there are 3 state federal reserves and one federal wildlife sanctuary, 4 natural parks of regional significance, 23 nature preserves of regional significance, and 105 natural monuments officially marked in this region

  19. Overview of the precursors and dynamics of the 2012-13 basaltic fissure eruption of Tolbachik Volcano, Kamchatka, Russia (United States)

    Belousov, Alexander; Belousova, Marina; Edwards, Benjamin; Volynets, Anna; Melnikov, Dmitry


    We present a broad overview of the 2012-13 flank fissure eruption of Plosky Tolbachik Volcano in the central Kamchatka Peninsula. The eruption lasted more than nine months and produced approximately 0.55 km3 DRE (volume recalculated to a density of 2.8 g/cm3) of basaltic trachyandesite magma. The 2012-13 eruption of Tolbachik is one of the most voluminous historical eruptions of mafic magma at subduction related volcanoes globally, and it is the second largest at Kamchatka. The eruption was preceded by five months of elevated seismicity and ground inflation, both of which peaked a day before the eruption commenced on 27 November 2012. The batch of high-Al magma ascended from depths of 5-10 km; its apical part contained 54-55 wt.% SiO2, and the main body 52-53 wt.% SiO2. The eruption started by the opening of a 6 km-long radial fissure on the southwestern slope of the volcano that fed multi-vent phreatomagmatic and magmatic explosive activity, as well as intensive effusion of lava with an initial discharge of > 440 m3/s. After 10 days the eruption continued only at the lower part of the fissure, where explosive and effusive activity of Hawaiian-Strombolian type occurred from a lava pond in the crater of the main growing scoria cone. The discharge rate for the nine month long, effusion-dominated eruption gradually declined from 140 to 18 m3/s and formed a compound lava field with a total area of ~ 36 km2; the effusive activity evolved from high-discharge channel-fed 'a'a lavas to dominantly low-discharge tube-fed pahoehoe lavas. On 23 August, the effusion of lava ceased and the intra-crater lava pond drained. Weak Strombolian-type explosions continued for several more days on the crater bottom until the end of the eruption around 5 September 2013. Based on a broad array of new data collected during this eruption, we develop a model for the magma storage and transport system of Plosky Tolbachik that links the storage zones of the two main genetically related magma


    Directory of Open Access Journals (Sweden)

    Maria Inês Barreto-Silva


    Full Text Available The purpose of this study was to evaluate inflammation in non-dialysed CKD patients with normal and high body adiposity level. One hundred and thirty four CKD patients (male: 56%; age=65±12 years under treatment for 3.0±2.0 years were evaluated in a cross-sectional study. Glomerular filtration rate (eGFR was estimated by MDRD equation. Body adiposity was assessed by BMI and total body fat (BF; dual-energy X-ray absorptiometry. Laboratorial measurements were: albumin, pro-inflammatory cytokines by Multiplexed analysis: tumor necrosis factor-α, interferon-γ, high sensitive C reactive protein, monocyte chemotactic protein, inteleukine 6 and 8, intercellular adhesion molecule-1 and vascular adhesion molecule-1. The inflammation status was defined according to the median values for each studied pro-inflammatory cytokines: negative for inflammation (Infl- (< median, positive for inflammation (Infl+ (≥ median. The cytokines were compared between patients with normal BMI (<25kg/m2 (46%; BMI=22.2±1.9 and high BMI (≥25kg/m2 (BMI=28.8±2.8. Both groups showed similar eGFR and CKD stages distribution (stage 3:42%, 4: 37%, 5: 21%. BF and all cytokines were higher in high BMI group than in normal BMI (P<0.0001. BMI and BF were correlated (r= 0.74; P<0.0001. The Infl+ condition was more prevalent, for all cytokines, in the high BMI group (range:61–76% than in normal (24–38%. Multivariate logistic regression analysis, for all cytokines, showed that Infl+ condition was associated with high BMI (Odds Ratio range: 2.5–4.2; 95%CI: 1.1 - 9.6; P<0.01, even after adjusted for age, gender, diabetes and eGFR. In conclusion, CKD patients with high BMI and body adiposity are at higher risk for inflammation. Therefore, the excess of adiposity should be carefully treated in these patients.

  1. Pro-inflammatory cytokines and bone fractures in CKD patients. An exploratory single centre study

    Directory of Open Access Journals (Sweden)

    Panuccio Vincenzo


    Full Text Available Abstract Background Pro-inflammatory cytokines play a key role in bone remodeling. Inflammation is highly prevalent in CKD-5D patients, but the relationship between pro-inflammatory cytokines and fractures in CKD-5D patients is unclear. We studied the relationship between inflammatory cytokines and incident bone fractures in a cohort of CKD-5D patients. Methods In 100 CKD-5D patients (66 on HD, 34 on CAPD; males:63, females:37; mean age: 61 ± 15; median dialysis vintage: 43 months belonging to a single renal Unit, we measured at enrolment bone metabolic parameters (intact PTH, bone and total alkaline phosphatase, calcium, phosphate and inflammatory cytokines (TNF-α, IL-6, CRP. Patients were followed-up until the first non traumatic fracture. Results During follow-up (median: 74 months; range 0.5 -84.0 18 patients experienced fractures. On categorical analysis these patients compared to those without fractures had significantly higher intact PTH (median: 319 pg/ml IQ range: 95–741 vs 135 pg/ml IQ: 53–346; p = 0.04 and TNF-α levels (median: 12 pg/ml IQ: 6.4-13.4 vs 7.8 pg/ml IQ: 4.6-11; p = 0.02. Both TNF-α (HR for 5 pg/ml increase in TNF-α: 1.62 95% CI: 1.05-2.50; p = 0.03 and intact PTH (HR for 100 pg/ml increase in PTH: 1.15 95% CI: 1.04-1.27; p = 0.005 predicted bone fractures on univariate Cox’s regression analysis. In restricted (bivariate models adjusting for previous fractures, age, sex and other risk factors both PTH and TNF-α maintained an independent association with incident fractures. Conclusions In our bivariate analyses TNF-α was significantly associated with incident fractures. Analyses in larger cohorts and with adequate number of events are needed to firmly establish the TNF α -fracture link emerged in the present study.

  2. Patterns of NSAIDs Use and Their Association with Other Analgesic Use in CKD. (United States)

    Zhan, Min; St Peter, Wendy L; Doerfler, Rebecca M; Woods, Corinne M; Blumenthal, Jacob B; Diamantidis, Clarissa J; Hsu, Chi-Yuan; Lash, James P; Lustigova, Eva; Mahone, Erin B; Ojo, Akinlolu O; Slaven, Anne; Strauss, Louise; Taliercio, Jonathan J; Winkelmayer, Wolfgang C; Xie, Dawei; Fink, Jeffery C


    Avoiding nonsteroidal anti-inflammatory drugs is important for safe CKD care. This study examined nonsteroidal anti-inflammatory drug use patterns and their association with other analgesic use in CKD. The Chronic Renal Insufficiency Cohort Study is an observational cohort study that enrolled 3939 adults ages 21-74 years old with CKD between 2003 and 2008 using age-based eGFR inclusion criteria. Annual visits between June of 2003 and December of 2011 were organized into 15,917 visit-pairs (with an antecedent and subsequent visit) for 3872 participants with medication information. Demographics, kidney function, and clinical factors were ascertained along with report of nonsteroidal anti-inflammatory drug or other analgesic use in the prior 30 days. In our study, 24% of participants reported nonsteroidal anti-inflammatory drug use at baseline or at least one follow-up study visit. Having a 10 ml/min per 1.73 m(2) higher eGFR level at an antecedent visit was associated with higher odds of starting nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 1.44; 95% confidence interval, 1.34 to 1.56). Seeing a nephrologist at the antecedent visit was associated with lower odds of starting or staying on nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 0.70; 95% confidence interval, 0.56 to 0.87 and odds ratio, 0.61; 95% confidence interval, 0.46 to 0.81, respectively). Starting and stopping nonsteroidal anti-inflammatory drugs were both associated with higher odds of increasing the number of other analgesics (odds ratio, 1.52; 95% confidence interval, 1.25 to 1.85 and odds ratio, 1.78; 95% confidence interval, 1.39 to 2.28, respectively) and higher odds of increasing the number of opioid analgesics specifically (odds ratio, 1.92; 95% confidence interval, 1.48 to 2.48 and odds ratio, 1.46; 95% confidence interval, 1.04 to 2.03, respectively). Nonsteroidal anti-inflammatory drug use is common among patients with CKD but less so among

  3. Impact of late-stage CKD and aging on medical utilization in the elderly population: a closed-cohort study in Taiwan. (United States)

    Lin, Ming-Yen; Hwang, Shang-Jyh; Mau, Lih-Wen; Chen, Hung-Chun; Hwang, Su-Chen; Wu, Ling-Chu; Chiu, Herng-Chia


    Taiwan has the highest incidence and prevalence of end-stage renal disease globally, especially in the elderly population. The elderly with chronic kidney disease (CKD) also had high mortality. However, population-based research on how the elderly with CKD utilize medical services is still unexplored. We aimed to examine the effects of CKD severity and aging on medical utilizations in the elderly population. This retrospective closed cohort study analysed 7868 elderly residents of Kaohsiung City, who participated in the government-sponsored annual physical examination in 1997. The information of medical services and expenses were obtained from the claimed data of the National Health Insurance from 1996 to 1999. CKD was grouped into five stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF K-DOQI) criteria with modifications. Late-stage CKD was defined as CKD Stages 3 to 5 [estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m(2)]. Those subjects with eGFR above 60 ml/min/1.73 m(2) were treated as the reference group. After adjusting all covariates, the odds ratios of hospitalization for elderly subjects with CKD stages 3a, 3b and 4/5 were 1.19 (95% CI = 1.08-1.32), 1.48 (95% CI = 1.26-1.73) and 1.68 (95% CI = 1.21-2.33) compared with the reference group, respectively (P < 0.001). The autoregressive generalized estimating equation analysis revealed that CKD stage had linear associations with medical expenditures during the study period, especially for those elderly subjects with later stage CKD. Increases in medical utilizations and expenses were demonstrated in elderly CKD subjects, especially those with late stage CKD. Early prevention of CKD is necessary to lessen the financial impact on medical health care.

  4. Impact of the Triglycerides to High-Density Lipoprotein Cholesterol Ratio on the Incidence and Progression of CKD: A Longitudinal Study in a Large Japanese Population. (United States)

    Tsuruya, Kazuhiko; Yoshida, Hisako; Nagata, Masaharu; Kitazono, Takanari; Iseki, Kunitoshi; Iseki, Chiho; Fujimoto, Shouichi; Konta, Tsuneo; Moriyama, Toshiki; Yamagata, Kunihiro; Narita, Ichiei; Kimura, Kenjiro; Kondo, Masahide; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi


    The impact of the triglycerides to high-density lipoprotein cholesterol (TG:HDL-C) ratio on chronic kidney disease (CKD) is unclear. Longitudinal cohort study. 124,700 participants aged 39 to 74 years in the Japanese Specific Health Check and Guidance System, including 50,392 men, 74,308 women, 102,900 without CKD, and 21,800 with CKD. Quartiles of TG:HDL-C ratio. Changes in estimated glomerular filtration rate (eGFR) and urinary protein excretion during the 2-year study period. Incident CKD in participants without CKD, and progression of CKD in participants with CKD. In the entire study population, higher quartile of TG:HDL-C ratio at baseline was significantly associated with greater decline in eGFR and increase in urinary protein excretion during the 2-year study period, even after adjustment for confounding factors. A higher ratio was associated with higher risk of incident CKD in participants without CKD and higher risk of rapid decline in eGFR and increase in urinary protein excretion in participants with CKD. Higher TG:HDL-C ratio was more strongly associated with decline in eGFR (P for interaction = 0.002) and with incident CKD (P for interaction = 0.05) in participants with diabetes than without diabetes. Short observation period and single measurement of all variables. A higher TG:HDL-C ratio affects the decline in eGFR and incidence and progression of CKD in the Japanese population. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Yu-Wei Chen; Han-Hsiang Chen; Tsang-En Wang; Ching-Wei Chang; Chen-Wang Chang; Chih-Jen Wu


    AIM: To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations. RESULTS: When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.

  6. Establishment of a integrative multi-omics expression database CKDdb in the context of chronic kidney disease (CKD) (United States)

    Fernandes, Marco; Husi, Holger


    Complex human traits such as chronic kidney disease (CKD) are a major health and financial burden in modern societies. Currently, the description of the CKD onset and progression at the molecular level is still not fully understood. Meanwhile, the prolific use of high-throughput omic technologies in disease biomarker discovery studies yielded a vast amount of disjointed data that cannot be easily collated. Therefore, we aimed to develop a molecule-centric database featuring CKD-related experiments from available literature publications. We established the Chronic Kidney Disease database CKDdb, an integrated and clustered information resource that covers multi-omic studies (microRNAs, genomics, peptidomics, proteomics and metabolomics) of CKD and related disorders by performing literature data mining and manual curation. The CKDdb database contains differential expression data from 49395 molecule entries (redundant), of which 16885 are unique molecules (non-redundant) from 377 manually curated studies of 230 publications. This database was intentionally built to allow disease pathway analysis through a systems approach in order to yield biological meaning by integrating all existing information and therefore has the potential to unravel and gain an in-depth understanding of the key molecular events that modulate CKD pathogenesis. PMID:28079125

  7. Testing and Adapting a Daytime Four Band Satellite Ash Detection Algorithm for Eruptions in Alaska and the Kamchatka Peninsula, Russia (United States)

    Andrup-Henriksen, G.; Skoog, R. A.


    Volcanic ash is detectable from satellite remote sensing due to the differences in spectral signatures compared to meteorological clouds. Recently a new global daytime ash detection algorithm was developed at University of Madison, Wisconsin. The algorithm is based on four spectral bands with the central wavelengths 0.65, 3.75, 11 and 12 micrometers that are common on weather satellite sensors including MODIS, AVHRR, GOES and MTSAT. The initial development of the algorithm was primarily based on MODIS data with global coverage. We have tested it using three years of AVHRR data in Alaska and the Kamchatka Peninsula, Russia. All the AVHRR data have been manually analyzed and recorded into an observational database during the daily monitoring performed by the remote sensing group at the Alaska Volcano Observatory (AVO). By taking the manual observations as accurate we were able to examine the accuracy of the four-channel algorithm for daytime data. The results were also compared to the current automated ash alarm used by AVO, based on the reverse absorption technique, also known as the split window method, with a threshold of -1.7K. This comparison indicates that the four- banded technique has a higher sensitivity to volcanic ash, but a greater number of false alarms. The algorithm was modified to achieve a false alarm rate comparable to current ash alarm while still maintaining increased sensitivity.

  8. Phase equilibria constraints on pre-eruptive magma storage conditions for the 1956 eruption of Bezymianny Volcano, Kamchatka, Russia (United States)

    Shcherbakov, Vasily D.; Neill, Owen K.; Izbekov, Pavel E.; Plechov, Pavel Yu.


    Phase equilibria experiments were performed on andesites from the catastrophic 1956 eruption of Bezymianny Volcano, Kamchatka, Russia, to determine pre-eruptive magma storage conditions. Fifteen experiments were conducted under water-saturated conditions, with oxygen fugacity equal to the Ni-NiO oxygen buffer, at temperatures between 775 and 1100 °C and pressures between 50 and 200 MPa. Simultaneous amphibole and plagioclase crystallization is reproduced at ≤ 850 °C and ≥ 200 MPa. The simultaneous crystallization temperature range of the plagioclase-clinopyroxene-orthopyroxene-Fe-Ti oxide assemblage increases with decreasing pressure, from 840 to 940 °C at 150 MPa to 940-1020 °C at 50 MPa. Melt inclusion compositions in plagioclase phenocrysts and matrix glass match experimental melt compositions reproduced at 50-100 MPa and ≤ 50 MPa, respectively. Presence of the silica phase in groundmass and mature amphibole breakdown rims suggests that magma has been stored at ca. 3 km depth prior to the final ascent for at least 40 days. Syn-eruptive ascent led to decompression-driven crystallization, which caused a temperature increase from 850-900 °C to 950-1000 °C.

  9. Triticella minini - a new ctenostome bryozoan from the abyssal plain adjacent to the Kuril-Kamchatka Trench (United States)

    Grischenko, Andrei V.; Chernyshev, Alexei V.


    A new species of ctenostome bryozoan, Triticella minini sp. nov., is described from the abyssal plain adjacent to the Kuril-Kamchatka Trench, based on material collected by the Russian-German deep-sea expedition KuramBio 2012. Colonies of T. minini sp. nov. were found attached to the oral spines of irregular sea urchin Echinosigra (Echinogutta) amphoraMironov, 1974 by means of rhizoid fibers that penetrated the substratum through circular borings. The specimens were examined by light microscopy, scanning electron microscopy, and confocal laser scanning microscopy with phalloidin and nuclear labeling. The description of T. minini sp. nov. combines a general taxonomic description with a description of the anatomy of the muscular system. The new species differs from congeners in lacking a stolon. It has an intertentacular organ. T. minini sp. nov. is the eleventh species described in the genus TriticellaDalyell, 1848, and the first record for this genus from the northwestern Pacific. The new species is the fifth ctenostome bryozoan known to occur in 5001-5500 m depth interval worldwide, and the deepest record reported for Triticella.

  10. "Quadruple whammy"- a preventable newly described syndrome of post-operative AKI in CKD II and CKD III patients on combination "Triple whammy" medications: a Mayo Clinic Health System, Eau Claire, Wisconsin experience. (United States)

    Onuigbo, M A; Agbasi, N


    The potential combination of diuretics- angiotensin-converting enzyme inhibitors- Non-steroidal anti-inflammatory drugs (diuretics-ACEIs-NSAIDs), the so-called 'triple whammy', to produce clinically significant nephrotoxicity in chronic kidney disease (CKD) is often unrecognized. In 2013, in the British Medical Journal, we described accelerated post-operative acute kidney injury (AKI) in CKD patients concurrently on 'triple whammy' medications, a new syndrome that we aptly named 'quadruple whammy'. Two case reports. I. A 59-year-old Caucasian male, hypertensive CKD III, serum creatinine (SCr) 1.42 mg/dL, developed accelerated oliguric AKI after elective right nephrectomy. Outpatient medications included Lisinopril-Hydrochlorothiazide and Nabumetone (NSAID). SCr rapidly more than doubled with metabolic acidosis and hyperkalemia within 24 hours, peaking at 4.02 mg/dL. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 1.64 mg/dL and stable, after three months. II. A 46-year-old Caucasian male, hypertensive CKD II, SCr 1.21 mg/dL, developed accelerated AKI after elective right hip arthroplasty. Outpatient medications included Lisinopril and Hydrochlorothiazide. Celecoxib (200 mg) was given pre-operatively. Within 36 hours, SCr rapidly more than doubled to 2.58 mg/dL, with metabolic acidosis. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 0.99 mg/dL, and stable, after one month. We have described two cases of preventable accelerated AKI following post-operative hypotension in CKD patients concurrently on 'triple whammy' medications. We dubbed this new syndrome "Quadruple Whammy". It is not uncommon. 'Renoprevention', the pre-emptive withholding of (potentially nephrotoxic) medications, including 'triple whammy' medications, pre-operatively, in CKD patients, together with the simultaneous avoidance of peri-operative hypotension would help reduce, if not eliminate such AKI - a call

  11. Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD: the nature, mechanisms, consequences and potential treatment. (United States)

    Vaziri, Nosratola D; Zhao, Ying-Yong; Pahl, Madeleine V


    Chronic kidney disease (CKD) results in systemic inflammation and oxidative stress which play a central role in CKD progression and its adverse consequences. Although many of the causes and consequences of oxidative stress and inflammation in CKD have been extensively explored, little attention had been paid to the intestine and its microbial flora as a potential source of these problems. Our recent studies have revealed significant disruption of the colonic, ileal, jejunal and gastric epithelial tight junction in different models of CKD in rats. Moreover, the disruption of the epithelial barrier structure and function found in uremic animals was replicated in cultured human colonocytes exposed to uremic human plasma in vitro We have further found significant changes in the composition and function of colonic bacterial flora in humans and animals with advanced CKD. Together, uremia-induced impairment of the intestinal epithelial barrier structure and function and changes in composition of the gut microbiome contribute to the systemic inflammation and uremic toxicity by accommodating the translocation of endotoxin, microbial fragments and other noxious luminal products in the circulation. In addition, colonic bacteria are the main source of several well-known pro-inflammatory uremic toxins such as indoxyl sulfate, p-cresol sulfate, trimethylamine-N-oxide and many as-yet unidentified retained compounds in end-stage renal disease patients. This review is intended to provide an overview of the effects of CKD on the gut microbiome and intestinal epithelial barrier structure and their role in the pathogenesis of systemic inflammation and uremic toxicity. In addition, potential interventions aimed at mitigating these abnormalities are briefly discussed.

  12. Muscle atrophy in patients wirh ckd results from fgf23/klotho-mediated supression of insulin/igf-i signaling

    Directory of Open Access Journals (Sweden)

    Shinsuke Kido


    Full Text Available Muscle atrophy is a significant consequence of chronic kidney disease (CKD that increases a patient’s risk of mortality and decrease their quality of life. In CKD patients, the circulation levels of FGF23 are significantly increased, but the exact pathological significance of the increase and relationship between FGF23 and muscle atrophy are not clear. Because of Klohto, acts as a co-receptor of FGF23 is detectable in limited tissues including in kidney and brain, but not in skeletal muscles. In contrast, recently reports indicated that the extracellular domain of klohto is cleavage for some reason on the cell surface and detected in the blood in animals. In this study, we attempted to identify the causative factors responsible for the shedding of Klotho, and whether both FGF23 and Klohto induced muscle atrophy via reduction of insulin/IGF-I signaling. We first investigated by treating kidney cells with various factors related in pathological factors in CKD. As a result, we found that advanced glycation endproducts (AGEs, an accumulated in patients with CKD and diabetes mellitus, increases shedding of Klohto in kidney cells. It is common knowledge that insulin/IGF-I signaling is necessary for normal skeletal growth. As a result, we showed that both FGF23 and Klohto inhibited differentiation of cultured skeletal muscle cells through down-regulation of insulin/IGF-I signaling. These observations suggested a divergent role of FGF23 and soluble klohto in the regulation of skeletal muscle differentiation and thereby muscle atrophy under pathological conditioned in CKD patients. Our results further imply that FGF23/Klohto may serve a new therapeutic target for CKD-induced muscle atrophy.

  13. Prevalence of Metformin Use and the Associated Risk of Metabolic Acidosis in US Diabetic Adults With CKD (United States)

    Kuo, Chin-Chi; Yeh, Hung-Chieh; Chen, Bradley; Tsai, Ching-Wei; Lin, Yu-Sheng; Huang, Chiu-Ching


    Abstract The use of metformin in chronic kidney disease (CKD) population has been intensely debated with conflicting evidence. Large population studies are needed to inform risk assessment and therapeutic decision-making. We evaluated the associations among metformin, metabolic acidosis, and CKD in a 10-year nationally representative noninstitutionalized civilian population in the United States. In this cross-sectional study, a total of 2279 diabetic adults aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012 were included and had measurements of serum bicarbonate, sodium, potassium, and chloride. The exposure was metformin use. The outcome was subclinical and severe metabolic acidosis defined by serum bicarbonate 16mEq/L and by serum bicarbonate 60 mL/min/1.73 m2 was also observed. In multiple linear regression analysis, metformin was significantly associated with decreased serum bicarbonate levels (β = −0.45, 95% CI: −0.73, −0.17) and increased serum anion gap levels (β = 0.40, 95% CI: 0.19, 0.61). The adjusted odds ratio of subclinical high anion gap and severe metabolic acidosis for metformin users was 1.68 (95% CI: 1.11, 2.55) and 1.31 (0.49, 3.47), respectively. The association between metformin and serum bicarbonate was significantly modified by CKD status. No interaction was found between metformin and CKD stages for serum anion gap and acidosis. Metformin is associated with subclinical metabolic acidosis but not with severe metabolic acidosis. The propensity of serum bicarbonate-lowering effect was intensified in advanced CKD; however, such tendency was not associated with the risk of clinically defined acidosis. Our findings highlight a potential of cautious expansion of metformin use among CKD-3b patients with diabetes meriting further investigations. PMID:26705203

  14. Application of MDRD and CKD-EPI equations in patients with peripheral arterial diseases%MDRD与CKD-EPI肾小球滤过率评估公式在外周动脉疾病患者中的应用

    Institute of Scientific and Technical Information of China (English)

    余思韵; 李觉; 张丽娟


    Objective To compare the performance of newly developed Chronic Kidney Disease Epideniology Collaboration (CKD-EPI) equation and Modification of Diet in Renal Disease (MDRD) equation in patients with peripheral arterial diseases (PAD).Methods A total of 841 patients with PAD were enrolled in this retrospective cohort study.Estimated glomerular filtration rate (eGFR), calculated by MDRD and CKD-EPI equation respectively, was analyzed by Spearman correlation analysis, Bland-Altman method and Kappa test for the evaluation of correlation and consistency.Net reclassification improvement (NRI) was adopted to compare the death risk assessment between these two equations.Results Although the eGFR was 4.33 ml· min-1 · (1.73 m2)-1 higher with MDRD equation than with CKD-EPI equation, there were still significant correlation and fine consistency between eGFRMDRD and eGFRCKD-EPI (Kappa: 0.749, r=0.991, P<0.05).The CKD-EPI equation re-classified 9 (1.1%) patients upward to higher eGFR category and 143 (17.0%) patients downward to lower eGFR category.Besides, the performance of risk assessment for all-cause death was better with CKD-EPI equation than with MDRD equation (NRI=0.059, P < 0.05), which was not the case for cardiovascular death (NRI=0.022, P > 0.05).Conclusions There is no solid evidence suggesting that CKD-EPI equation performs better than MDRD equation.%目的 比较简化MDRD公式与慢性肾脏病学流行病学合作研究(CKD-EPI)公式在评估外周动脉疾病(peripheral arterial disease,PAD)患者肾小球滤过率(GFR)中的适用性.方法 采用回顾性队列研究,选择2005年在上海市和北京市8家医院被确诊为PAD的841例患者作为研究对象,分别利用MDRD与CKD-EPI公式估算肾小球滤过率(eGFR),应用Spearman相关性检验、Bland-Ahman曲线和Kappa检验比较两种方程估算GFR的相关性和一致性,并利用净重新分类指数(net re-classification improvement,NRI)比较2个公式对死

  15. Occupational lead exposure and severe CKD: a population-based case-control and prospective observational cohort study in Sweden. (United States)

    Evans, Marie; Fored, Carl Michael; Nise, Gun; Bellocco, Rino; Nyrén, Olof; Elinder, Carl-Gustaf


    The role of low-level lead exposure in the cause of chronic kidney disease (CKD) is unsettled. Case-control study and prospective observational cohort study. 926 cases with incident severe CKD (serum creatinine > 3.4 mg/dL for men and > 2.8 mg/dL for women for the first time) and 998 population controls were included. Cases represented nearly all patients with incident severe CKD in Sweden during 2 years. Cases also were followed up prospectively for 7-9 years. Exposed and nonexposed cases were compared with regard to rate of change in estimated glomerular filtration rate (eGFR) and renal survival. Lead exposure was assessed using the expert rating method. Associations between lead exposure and risk of CKD, adjusted for factors associated with this outcome, were analyzed using multivariable logistic regression modeling, whereas links to the rate of change in eGFR were analyzed in mixed-effects multivariable models based on up to 6 measurements. Renal survival in relation to lead exposure was analyzed in a Cox proportional hazards model. The adjusted OR for incident severe CKD was 0.97 (95% CI, 0.68-1.38) in lead-exposed compared with nonexposed participants. The OR for individuals with the highest average exposure (>0.0075 mg/m(3)) was 1.09 (95% CI, 0.64-1.85). ORs for CKD caused by glomerulonephritis, nephrosclerosis, and diabetic nephropathy did not differ importantly. In patients with CKD ever exposed and most exposed to lead, eGFRs changed by -4.27 and -3.39 mL/min/1.73 m(2)/y compared with -4.55 mL/min/1.73 m(2)/y in nonexposed patients, respectively. Only native Swedes were included, which may limit generalizability. Blood lead was not measured to confirm the validity of the expert rating method. Our data provide no evidence of an important role of low-level occupational lead exposure in the cause or progression of severe CKD. Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  16. Accumulation reconstruction and water isotope analysis for 1736-1997 of an ice core from the Ushkovsky volcano, Kamchatka, and their relationships to North Pacific climate records (United States)

    Sato, T.; Shiraiwa, T.; Greve, R.; Seddik, H.; Edelmann, E.; Zwinger, T.


    An ice core was retrieved in June 1998 from the Gorshkov crater glacier at the top of the Ushkovsky volcano, in central Kamchatka. This ice core is one of only two recovered from Kamchatka so far, thus filling a gap in the regional instrumental climate network. Hydrogen isotope (δD) analyses and past accumulation reconstructions were conducted for the top 140.7 m of the core, spanning 1736-1997. Two accumulation reconstruction methods were developed and applied with the Salamatin and the Elmer/Ice firn-ice dynamics models, revealing a slightly increasing or nearly stable trend, respectively. Wavelet analysis shows that the ice core records have significant decadal and multi-decadal variabilities at different times. Around 1880 the multi-decadal variability of δD became lost and its average value increased by 6‰. The multi-decadal variability of reconstructed accumulation rates changed at around 1850. Reconstructed accumulation variations agree with ages of moraines in Kamchatka. Ice core signals were significantly correlated with North Pacific sea surface temperature (SST) and surface temperature (2 m temperature). δD correlates with the North Pacific Gyre Oscillation (NPGO) index after the climate regime shift in 1976/1977, but not before that. Therefore, our findings imply that the ice core record contains various information on the local, regional and large-scale climate variability in the North Pacific region. Understanding all detailed mechanisms behind the time-dependent connections between these climate patterns is challenging and requires further efforts towards multi-proxy analysis and climate modelling.

  17. Characteristics of a crater glacier at Ushkovsky volcano, Kamchatka, Russia, as revealed by the physical properties of ice cores and borehole thermometry


    Shiraiwa, Takayuki; Murav'yev, Yaroslav D.; Kameda,Takao; Nishio,Fumihiko; Toyama, Yoko; Takahashi, Akiyoshi; Ovsyannikov, Alexander A.; Salamatin, Andrey N.; YAMAGATA, Kotaro


    A glacier at the summit of Ushkovskyvolcano, Kamchatka peninsula, Russia, was studied in order to obtain information about the physical characteristics of a glacier that fills a volcanic crater. The glacier has a gentle surface and a concave basal profile with a maximum measured depth of 240 m at site K2. The annual accumulation rate was 0.54 m a-1 w.e., and the 10 m depth temperature was -15.8°C. A 211.70 m long ice core drilled at K2 indicates that (1) the site is categorized as a percolati...

  18. Velocity structure of the crust and upper mantle at the northern group of Kamchatka volcanoes (Based on the travel time of P-waves from volcanic earthquakes) (United States)

    Slavina, L. B.; Pivovarova, N. B.; Senyukov, S. L.


    The results of a calculation of the P-wave ( V P ) velocity fields are presented on the basis of the method of the reversible wave and the TAU parameter characterizing the V P / V S ratio of seismic waves from the local volcanic earthquakes that occurred at the northern group of Kamchatka volcanoes in 2005-2007. The 3D velocity cross sections were constructed along the SW-NE-trending volcanic group from the Ploskii Tolbachik volcano in the southwest up to the Shiveluch volcano in the northeast. The change of velocity field in time and depth is found. The problems of relating these changes to volcanic activity is reviewed.

  19. The dysfunctional endothelium in CKD and in cardiovascular disease : mapping the origin(s) of cardiovascular problems in CKD and of kidney disease in cardiovascular conditions for a research agenda

    NARCIS (Netherlands)

    Fliser, Danilo; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Goldsmith, David; Covic, Adrian; London, Gerard; Zoccali, Carmine


    Endothelial dysfunction resulting in disintegration of vascular structure and function is a key element in the progression of chronic kidney disease (CKD). Many risk factors-traditional and non-traditional-are thought to have a role in the progression and development of cardiovascular disease (CVD)

  20. A population-based screening for microalbuminuria among relatives of CKD patients : The Kidney Evaluation and Awareness Program in Sheffield (KEAPS)

    NARCIS (Netherlands)

    Bello, Aminu K.; Peters, Jean; Wight, Jeremy; de Zeeuw, Dick; El Nahas, Meguid


    Background: Microalbuminuria has been used to detect subjects at risk of cardiovascular disease and chronic kidney disease (CKD) in patients with diabetes, those with hypertension, and the general population. However, relatives of patients with CKD have not been investigated for microalbuminuria in

  1. CKD6B型内燃机车的研制与运用

    Institute of Scientific and Technical Information of China (English)




  2. Serum Calcification Propensity Predicts All-Cause Mortality in Predialysis CKD (United States)

    Ford, Martin L.; Tomlinson, Laurie A.; Bodenham, Emma; McMahon, Lawrence P.; Farese, Stefan; Rajkumar, Chakravarthi; Holt, Stephen G.; Pasch, Andreas


    Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification. PMID:24179171

  3. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression. (United States)

    Garneata, Liliana; Stancu, Alexandra; Dragomir, Diana; Stefan, Gabriel; Mircescu, Gabriel


    Dietary protein restriction may improve determinants of CKD progression. However, the extent of improvement and effect of ketoanalogue supplementation are unclear. We conducted a prospective, randomized, controlled trial of safety and efficacy of ketoanalogue-supplemented vegetarian very low-protein diet (KD) compared with conventional low-protein diet (LPD). Primary end point was RRT initiation or >50% reduction in initial eGFR. Nondiabetic adults with stable eGFRproteins and 1 cps/5 kg ketoanalogues per day) or continue LPD (0.6 g/kg per day) for 15 months. Only 14% of screened patients patients were randomized, with no differences between groups. Adjusted numbers needed to treat (NNTs; 95% confidence interval) to avoid composite primary end point in intention to treat and per-protocol analyses in one patient were 4.4 (4.2 to 5.1) and 4.0 (3.9 to 4.4), respectively, for patients with eGFR<30 ml/min per 1.73 m(2) Adjusted NNT (95% confidence interval) to avoid dialysis was 22.4 (21.5 to 25.1) for patients with eGFR<30 ml/min per 1.73 m(2) but decreased to 2.7 (2.6 to 3.1) for patients with eGFR<20 ml/min per 1.73 m(2) in intention to treat analysis. Correction of metabolic abnormalities occurred only with KD. Compliance to diet was good, with no changes in nutritional parameters and no adverse reactions. Thus, this KD seems nutritionally safe and could defer dialysis initiation in some patients with CKD.

  4. Multilocus sequence analysis of Thermoanaerobacter isolates reveals recombining, but differentiated, populations from geothermal springs of the Uzon Caldera, Kamchatka, Russia (United States)

    Wagner, Isaac D.; Varghese, Litty B.; Hemme, Christopher L.; Wiegel, Juergen


    Thermal environments have island-like characteristics and provide a unique opportunity to study population structure and diversity patterns of microbial taxa inhabiting these sites. Strains having ≥98% 16S rRNA gene sequence similarity to the obligately anaerobic Firmicutes Thermoanaerobacter uzonensis were isolated from seven geothermal springs, separated by up to 1600 m, within the Uzon Caldera (Kamchatka, Russian Far East). The intraspecies variation and spatial patterns of diversity for this taxon were assessed by multilocus sequence analysis (MLSA) of 106 strains. Analysis of eight protein-coding loci (gyrB, lepA, leuS, pyrG, recA, recG, rplB, and rpoB) revealed that all loci were polymorphic and that nucleotide substitutions were mostly synonymous. There were 148 variable nucleotide sites across 8003 bp concatenates of the protein-coding loci. While pairwise FST values indicated a small but significant level of genetic differentiation between most subpopulations, there was a negligible relationship between genetic divergence and spatial separation. Strains with the same allelic profile were only isolated from the same hot spring, occasionally from consecutive years, and single locus variant (SLV) sequence types were usually derived from the same spring. While recombination occurred, there was an “epidemic” population structure in which a particular T. uzonensis sequence type rose in frequency relative to the rest of the population. These results demonstrate spatial diversity patterns for an anaerobic bacterial species in a relative small geographic location and reinforce the view that terrestrial geothermal springs are excellent places to look for biogeographic diversity patterns regardless of the involved distances. PMID:23801987

  5. Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD

    DEFF Research Database (Denmark)

    Desai, Akshay S; Toto, Robert; Jarolim, Petr


    In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing e...

  6. Hematological profile of chronic kidney disease (CKD patients in Iran, in pre-dialysis stages and after initiation of hemodialysis

    Directory of Open Access Journals (Sweden)

    Afshar Reza


    Full Text Available Anemia is a common sequealae of chronic kidney disease (CKD, associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodia-lyzed, 46 pre-dialyzed. Data including, complete blood count, BUN, creatinine, creatinine clea-rance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%, hypochromic-microcytic (15% and macrocytic (5%. The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001. The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL in 5%, moderate in 70% and severe (Hgb < 7 g/dL in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

  7. CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record. (United States)

    Patel, Thakor G; Pogach, Leonard M; Barth, Robert H


    At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.

  8. A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate (United States)

    Goraya, Nimrit; Simoni, Jan; Jo, Chan-Hee


    Summary Background and objectives Current guidelines recommend Na+-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15–29 ml/min per 1.73 m2) CKD due to hypertensive nephropathy, had a PTCO2 level fruits and vegetables dosed to reduce dietary acid by half (n=36). Results Plasma cystatin C–calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; Pfruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; Pfruits and vegetable group (Pfruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia. PMID:23393104

  9. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.

    NARCIS (Netherlands)

    Matsushita, K.; Mahmoodi, B.K.; Woodward, M.; Emberson, J.R.; Jafar, T.H.; Jee, S.H.; Polkinghorne, K.R.; Shankar, A.; Smith, D.H.; Tonelli, M.; Warnock, D.G.; Wen, C.P.; Coresh, J.; Gansevoort, R.T.; Hemmelgarn, B.R.; Levey, A.S.; Wetzels, J.F.


    CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk

  10. Hemoglobin A(1c) and fructosamine for assessing glycemic control in diabetic patients with CKD stages 3 and 4. (United States)

    Chen, Harn-Shen; Wu, Tzu-En; Lin, Hong-Da; Jap, Tjin-Shing; Hsiao, Li-Chuan; Lee, Shen-Hung; Lin, Shu-Hsia


    Hemoglobin A(1c) (HbA(1c)) and fructosamine can be used to monitor glycemic control in diabetic patients with normal kidney function, but their validity in patients with chronic kidney disease (CKD) has not been evaluated. In this study, we evaluated the correlation and accuracy of these 2 measures of glycemic control in type 2 diabetic patients with CKD stages 3-4. Diagnostic test study. Type 2 diabetic patients with normal (n = 30) and abnormal kidney function (n = 30) were recruited in Taipei Veterans General Hospital, Taiwan. HbA(1c) and fructosamine. Self-monitoring of blood glucose levels. Blood glucose measurements consisted of 6 preprandial, 6 postprandial, and 2 bedtime assessments in a week with a cycle of 4-week intervals for 12 weeks. Correlation coefficients between HbA(1c) level or fructosamine-albumin ratio and mean blood glucose levels were 0.836 and 0.645 in participants with normal kidney function and 0.813 and 0.649 in participants with CKD stages 3-4, respectively. In patients with CKD stages 3-4, mean blood glucose levels in weeks 1-12 were 21.9 mg/dL (95% CI, 11.6-32.5) higher than estimated average glucose (eAG) levels calculated from HbA(1c) levels in participants with normal kidney function. In patients with CKD stages 3-4, mean blood glucose levels in weeks 10-12 were 15.5 mg/dL (95% CI, 5.2-30.5) higher than eAG levels calculated from fructosamine levels in participants with normal kidney function, but without statistical significance when eAG calculated from fructosamine level was corrected for serum albumin level (difference of 5.6 mg/dL; 95% CI, -8.6 to 19.8). Relatively small number of participants with limited amount of blood glucose measurement data. Our data show that eAG calculated from HbA(1c) and fructosamine levels might underestimate mean blood glucose levels in patients with CKD stages 3-4. References ranges may need to be modified when interpreting results of measurements of glycemic control in type 2 diabetic patients with

  11. The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study: protocol of a randomized trial

    Directory of Open Access Journals (Sweden)

    McMahon Emma J


    Full Text Available Abstract Background Despite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD in chronic kidney disease (CKD, quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD. Methods/design The LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day compared with a low (60 mmol/day sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV. The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity, proteinuria and fluid status. The randomized crossover trial (Phase 1 is supported by an ancillary trial (Phase 2 of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers, quality of life and taste assessment. Discussion The LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients. Trial registration Universal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932

  12. Climatic Seesaws Across The North Pacific As Revealed By High-Mountain Ice Cores Drilled At Kamchatka And Wrangell-St. Elias Mountains (United States)

    Shiraiwa, T.; Goto-Azuma, K.; Kanamori, S.; Matoba, S.; Benson, C. S.; Muravyev, Y. D.; Salamatin, A. N.


    We drilled ca. 210-m deep ice cores at Mt. Ushkovsky (Kamchatka: 1998), King Col of Mt. Logan (2002) and Mt. Wrangell (2004). Thanks to the high accumulation rates up to 2 m per year in these mountains, the ice cores are expected to unveil the climate and atmospheric changes in the northern North Pacific during the last several centuries. The reconstructed annual accumulation rates time-series of Mt. Ushkovsky showed, for example, decadal to interdecadal oscillations which were closely correlated to the Pacific Decadal Oscillations (PDO). Comparison between the reconstructed accumulation rates between the Ushkovsky and our two ice cores from Wrangell-St. Elias mountains suggests that the PDO played an important role in determining the precipitation at both side of the northern North Pacific: positive PDO supplied high precipitation in the Pacific North America and the negative PDO did high in Kamchatka during the last two centuries. Beside the significance of the climate proxy signals, the physical properties of the ice cores and the related glaciological features at the three mountains provided unique feature of glaciers developing on high mountains with complicated topographies and high accumulation rates. It was shown that careful treatment of dynamic behavior in these high mountain glaciers are indispensable for the precise reconstruction of past accumulation time-series.

  13. Mapping resource use over a Russian landscape: an integrated look at harvesting of a non-timber forest product in central Kamchatka (United States)

    Hitztaler, Stephanie K.; Bergen, Kathleen M.


    Small-scale resource use became an important adaptive mechanism in remote logging communities in Russia at the onset of the post-Soviet period in 1991. We focused on harvesting of a non-timber forest product, lingonberry (Vaccinium vitis-idaea), in the forests of the Kamchatka Peninsula (Russian Far East). We employed an integrated geographical approach to make quantifiable connections between harvesting and the landscape, and to interpret these relationships in their broader contexts. Landsat TM images were used for a new classification; the resulting land-cover map was the basis for linking non-spatial data on harvesters’ gathering behaviors to spatial data within delineated lingonberry gathering sites. Several significant relationships emerged: (1) mature forests negatively affected harvesters’ initial choice to gather in a site, while young forests had a positive effect; (2) land-cover type was critical in determining how and why gathering occurred: post-disturbance young and maturing forests were significantly associated with higher gathering intensity and with the choice to market harvests; and (3) distance from gathering sites to villages and main roads also mattered: longer distances were significantly correlated to more time spent gathering and to increased marketing of harvests. We further considered our findings in light of the larger ecological and social dynamics at play in central Kamchatka. This unique study is an important starting point for conservation- and sustainable development-based work, and for additional research into the drivers of human-landscape interactions in the Russian Far East.

  14. Radioactive contamination of the soil-plant cover at certain locations of Primorsky Krai, Sakhalin Island and Kamchatka Peninsula: Assessment of the Fukushima fallout. (United States)

    Mikhailovskaya, L N; Molchanova, I V; Pozolotina, V N; Zhuravlev, Yu N; Timofeeva, Ya O; Burdukovsky, M L


    The contamination densities of soil-plant cover at certain locations within the Primorsky Krai, Sakhalin Island and Kamchatka Peninsula attributable to (90)Sr, (137)Cs and (239,240)Pu were 500-1390 Bq m(-2), 980-2300 Bq m(-2) and 37-74 Bq m(-2), respectively. These values do not exceed average global background levels, typical for mid-latitudes of the Northern Hemisphere. The spatial distribution of radionuclides depends on the climatic conditions of the region. A positive dependence of the (90)Sr and (137)Cs contamination densities, as well as additional (137)Cs from NPP "Fukushima" in the soil, was determined based on the sum of annual atmospheric precipitation within the study areas. No trends in the spatial distribution of Pu isotopes were observed. The (137)Cs contribution from the "Fukushima" NPP constitutes 11-300 Bq m(-2) in the Primorsky Krai, Sakhalin Island and at the Kamchatka peninsula, i.e., 1-22% of the total amount of radionuclides in the soil. The contribution of this radionuclide to the contamination of moss-lichen vegetation ranged from 7 to 42%. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Chlorinated, brominated, and perfluorinated compounds, polycyclic aromatic hydrocarbons and trace elements in livers of sea otters from California, Washington, and Alaska (USA), and Kamchatka (Russia) (United States)

    Kannan, K.; Moon, H.-B.; Yun, S.-H.; Agusa, T.; Thomas, N.J.; Tanabe, S.


    Concentrations of organochlorine pesticides (DDTs, HCHs, and chlordanes), polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), polycyclic aromatic hydrocarbons (PAHs), perfluorinated compounds (PFCs), and 20 trace elements were determined in livers of 3- to 5-year old stranded sea otters collected from the coastal waters of California, Washington, and Alaska (USA) and from Kamchatka (Russia). Concentrations of organochlorine pesticides, PCBs, and PBDEs were high in sea otters collected from the California coast. Concentrations of DDTs were 10-fold higher in California sea otters than in otters from other locations; PCB concentrations were 5-fold higher, and PBDE concentrations were 2-fold higher, in California sea otters than in otters from other locations. Concentrations of PAHs were higher in sea otters from Prince William Sound than in sea otters from other locations. Concentrations of several trace elements were elevated in sea otters collected from California and Prince William Sound. Elevated concentrations of Mn and Zn in sea otters from California and Prince William Sound were indicative of oxidative stress-related injuries in these two populations. Concentrations of all of the target compounds, including trace elements, that were analyzed in sea otters from Kamchatka were lower than those found from the US coastal locations. ?? The Royal Society of Chemistry.

  16. Deep-sea epibiotic hydroids from the abyssal plain adjacent to the Kuril-Kamchatka Trench with description of Garveia belyaevi sp. nov. (Hydrozoa, Bougainvilliidae) (United States)

    Stepanjants, Sofia D.; Chernyshev, Alexey V.


    Examination of material collected by the German-Russian KuramBio Deep-Sea Expedition to the abyssal plain adjacent to the Kuril-Kamchatka Trench revealed about 17 hydroid species, including two species presumably new to science. Before the KuramBio Expedition only fragments of the unidentified hydroids and Cryptolaria sp. were collected in the Kuril-Kamchatka Trench from depths exceeding 3000 m. Descriptions of three species of epibiotic hydroids (including one new species, Garveia belyaevi sp. nov.) are presented herein. A colony of G. belyaevi sp. nov. (the third deep-sea and deepest species of the wide distributed genus Garveia) was attached to the spines of unidentified irregular sea urchins from depths 5217 to 5229 m. Нalitholus (?) sp. (Hydrozoa, Anthoathecata) colonized the skin of spoon worms (Echiura) but could not be identified to species level because the mature medusa stage was absent in the material. An unidentified juvenile polyp (Pandeidae) was found on the bryozoan Tricitella minini attached to spines of irregular sea urchins Echinosigra amphora. Colonial sedentary organisms inhabiting abyssal plains with soft bottoms may colonize invertebrates which are seldom used as substrates for epibiota in shallow waters. Epibiosis among abyssal colonial invertebrates, though extremely poorly studied, appears to be rather frequent.

  17. [Karyological differences of the Northern Dolly Varden Salvelinus malma malma and the white char Salvelinus albus from the Kamchatka River basin]. (United States)

    Frolov, S V


    The karyotypes of northern Dolly Varden and white char, sympathrically inhabiting the Kamchatka River basin, were studied. The karyotype of Dolly Varden was stable: 2n = 78 and NF = 98 + 2, while in white char, polymorphism and mosaicism for the chromosome number were revealed: 2n = 76-79, NF = 98 + 2. Using a routine chromosome staining technique, the karyotype of white char (2n = 78) was shown to be identical to that of Dolly Varden. In both karyotypes, similar sets of marker chromosomes were present: two pairs of submetacentric (SM), one pair of submeta-subtelocentric (SM-ST), one pair of large acrocentric (A), and one pair of large sub-telocentric (ST) chromosomes. However, the karyotypes of Dolly Varden and white char differed in the number and location of nucleolus organizer regions (NORs). In Dolly Varden, single NORs located in the telomeric regions of the marker SM-ST chromosomes were observed. In white char, NORs were multiple and located both in the telomeric regions of the marker SM-ST chromosomes and on the short and long arms of large ST chromosomes. The identical marker chromosomes indicate considerable phylogenetic relatedness between Dolly Varden and white char from the Kamchatka River basin. Variation in NORs provides evidence for the reproductive isolation of these chars and their species status.

  18. Adolescence depressions

    National Research Council Canada - National Science Library

    Matot, J P


    This article considers the depressive problematics emerging during adolescence in the frame of the transformations that characterize this period of life, with a focus on the interference of socio-cultural dimensions...

  19. Postpartum Depression

    DEFF Research Database (Denmark)

    Smith-Nielsen, Johanne

    Background: In three academic articles, this PhD thesis investigates maternal postpartum depression (PPD) as a risk factor for the infant-mother attachment and infant development. Previous studies have been contradictory with respect to the question of whether PPD can have long term effects...... on offspring. This may be due to not differing between when PPD is only occurring in the postpartum period and when effects are also due to ongoing or recurrent depression. However, it may also be due to viewing maternal depression as a unitary construct, and not considering underlying maternal psychological...... difficulties which may moderate potential adverse effects. The present thesis investigates two potential maternal moderators of risk:. Comorbid personality disorder and adult attachment insecurity. Moreover, the question of early environmental effects of PPD versus effects of later or ongoing depression...

  20. Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD. (United States)

    Weiner, Shoshana; Fink, Jeffery C


    CKD patients have several features conferring on them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired kidney function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated kidney function loss, acute kidney injury, ESRD, and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations that hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review, we summarize previous assessments of the pre-dialysis CKD populations' proficiency in using telemedicine modalities and describe the use of interactive voice-response system to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded interactive voice-response system use in CKD to address the safety threats inherent to this population.

  1. [Vascular Calcification - Pathological Mechanism and Clinical Application - . Vascular calcification in chronic kidney disease-mineral and bone disorder (CKD-MBD)]. (United States)

    Omata, Momoyo; Fukagawa, Masafumi; Kakuta, Takatoshi


    Chronic kidney disease-mineral and bone disorder (CKD-MBD), is sequential pathophysiology that starts in the very early stages of CKD. Three major aspects of CKD-MBD are laboratory abnormalities, bone abnormalities and vascular calcification. In dialysis patients, the prevalence of death due to cardiovascular disease accounts for more than 40% of all-cause mortality. Therefore, arteriosclerosis with vascular calcification may be an important pathophysiological mechanism in the development of cardiovascular disease. Vascular calcification is known to be an important risk factor influencing mortality in CKD patients. A number of studies have suggested a close association between serum FGF23 concentration and the risks of mortality, cardiovascular disease vascular calcification as well as CKD progression. Renal insufficiency leads to decline in klotho level and impaired phosphate excretion. However serum phosphate levels are maintained in the normal range by up regulation of FGF23 and PTH in early CKD stage. Early treatment intervention is necessary to improve the prognosis of the CKD patient.

  2. Anti-inflammatory effect of white wine in CKD patients and healthy volunteers. (United States)

    Migliori, Massimiliano; Panichi, Vincenzo; de la Torre, Rafael; Fitó, Montserrat; Covas, Maribel; Bertelli, Alberto; Muñoz-Aguayo, Daniel; Scatena, Alessia; Paoletti, Sabrina; Ronco, Claudio


    Mediterranean-style diet has been considered for its important beneficial effects on the progression of CV disease. Wine is an important component of the Mediterranean diet, and moderate wine drinkers have lower mortality rates than nondrinkers and heavy drinkers in epidemiologic studies. The beneficial effects of red wine are thought to be dependent on the polyphenol compounds such as resveratrol that exhibit potent antioxidant activity. However, white wine, although lacking polyphenols, contains simple phenols, such as tyrosol (Tyr) and hydroxytyrosol (OH-Tyr), characteristic also of extra-virgin olive oil, which may share similar antioxidant and inflammatory properties. The effect of white wine and extra-virgin olive oil on inflammatory markers was evaluated in 10 healthy volunteers and in 10 patients with CKD (chronic kidney disease) K-DOQI stage III-IV in a prospective, single blind, randomized, cross-over trial. After two weeks of wash-out from alcoholic beverages, subjects were randomized to a cross-over design A-B or B-A of a 2-week treatment with white wine (4 ml/kg body weight, 0.48 g/kg of alcohol 12%, corresponding to 2-3 glasses/daily) and extra-virgin olive oil (treatment A) or extra-virgin olive oil alone (treatment B). The two study periods were separated by a two-week wash-out period. At baseline and at the end of each treatment, plasma levels of inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-8 (IL-8) concentration were determined. Urinary levels of Tyr, OH-Tyr, and their metabolites were measured at the same time. During combined consumption of white wine and extra-virgin olive oil (treatment A), plasma levels of CRP and IL-6 decreased from 4.1 ± 1.8 to 2.4 ± 1.9 mg/l (p patients. CRP decreased from 2.6 ± 1.2 to 1.9 ± 0.9 mg/l (p chronic inflammation were significantly reduced in CKD patients during the combined consumption of white wine and olive oil, suggesting a

  3. Unexpectedly higher metazoan meiofauna abundances in the Kuril-Kamchatka Trench compared to the adjacent abyssal plains (United States)

    Schmidt, Christina; Martínez Arbizu, Pedro


    We studied meiofauna standing stocks and community structure in the Kuril-Kamchatka Trench and its adjacent abyssal plains in the northwestern Pacific Ocean. In general, the Nematoda were dominant (93%) followed by the Copepoda (4%). Nematode abundances ranged from 87% to 96%; those of copepods from 2% to 7%. The most diverse deployment yielded 17 taxa: Acari, Amphipoda, Annelida, Bivalvia, Coelenterata, Copepoda, Cumacea, Gastrotricha, Isopoda, Kinorhyncha, Loricifera, Nematoda, Ostracoda, Priapulida, Tanaidacea, Tantulocarida, and Tardigrada. Nauplii were also present. Generally, the trench slope and the southernmost deployments had the highest abundances (850-1392 individuals/cm2). The results of non-metric multidimensional scaling indicated that these deployments were similar to each other in meiofauna community structure. The southernmost deployments were located in a zone of higher particulate organic carbon (POC) flux (g Corg m-2 yr-1), whereas the trench slope should have low POC flux due to depth attenuation. Also, POC and abundance were significantly correlated in the abyssal plains. This correlation may explain the higher abundances at the southernmost deployments. Lateral transport was also assumed to explain high meiofauna abundances on the trench slope. Abundances were generally higher than expected from model results. ANOSIM revealed significant differences between the trench slope and the northern abyssal plains, between the central abyssal plains and the trench slope, between the trench slope and the southern abyssal plains, between the central and the southern abyssal plains, and between the central and northern deployments. The northern and southern abyssal plains did not differ significantly. In addition, a U-test revealed highly significant differences between the trench-slope and abyssal deployments. The taxa inhabited mostly the upper 0-3 cm of the sediment layer (Nematoda 80-90%; Copepoda 88-100%). The trench-slope and abyssal did not differ

  4. Rate of change in kidney function and the risk of death: the case for incorporating the rate of kidney function decline into the CKD staging system. (United States)

    Al-Aly, Ziyad; Cepeda, Oscar


    Chronic kidney disease (CKD) is associated with increased risk of death. A wave of recent studies used longitudinal data to examine the effect of the rate of decline of kidney function on the risk of death. The results from these studies show that there is an independent and graded association between the rate of kidney function decline and the risk of death. There is a need to incorporate the rate of decline in the definition of CKD. This redefinition of CKD will transform a static definition into a dynamic one that more accurately describes the disease state in an individual patient.

  5. Confounding and control of confounding in nonexperimental studies of medications in patients with CKD. (United States)

    Bradbury, Brian D; Gilbertson, David T; Brookhart, M Alan; Kilpatrick, Ryan D


    Confounding is an important source of bias in nonexperimental studies, arising when the effect of an exposure on the occurrence of an outcome is distorted by the effect of some other factor. In nonexperimental studies of patients with CKD or who are on chronic dialysis, confounding is a significant concern owing to the high burden of comorbid disease, extent of required clinical management, and high frequency of adverse clinical events in this patient population. Confounding can be addressed in both the design stage (restriction, accurate measurement of confounders) and analysis stage (stratification, multivariable adjustment, propensity scores, marginal structural models, instrumental variable) of a study. Time-dependent confounding and confounding by indication are 2 special cases of confounding that can arise in studies of treatment effects and may require more sophisticated analytic techniques to adequately address. The availability and expanded use of large health care databases have ensured greater precision and have now placed the focus on validity. Addressing the major threats to validity, such as confounding, should be a first-order concern.

  6. First data on magma ascent and residence times retrieved from Fe-Mg and trace element zonation in olivine phenocrysts from Kamchatka basalts (United States)

    Gordeychik, Boris; Churikova, Tatiana; Kronz, Andreas; Simakin, Alexander; Wörner, Gerhard


    Compositional zonation in olivine phenocrysts and diffusion modelling have been used in the last ten years to estimate magma residence times and the duration of magma ascent. The fundamental assumption is that mixing with newly injected magma into a reservoir triggers diffusional exchange between mafic olivine crystals and more evolved magma and that this magma mixing eventually triggers eruption. If depth of mixing is known, this translates to ascent rates of magmas to the surface. We applied this approach to a series of different arc basalt lavas from Kamchatka to constrain the rates of magma ascent and magma resident in what is one of the most active subduction zones in the world that is also dominated by an abundance of unusually mafic magmas. Our sample collection cover the principal modes of arc magmatism in Kamchatka: from different volcanic complexes (stratovolcano, dikes, summit eruptions, monogenetic cones), of different age (from Late-Pleistocene to Holocene and recent eruptions), from different magmatic regimes (long-lived volcanoes vs. monogenetic eruptions) and different major element composition (from basalt to basaltic andesite of different geochemical character including LILE enrichments). We analyzed and modelled zonation profiles for a range of elements with different diffusivities (e.g. Mg-Fe, Ca, Ni, Mn, Cr) to assess the role of variable diffusivities as a function of major and trace elements in the olivines from different P-T conditions. First data were obtained on samples from the Klyuchevskoy, Shiveluch and Tolbachik, including recent most eruption in 2012/2013. These data show that for some samples the zonation patterns are much more complex than is usually observed: high-Mg olivines at different volcanoes have very different zonation patterns, including normally, reversely zoned grains or even show highly complex repetitive zonation that indicate large compositional changes in the surrounding magma at very short time scales (years). Thus

  7. Cardiac troponin I concentration is commonly increased in nondialysis patients with CKD: experience with a sensitive assay. (United States)

    Lamb, Edmund J; Kenny, Claire; Abbas, Nasir A; John, R Ian; Webb, Michelle C; Price, Christopher P; Vickery, Susan


    Cardiac troponin (cTn) concentrations commonly are increased in patients with chronic kidney disease (CKD) in the absence of an acute coronary syndrome. cTn T (cTnT) concentration reportedly is increased more commonly than cTn I (cTnI). Using a sensitive cTnI assay, we studied cTnI concentrations in predialysis patients with CKD who did not have an acute coronary event. Observational cohort study. Nondialysis patients with CKD attending an outpatient clinic. Plasma cTnI was measured using the cTnI-Ultra assay (Bayer HealthCare LLC, Diagnostics Division, Tarrytown, NY), the same manufacturer's standard cTnI assay, and a cTnT assay (Roche Diagnostics PLC, East Sussex, UK). Prevalence of increased cTn concentration, effect of clinical variables on cTnI-Ultra concentration, and independent associations between cTn assays and all-cause mortality by using multiple regression modeling. Plasma cTnI-Ultra concentration exceeded the upper limit of normal in 33% of patients compared with 18% with the cTnI-standard assay and 43% with the cTnT assay. Age, vascular disease, parathyroid hormone concentration, and left ventricular mass, but not kidney function, had independent effects on plasma cTnI-Ultra concentrations. There were 39 deaths during follow-up. Survival was decreased in patients with baseline cTnI-Ultra concentrations of 0.040 ng/mL or greater (54% versus 83%; P sensitive assay, we found that the prevalence of increased cTnI concentrations in patients with CKD is similar to that observed for cTnT. cTnT concentration, but not cTnI, was independently associated with death.

  8. [Comparison of the cardiovascular predictive value of MDRD and CKD-EPI in estimating chronic kidney disease]. (United States)

    Cinza-Sanjurjo, S; Calvo-Gómez, C; Hermida-Ameijeiras, A; López-Paz, J E; González-Juanatey, J R


    To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9±2.6 mL/min/1.73m(2) and 76.9±2.2 mL/min/1.73m(2), respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95%CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. (United States)

    Tong, Allison; Cheung, Katharine L; Nair, Sumi Sukumaran; Kurella Tamura, Manjula; Craig, Jonathan C; Winkelmayer, Wolfgang C


    Although dialysis prolongs life for patients with end-stage kidney disease, 20% of deaths in this population are preceded by dialysis therapy withdrawal. Recently, there has been more focus on conservative (nondialytic) care as a legitimate option, particularly for elderly patients. This study aims to describe patients' and caregivers' perspectives on conservative treatment and end-of-life care in chronic kidney disease (CKD). Systematic review and thematic synthesis of qualitative studies. Patients with CKD and caregivers. MEDLINE, Embase, PsycINFO, CINAHL, and reference lists were searched to May 2013. Thematic synthesis was used to analyze the findings. 26 studies involving more than 711 patients (non-dialysis dependent [n=41], hemodialysis [n=544], peritoneal dialysis [n=9]; unspecified dialysis modality [n=31], conservative management [n=86]) and 178 caregivers were included. We identified 5 themes: invasive suffering (bodily deterioration, loss of freedom and independence, unyielding fatigue and pain, resignation, treatment burden and harm, financial strain), personal vulnerability (imminence of death, misunderstanding and judgment, autonomy and dignity, medical abandonment, trust and safety), relational responsibility (being a burden, demonstrating loyalty, protecting others from grief), negotiating existential tensions (accepting natural course of life, disrupted aging, worthlessness, living on borrowed time, respecting sanctity of life, life satisfaction, preserving self-identity), and preparedness (decisional clarity, informational power, spirituality and hope). Non-English articles were excluded; therefore, the transferability of findings to other populations is unclear. Some patients with CKD experience physical and psychosocial frailty and feel ambivalent about prolonging life. Some caregivers believe in providing relief from suffering, but are uncertain about making decisions regarding dialysis therapy initiation and discontinuation. We suggest that

  10. Extreme Elevations in Blood Pressure and All-Cause Mortality in a Referred CKD Population: Results from the CRISIS Study. (United States)

    Ritchie, James; Rainone, Francesco; Green, Darren; Alderson, Helen; Chiu, Diana; Middleton, Rachel; O'Donoghue, Donal; Kalra, Philip A


    Hypertension frequently complicates chronic kidney disease (CKD), with studies showing clinical benefit from blood pressure lowering. Subgroups of patients with severe hypertension exist. We aimed to identify patients with the greatest mortality risk from uncontrolled hypertension to define the prevalence and phenotype of patients who might benefit from adjunctive therapies. 1691 all-cause CKD patients from the CRISIS study were grouped by baseline blood pressure-target (extreme (>190 and/or 100 mmHg). Groups were well matched for age, eGFR, and comorbidities. 77 patients had extreme hypertension at recruitment but no increased mortality risk (HR 0.9, P = 0.9) over a median follow-up period of 4.5 years. The 1.2% of patients with extreme hypertension at recruitment and at 12-months had a significantly increased mortality risk (HR 4.3, P = 0.01). This association was not seen in patients with baseline extreme hypertension and improved 12-month blood pressures (HR 0.86, P = 0.5). Most CKD patients with extreme hypertension respond to pharmacological blood pressure control, reducing their risk for death. Patients with extreme hypertension in whom blood pressure control cannot be achieved have an approximate prevalence of 1%. These patients have an increased mortality risk and may be an appropriate group to consider for further therapies, including renal nerve ablation.

  11. Validation of Indonesian Version of FACIT Fatigue Scale Questionnaire in Chronic Kidney Disease (CKD Patients with Routine Hemodialysis

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    Jhonson P. Sihombing


    Full Text Available Anemia is common in Chronic Kidney Disease (CKD. One of anemia consequences is fatigue which can lead to decrease in quality of life. Functional Assessment Chronic Illness Therapy (FACIT Fatigue Scale is an instrument to measure patient’s score of fatigue. This questionnaire is not validated yet in Indonesia. The aim of this study is to validate Indonesian version of Functional Assessment Chronic Illness Therapy (FACIT Fatigue Scale as an instrument for patient’s quality of life. FACIT Fatigue Scale was translated into Indonesian and administrated to CKD patients with routine homodialysis in an academic hospital in Yogyakarta on May until October 2015. The validity was evaluated by Pearson correlation test and the reliability was evaluated by Cronbach’s alpha test. Validity test showed that all of the questions were valid because r count was bigger than r table=0,279 and reliable because r11=0,646>0,6. In conclusion, Indonesian version of FACIT Fatigue Scale was a brief and valid to monitor important symptom and its effect on CKD patients with routine hemodialysis.

  12. Survey of attitudes of physicians toward the current evaluation and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD

    Directory of Open Access Journals (Sweden)

    Souqiyyeh Muhammad


    Full Text Available We aimed in this study to determine the opinion of the medical directors of dialysis centers in the Kingdom of Saudi Arabia (KSA about the updates of strategies for evaluation and treatment of chronic kidney disease-mineral and bone Disorder (CKD-MBD. A questionnaire was sent to medical directors of 174 dialysis centers in the KSA between July and November 2009. The questionnaire was opinion based and comprised the prevalence of the CKD-MBD, strategies of therapy and indications of cinacalcet, a new therapy in the CKD patients. A total of 154 medical directors of the 174 (88.5%, who are the therapeutic decision-makers for 10100 (89% dialysis patients, answered the questionnaire. There were 84 respondents (54% who believed that the parathormone (PTH blood levels initially increase at a glomerular filtration rate (GFR < 30%. There were 80 (53% respondents who believed that changes of phosphorus (PO4 and cal-cium (Ca blood levels are initially observed at GFR < 30 mL/min. The majority of respondents, 115 (77%, 116 (80%, 95 (66%, and 134 (90% currently have observed increased prevalence of vascular calcifications, adynamic bone disease, PTH > 500 pmol/L, and elevated Ca blood levels, respectively, only in the minority of advanced CKD. However, 88 (58% respondents observed increased prevalence of elevated PO4 blood levels in the majority of new dialysis and advanced CKD patients. There were 137 (89% respondents who believed from the current published evi-dence that CKD-MBD may result in increased morbidity (e.g. fractures and mortality (e.g. cardiovascular in advanced CKD and new dialysis patients. However, only 41 (27% respondents follow the PTH levels in their patients every 2-3 months, while 81(53% follow it every 6 months. There were 127 (83%, 129 (84%, 114 (75% respondents who would start vitamin D (vit D in dialysis and CKD patients for hypocalcemia, high PTH, and vit D 1,25 deficiency, respectively. However, only 51 (34% respondents would

  13. Can Lupus Cause Depression? (United States)

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  14. Older Adults and Depression (United States)

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  15. Depression and Multiple Sclerosis (United States)

    ... Symptoms Depression Share this page Facebook Twitter Email Depression Depression Fatigue Walking (Gait) Difficulties Numbness or Tingling ... away from addictive substances such as alcohol. Clinical depression It’s important to distinguish between mild, everyday “blues” — ...

  16. Gibt es neben der Prähypertonie auch ein Vorstadium der chronischen Niereninsuffizienz (Prä-CKD ?

    Directory of Open Access Journals (Sweden)

    Ribitsch W


    Full Text Available Die Prävalenz der chronischen Niereninsuffizienz (CKD wird in den nächsten Jahren weiter zunehmen und aller Voraussicht deutlich auf einen Anteil 10 % der Gesamtbevölkerung ansteigen. Sie ist mit wesentlichen negativen Auswirkungen inklusive erhöhter kardiovaskulärer Morbidität und Mortalität assoziiert. Die wichtigsten traditionellen Risikofaktoren für die Entwicklung einer chronischen Niereninsuffizienz beinhalten Adipositas, arterielle Hypertonie und Diabetes mellitus. Bisherige Definitionen der arteriellen Hypertonie und des Diabetes mellitus wurden aufgrund von Studien erweitert, die zeigten, dass bereits Blutdruckwerte und Blutzuckerspiegel unterhalb der Normbereichsgrenze mit einem erhöhten kardiovaskulären Risiko einhergehen. Diese Erkenntnisse führten zur Einführung der Begriffe „Prähypertonie“ und „Prädiabetes“. Prähypertonie beschreibt einen Blutdruck zwischen 130–139/85– 90 mmHg, während ein Prädiabetes durch eine gestörte Nüchternglukose bzw. das Vorliegen einer gestörten Glukosetoleranz definiert ist. Patienten beider Entitäten unterliegen der Gefahr einer Krankheitsprogression und damit einhergehend einer erhöhten kardiovaskulären Morbidität und Mortalität. Der Begriff einer Prä-CKD war in der Nephrologie bislang noch nicht etabliert. In der jüngeren Vergangenheit mehrten sich jedoch Hinweise, wonach bereits bei normaler und leicht eingeschränkter Nierenfunktion eine Assoziation zwischen Phosphatspiegel und kardiovaskulärem Risiko besteht. Diese Beobachtungen lenkten die Aufmerksamkeit der Nephrologen auf die frühen Stadien der Niereninsuffizienz, wobei vor allem das „Phosphatonin Fibroblast Growth Factor 23“ (FGF-23 im komplexen System des Phosphatstoffwechsels ein vielversprechender Parameter zu sein scheint. FGF- 23 steigt bereits früh im Verlauf einer chronischen Niereninsuffizienz an, wenn der Patient üblicherweise noch keinem Nephrologen vorgestellt wird. Aufgrund der limitierten

  17. Late Cretaceous paleomagnetism of the East Ranges island arc complex, Kamchatka: Implications for terrane movements and kinematics of the northwest Pacific (United States)

    Levashova, Natalia M.; Bazhenov, Mikhail L.; Shapiro, Mikhail N.


    A Campanian-lower Paleocene island arc complex was sampled for paleomagnetic studies at 12 sites in the East Ranges tectonic zone of Kamchatka. After thermal demagnetization, a reversed polarity characteristic remanent magnetization (ChRM) was isolated from most volcanoclastic and basaltic units as well as from lava debris from intraformational conglomerates. The fold and conglomerate tests are positive, and the ChRM in the studied rocks is likely primary. The formation-mean inclination of 66.3°±3.7° corresponds to a paleolatitude of 48.7°±5.0°N which is about 20° lower than the Late Cretaceous North American reference values. Because northward displacement of the studied terrane is indicated by the paleomagnetic data, we examine several models of intraoceanic transport with the Pacific and/or Kula plates and coastwise transport after terrane accretion, far to the south of the present-day position of Kamchatka. Our preferred interpretation is that the studied island arc complex accumulated at about 83-79 Ma; the island arc, to which the studied terrane had originally belonged, was active between this time and 65-60 Ma. According to geological data, the docking time nearly coincided with cessation of volcanic activity, and northward movement of the island arc took place simultaneously with the volcanic activity. The absolute motion of a subduction zone should have the same direction as the overriding plate; therefore, the subduction zone related to the East Ranges island arc is inferred to have moved northward with the Kula plate or with the Kula and Pacific plates, successively, consuming either the oceanic periphery of a continental plate or some unknown minor oceanic plate. This process went on until 65-55 Ma when the island arc and related subduction zone approached the continental margin and became extinct. The proposed models also place additional constraints on kinematics of the Kula-Pacific transform plate boundary.

  18. New deep-sea large free-living nematodes from macrobenthos in the Kuril-Kamchatka Trench (the North-Western Pacific) (United States)

    Fadeeva, Natalia; Mordukhovich, Vladimir; Zograf, Julia


    The composition of deep-sea nematode assemblages of the North-Western (NW) Pacific is poorly-studied. According to the available literature data more than 700 valid species of nematodes were reported from the depth of 400 m and deeper, out of that only 6 species were registered in the NW Pacific: 2 species from the coast of the Japanese Islands and 4 from the Sea of Japan. Ecological studies of the deep-sea nematode communities of this region are scanty and represent very scarce and fragmentary information. The first recent study of free-living nematodes collected from the abyssal plain adjacent to the Kuril-Kamchatka Trench has revealed more than 50 species of nematodes in macrobenthic samples. Families Anticomidae, Comesomatidae, Desmodoridae, Leptosomatidae, Oncholaimidae, Oxystominidae, Phanodermatidae, Siphonolaimidae and Thoracostomopsidae were the most abundant and diverse. Such taxonomic composition differs greatly from previously described meiobenthical nematode communities of NW Pacific and even World Ocean and similar to macrofaunal nematode assemblages of the Atlantic and Arctic regions. Several genera of nematodes can be considered as new records for the NW Pacific region. Micoletzkyia kamchatika sp. nov., Metaphanoderma improvisa sp. nov., and Phylloncholaimus palmaris sp. nov. are described from the Kuril-Kamchatka Trench. Micoletzkyia kamchatika sp. nov. is particularly characterized by a developed cuticular cephalic capsule underlying amphids, relatively small amphids, and the shape of the gubernaculum. Metaphanoderma improvisa sp. nov. is particularly characterized by a developed cuticular cephalic capsule, relatively large amphids, and the absence of pigmented eye spots. Phylloncholaimus palmaris sp. nov. is similar to the type species in many measurements but may be differentiated from that by the smaller amphid, shape of spicules and gubernaculums and by large precloacal papillae with four setae.

  19. Individuals with a family history of ESRD are a high-risk population for CKD: implications for targeted surveillance and intervention activities. (United States)

    McClellan, William M; Satko, Scott G; Gladstone, Elisa; Krisher, Jenna O; Narva, Andrew S; Freedman, Barry I


    Activities intended to improve the detection, treatment, and control of chronic kidney disease (CKD) should be incorporated into existing health care systems and targeted to high-risk populations to avoid redundancy and waste of resources. One high-risk population consists of first- or second-degree family members of patients with end-stage renal disease (ESRD), who are 2 to 3 times as likely to have incident ESRD, have high rates of impaired kidney function and undetected and uncontrolled high blood pressure, and are more likely to be obese. These individuals usually are unaware of their underlying CKD and may discount their own risk of ESRD. The ESRD Network 6 Family History Project shows that the ESRD Networks, which constitute a national CKD surveillance system for patients with stage 5 CKD, may be an existing resource that can be used to identify relatives of incident patients with ESRD and provide these families with information about CKD. Nationally available resources have been developed by the National Kidney Disease Education Program for use with these at-risk families. Individuals interested in population-based CKD control activities should be aware of and use these resources.

  20. Serum Testosterone Levels and Mortality in Men With CKD Stages 3–4 (United States)

    Khurana, Kiranpreet K.; Navaneethan, Sankar D.; Arrigain, Susana; Schold, Jesse D.; Nally, Joseph V.; Shoskes, Daniel A.


    Background Hypogonadism in men (total testosterone level testosterone measured for-cause between January 1, 2005 and October 31, 2011 at a tertiary care center in Cleveland, Ohio. Predictors Total testosterone measured using an immunoassay measurement in 3 forms: a) categorized as low or testosterone replacement therapy versus normal, b) continuous log testosterone, and c) quintiles (100–226, 227–305, 306–392, 393–511, 512–3153 ng/dL). Outcomes Factors associated with low total testosterone, and association between low total testosterone and all-cause mortality were evaluated using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves. Results Hypogonadism was found in 1288/2419 (53%) of men. In a multivariable logistic regression analysis, African American ethnicity and higher eGFR were associated with lower odds of having hypogonadism. Diabetes and higher body mass index were associated with higher odds of having hypogonadism. 357/2419 (15%) patients died during a median follow up of 2.3 years. In the multivariate Cox model, testosterone testosterone replacement therapy were not associated with mortality. In a multivariable model also adjusted for testosterone supplementation, higher log testosterone was associated with significantly lower mortality (HR per 1 log unit, 0.70; 95% CI, 0.55–0.89). When compared to the highest quintile, the second lowest quintile of testosterone was associated with higher mortality (HR, 1.53; 95% CI, 1.09–2.16). Limitations Single center study, timing of testosterone testing, lack of adjustment for proteinuria, and sampling bias. Conclusions Low total testosterone may be associated with higher mortality in men with CKD stages 3–4 but more studies are needed. PMID:24726629

  1. Carbon isotope curve and iridium anomaly in the Albian-Cenomanian paleoceanic deposits of the Eastern Kamchatka (United States)

    Savelyev, D. P.; Savelyeva, O. L.; Palechek, T. N.; Pokrovsky, B. G.


    We studied Albian-Cenomanian paleoceanic carbonate-siliceous deposits of the Kamchatsky Mys Peninsula (Eastern Kamchatka, Russia). They are deposited in association with pillow-basalts and hyaloclastites. The thickness of the studied section is about 10 m. The deposits are represented mainly by rhythmical intercalation of red-brown radiolarian jaspers, pink nannoplankton limestones as well as siliceous limestones. In the middle and upper parts of the section there are two beds enriched by organic carbon. The largest organic matter contents in this beds amount to 68%. The calculated values of the hydrogen and oxygen indexes indicate that the carbonaceous beds consist of marine organic matter. The accumulation of the carbonaceous beds reflects oxygen depletion in intermediate oceanic waters (ocean anoxic events, OAE). The structure of the studied section emphasizes its similarity to the contemporary deposits recovered by ODP and DSDP sites on Hess and Shatsky Rises. Two orders of rhythmicity were observed in the section. The rhythmicity of the first order (average thickness of a rhythm is 5-7 cm) is an alternation of reddish brown radiolarian jaspers and pink nannofossil limestones. The rhythmicity of the second order is characterized by an increase in thickness of the jasper or limy layer in every 4th-5th rhythm of the first order and marked by an elevation of the silica content in calcareous layers. The rhythmicity formation can be attributed to fluctuation of astronomical parameters (Milankovitch cycles) with periods of 21 and 100 kyr. The character of atmospheric circulation and ocean currents served as transmission link. The section was sampled layerwise and more than 100 samples were taken. The radiolarians were extracted from the samples of jaspers and siliceous limestones lying between carbonaceous beds. The educed radiolarian complexes allowed us to define the age of the deposits as Cenomanian. For more detailed dating of members of the section we have

  2. Geochemical Similarities Between the Pre-Caldera and Modern Evolutionary Series of Eruptive Products from Gorely Volcano, Kamchatka (United States)

    Gavrilenko, M.; Ozerov, A.


    Gorely volcano, in southern Kamchatka, is a large, long-lived shield-type volcano that is currently in an eruptive phase. Prior eruptions occurred in 1980 and 1984. It is comprised of three structural units: Pra-Gorely volcano; thick ignimbrite complex, associated with a caldera forming eruption; modern edifice named ‘Young Gorely’. An integrated mineralogical-geochemical have been conducted on all structural units of the Gorely volcanic edifice to determine their genetic conditions. After geochemical analysis two evolution series were found. First, Pra-Gorely volcano is represented by a suite of compositions ranging from basalt to rhyolite, with in this series, high-Mg basalts were discovered. Second, Young Gorely edifice is composed of only basalt, andesite and dacite. The reconstruction of chemical evolution trends shows that both volcanic series of Gorely volcano share the same genetic history with similar evolutionary stages. We suggest fractionation of an upper mantle peridotite as a common means to produce both volcanic series as a result of which the evolution of all rocks was generated. The magmatic series of Pra-Gorely and Young Gorely volcanoes were formed under different geodynamic conditions. Between these two series was a powerful stage of caldera formation, during which 100 km3 of ignimbrites were emplaced. The 12-km diameter caldera collapse was the catalyst for large-scale reorganization of the volcanic feeding system. Nevertheless following caldera collapse, Young Gorely was formed by activity inside the caldera and shows very similar evolutionary trends to that of Pra-Gorely. It can be confidently stated that crustal components are practically absent in the evolution of the series, and the compositional range is attributed directly to the evolution of the magmatic melts of Gorely volcano. Microprobe analyses conducted on olivine and pyroxene phenocrysts of Gorely volcano lavas, show that there were at least two stages of crystallization

  3. The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD in primary care

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    du Bois Elizabeth


    Full Text Available Abstract Background Chronic kidney disease (CKD is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small

  4. CKD6E5000型混合动力交流传动内燃调车机车的研制%Development of the Type CKD6E5000 Hybrid Power Shunting Diesel Locomotive with AC Drive

    Institute of Scientific and Technical Information of China (English)

    孟玉发; 彭长福; 王选民; 刘顺国; 任聪



  5. Serum uric acid level as an indicator for CKD regression and progression in patients with type 2 diabetes mellitus-a 4.6-year cohort study. (United States)

    Chang, Yu-Hung; Lei, Chen-Chou; Lin, Kun-Chen; Chang, Dao-Ming; Hsieh, Chang-Hsun; Lee, Yau-Jiunn


    To investigate the association of serum uric acid level with renal function change in patients with type 2 diabetes mellitus (T2DM). T2DM patients who had been followed-up for at least 3 years were included. Participants were categorized into stable, progression, or regression groups according to their change in chronic kidney disease (CKD) stage. During the follow-up period, all numeric values of metabolic factors, including the uric acid level and the medication possession rate, were calculated in order to investigate their associations with CKD development. Multivariate Cox regression analyses were used to identify independent factors associated with change in CKD. A total of 2367 T2DM patients were enrolled in this study and followed-up for a mean of 4.6 years. The numbers of patients in the stable, progression and regression groups were 1133 (47.9%), 487 (20.6%), and 747 (31.5%), respectively. The progression group had the highest serum uric acid level (6.9 ± 1.8 mg/dL), and the regression group had the lowest uric acid level (5.4 ± 1.5 mg/dL). In addition, we found that the serum uric acid level was an independent factor associated with CKD progression when the value exceeded 6.3 mg/dL. A lower uric acid level could be beneficial for CKD improvement in T2DM patients with stage 3-5 CKD. Our data indicated that the serum uric acid level is associated with CKD regression and progression and suggested that a high normal serum uric acid level should be closely monitored in patients with T2DM. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Correction of iron deficiency anaemia using IV CosmoFer in CKD patients with asthma: a prospective study. (United States)

    Syed, A; Bhandari, S


    Intravenous (IV) iron is commonly used for correcting iron deficiency anaemia in patients with chronic kidney disease (CKD). There remains a concern for its use in patients with asthma as it may trigger an acute exacerbation. Pre-treatment with a single dose of parenteral hydrocortisone may obviate this risk. We carried out a prospective study of known asthmatic patients with CKD requiring single-dose iron repletion therapy. We analysed the efficacy and safety of IV CosmoFer (low molecular weight iron dextran). Twenty non-dialysis CKD patients with iron deficiency anaemia and a history of asthma were enrolled. Severity of asthma and level of control were recorded as per British Thoracic Society Guidelines and Royal Collage of Physician questionnaire, respectively. All patients received IV hydrocortisone 30 min before the test dose of CosmoFer followed by the remaining total dose. Patients were monitored for adverse reactions. Haemoglobin, serum ferritin levels and estimated glomerular filtration rate were measured pre and 6-weeks post-infusion. All patients were followed up until 6 weeks to assess the control of their asthma. All 20 patients completed the study. No patient experienced acute hypersensitivity or infusion reactions. At 6 weeks follow-up, no patient reported worsening of their asthma. There was an increase in mean haemoglobin from 10.1 to 11.1 g/dl and mean ferritin from 93.5 to 302.6 ng/ml. This study demonstrates that IV CosmoFer may be administered safely in asthmatics by administering a single 50 mg dose of hydrocortisone pre-infusion. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email:

  7. Report on the Workshop and Regular Meeting of the Imode-CKD and Bcmolmed Marie Curie Training and Research Programs. (United States)

    Krochmal, Magdalena; Cisek, Katryna; Markoska, Katerina; Spasovski, Goce; Vlahou, Antonia


    A Workshop and Regular Meeting of the Marie Curie Training and Research Programs iMODECKD (Identification of the Molecular Determinants of established Chronic Kidney Disease) and BCMolMed (Molecular Medicine for Bladder Cancer) was held from 20-22 March at the Macedonian Academy of Science and Arts (MASA). The meeting was hosted by the participating center University of Skopje (SKO) - Goce Spasovski and MASA - Momir Polenakovic (R. Macedonia). The representative from MASA proteomic research center - Katerina Davalieva (R. Macedonia) had presentation on proteomic research in prostate cancer (PCa). 40 researchers from 13 different countries participated at the meeting. The Workshop was devoted on "Chronic Kidney Disease: Clinical Management issues", and consisted of 15 oral presentations given by nephrologists and experts in the field of CKD. Raymond Vanholder (Belgium) - past president of ERA-EDTA had a keynote lecture on "CKD: Questions that need to be answered and are not (or at least not entirely)". The workshop continued in four sessions with lectures from Alberto Ortiz (Spain), Olivera Stojceva-Taneva (R. Macedonia), Dimitrios Goumenos (Greece), Joachim Beige (Germany), Marian Klinger (Poland), Goce Spasovski (R. Macedonia), Joachim Jankowski (Germany), Adalbert Schiller (Romania), Robert Johnson (USA), Franco Ferrario (Italy), Ivan Rychlik (Czech Republic), Fulvio Magni (Italy) and Giovambattista Capasso (Italy), all covering a training theme. Within the meeting there were two lectures on complimentary skills for ethics in science and career advancement from two principal investigators - Goce Spasovski (R. Macedonia) and Joost Schanstra (France). During the Regular Meeting, 13 PhD students i.e. Early Stage Researchers and one Experienced Researcher from both Programs presented their work and progress within iMODE-CKD and BCMolMed projects. This meeting was a great opportunity to exchange experience and ideas in the field of systems biology approaches and

  8. Patient INformation about Options for Treatment (PINOT): a prospective national study of information given to incident CKD Stage 5 patients. (United States)

    Morton, Rachael L; Howard, Kirsten; Webster, Angela C; Snelling, Paul


    Informed decision-making requires the presentation of all possible courses of action; however, it is unclear what proportion of Stage 5 chronic kidney disease (CKD) patients are routinely informed of all their treatment options. The aim of this study was to determine the effect of patient and unit characteristics on the type and timing of information provided. A prospective national multi-centre study of information was given to incident pre-emptive transplant, dialysis and conservatively managed patients in Australian renal units, over a 3-month period. Sixty-six of 73 renal units participated in the study. Seven hundred and twenty-one incident CKD Stage 5 patients including 102 who chose not to dialyse were identified. Of these, 603 (84%) were presented with information about their options prior to commencing treatment. Three quarters (n = 543) were presented with home dialysis, one-third (n = 230) pre-emptive transplantation and 65% (n = 470) were informed about conservative care as an option. Patients were more likely to receive information prior to commencing treatment if they were known to a nephrologist for more than 3 months (OR 7.29, 95% CI 3.86-13.79) or were treated in small units with < 100 dialysis patients (OR 2.40, 95% CI 1.26-4.60). The mean estimated glomerular filtration rate at the time information was first presented was 13.3 mL/min/1.73 m(2) (95% CI 12.7-13.8) and mean serum creatinine was 449 μmol/L (95% CI 431-467). Most Australian patients were informed of their treatment options prior to starting treatment, albeit in late stage CKD. Earlier education and support for informed decision-making may help optimize the uptake of pre-emptive transplantation and home dialysis therapies.

  9. Dietary Patterns and Risk of Death and Progression to ESRD in Individuals With CKD: A Cohort Study (United States)

    Gutiérrez, Orlando M.; Muntner, Paul; Rizk, Dana V.; McClellan, William M.; Warnock, David G.; Newby, P.K.; Judd, Suzanne E.


    Background Nutrition is strongly linked with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD. Study Design Observational cohort study. Setting & Participants 3,972 participants with CKD (defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2 or an albumin-creatinine ratio ≥30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort study of 30,239 black and white adults at least 45 years of age. Predictors Five empirically derived dietary patterns identified via factor analysis: “Convenience” (Chinese and Mexican foods, pizza, other mixed dishes), “Plant-Based” (fruits, vegetables), “Sweets/Fats” (sugary foods), “Southern” (fried foods, organ meats, sweetened beverages), and “Alcohol/Salads” (alcohol, green-leafy vegetables, salad dressing). Outcomes All-cause mortality and end-stage renal disease (ESRD). Results A total of 816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of Convenience, Sweets/Fats or Alcohol/Salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, co-morbidities, and baseline kidney function, higher Plant-Based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95%CI, 0.61–0.97) whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95%CI, 1.19–1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models. Limitations Missing dietary pattern data, potential residual confounding from lifestyle factors. Conclusions A

  10. Helping your teen with depression (United States)

    Teen depression - helping; Teen depression - talk therapy; Teen depression - medicine ... teen the most. The most effective treatments for depression are: Talk therapy Antidepressant medicines If your teen ...

  11. Cognitive Disorders, Depressive Status and Chronic Complications of Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Tache Mirela


    Full Text Available Background and aims: Depression and cognitive disorders were reported more frequently in patients with diabetes mellitus (DM. Our aim was to analyze the association of cognitive disorders and depression association with chronic complications of DM in a group of Romanian patients. Materials and methods: The data was analyzed from 181 patients, with a mean age of 58,3 years to whom we applied the MMSE (Mini- Mental State Examination and MADRS (Montgomery-Asberg Depression Rating Scale questionnaires. We also analyzed the presence of chronic DM complications, HbA1c and lipid profile. Results: Most patients with type 2 diabetes mellitus (T2DM had mild cognitive impairment (92%, more common in the age group 50-59 years. Chronic macrovascular complications were present in 74.58%, while chronic microvascular complications were present in 61.87% of patients with T2DM who associated mild and moderate cognitive impairment (p = 0.013. The most common form of depression was mild depression (90.2%, present in most patients with DM, regardless of progression and type of treatment. MADRS depression test scores were statistically significant correlated with the presence of peripheral artery disease - PAD (p <0.001, ischemic heart disease - IHD (p <0.001 and chronic kidney disease - CKD (p =0.05. We did not find a statistically significant correlation with HbA1c and serum lipid values (p˃0,05. Conclusion: Chronic diabetes macrovascular complications (PAD, IHD and CKD were more frequently associated with cognitive disorders and depression in patients with T2DM independent of the degree of metabolic control.

  12. Electric Drive and Control System of CKD6E Hybrid Power Locomotive%CKD6E混合动力机车电传动及控制系统

    Institute of Scientific and Technical Information of China (English)

    何良; 姚晓阳


    对我国研制的首台节能环保型混合动力机车——CKD6E机车进行了介绍,对机车电传动电路、控制系统、工作方式进行了设计说明,提出了机车开发调试过程中的关键问题及解决措施,总结了混合动力机车区别于传统机车的特点,并提出了改进建议.%CKD6E locomotive, the China's first developed hybrid power locomotive with energy conservation and environmental protection, was introduced, and electric drive circuit, control system and working methods were illuminated. Key issues and solutions measures of the locomotive development and debugging process were proposed. In addition, hybrid power locomotive features different from the traditional were summarized, and improving countermeasures were proposed.

  13. Retinopathy and CKD as Predictors of All-Cause and Cardiovascular Mortality: National Health and Nutrition Examination Survey (NHANES) 1988–1994 (United States)

    Ricardo, Ana C.; Grunwald, Juan E.; Parvathaneni, Sharmila; Goodin, Sean; Ching, Alice; Lash, James P.


    Background Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of US adults. Study Design Prospective cohort study. Setting & Participants 7,640 adults from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 with mortality linkage through 12/31/2006. Predictors CKD, defined as low estimated glomerular filtration rate (eGFR; <60 ml/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30mg/g), and retinopathy, defined as presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph. Outcomes All-cause and cardiovascular mortality. Measurements Multivariable-adjusted Cox proportional hazards. Results Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women and 81% non-Hispanic white. Prevalence of retinopathy in CKD was 11%. We identified 2,634 deaths during 14.5 years’ follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, the HRs for all-cause mortality were 1.02 (95% CI, 0.75–1.38), 1.52 (95% CI, 1.35–1.72), and 2.39 (95% CI, 1.77–3.22) for individuals with retinopathy only, for those with CKD only, and for those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50–1.84), 1.72 (95% CI, 1.47–2.00) and 2.96 (95% CI, 2.11–4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (p=0.04). Limitations Presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied. Conclusions In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population. PMID:24656452

  14. Effects of the Use of Non-Calcium Phosphate Binders in the Control and Outcome of Vascular Calcifications: A Review of Clinical Trials on CKD Patients

    Directory of Open Access Journals (Sweden)

    Piergiorgio Bolasco


    Full Text Available Vascular calcifications produce a high impact on morbidity and mortality rates in patients affected by chronic kidney disease and mineral bone disorder (CKD-MBD. Effects are manifested from the more advanced stages of CKD (stages 3-4, particularly in patients undergoing dialysis (CKD5D. In recent years, a large number of therapeutic options have been successfully used in the treatment of secondary hyperparathyroidism (SHPT, despite eliciting less marked effects on nonbone calcifications associated with CKD-MBD. In addition to the use of Vitamin D and analogues, more recently treatment with calcimimetic drugs has also been undertaken. The present paper aims to analyze comparative and efficacy studies undertaken to assess particularly the impact on morbidity and mortality rates of non-calcium phosphate binders. Moreover, the mechanism of action underlying the depositing of calcium and phosphate along blood vessel walls, irrespective of the specific contribution provided in reducing the typical phosphate levels observed in CKD largely at more advanced stages of the disease, will be investigated. The aim of this paper therefore is to evaluate which phosphate binders are characterised by the above action and the mechanisms through which these are manifested.

  15. Chlorine Stable Isotopes to reveal contribution of magmatic chlorine in subduction zones: the case of the Kamchatka-Kuril and the Lesser Antilles Volcanic Arcs (United States)

    Agrinier, Pierre; Shilobreeva, Svetlana; Bardoux, Gerard; Michel, Agnes; Maximov, Alexandr; Kalatcheva, Elena; Ryabinin, Gennady; Bonifacie, Magali


    By using the stable isotopes of chlorine (δ 37Cl), we have shown that magmatic chlorine (δ 37Cl ≤ -0.6 ‰ [1]) is different from surface chlorine (δ 37Cl ≈ 0 ‰ [1]) in hydrothermal system of Soufrière and Montagne Pelé from the young arc volcanic system of Lesser Antilles. First measurements on condensed chlorides from volcanic gases (e.g. [2], [3]) did not permitted to get sensible δ 37Cl values on degassed chlorine likely because chlorine isotopes are fractionated during the HClgas - chloride equilibrium in the fumaroles or during sampling artifacts. Therefore we have developed an alternative strategy based on the analysis of chloride in thermal springs, streams, sout{f}lowing on the flanks of the volcanoes. Due to the highly hydrophilic behavior of Cl, we hypothesize that thermal springs incorporate chlorine without fractionation of chlorine isotopes and might reflect the chlorine isotopic composition degassed by magmas [1]. Indeed Thermal spring with low δ 37Cl chlorides (≤ -0.6 perthousand{}) are linked with magmatic volatiles characters (3He ratio at 5 Ra at and δ 13C CO2 quad ≈ -3 perthousand{}). To go further in the potentiality of using the Chlorine isotopes to reveal contribution of magmatic chlorine in volcanic systems, we have started the survey of thermal springs and wells waters in the Kamchatka-Kuril volcanic mature Arc (on sites Mutnovsky, Paratunka, Nalychevsky, Khodutkinsky, Paramushir Island, identified by Taran, 2009 [4] for concentrations of chloride). Preliminary results show δ 37Cl values ranging from 0.5 to -0.2 ‰ and generally higher chloride concentrations. The δ 37Cl values are higher than the value recorded for the young arc volcanic system of lesser Antilles. At present moment very few negative δ 37Cl have been measured in the Kamchatka-Kuril volcanic mature Arc. [1] Li et al., 2015 EPSL in press. [2] Sharp et al. 2010 GCA. [3] Rizzo et al., 2013, EPSL, 371, 134. [4] Taran, 2009, GCA, 73, 1067

  16. Evaluation of relationship between sexual functions, depression and quality of life in patients with chronic kidney disease at predialysis stage. (United States)

    Esen, Bennur; Kahvecioglu, Serdar; Atay, Ahmet Engin; Ozgen, Gulten; Okumus, Muhammed Masuk; Seyahi, Nurhan; Sit, Dede; Kadioglu, Pınar


    The relation of chronic kidney disease (CKD) with metabolic, psychiatric and endocrinologic disorder is well-known. Depressive mood and sexual dysfunction are frequently observed as renal functions deteriorate. We aimed to analyze the relationship of sexual dysfunction, depressive mood and life quality in patients with CKD at predialysis stage. Fifty-three patients; 27 female and 26 male with CKD who had estimated glomerular filtration rate (eGFR) between 15 and 90 mL/min and followed up in the Nephrology Department, Bursa Sevket Yılmaz Education and Research Hospital, were enrolled. Age- and sex-matched 20 female and 20 male healthy control subjects were assigned to the control group. Detailed medical and sexual history was obtained by using Female Sexual Function Index (FSFI), Erectile Function International Evaluation Form (IEFF), Short form (SF) 36 Form and Beck Depression Questionnaire (BDI). Biochemical and hormonal parameters including urea, creatinine, uric acid, sedimentation rate, c-reactive protein, total testosterone, DHEA-S, FSH, LH, TSH, estradiol and prolactin were analyzed. Depression was observed in 12 male (46%) and 14 female (51%) patients. The frequency of depression among male patients and control subjects was similar, however, significantly higher in female patients than female controls (p=0.036). Physical function score, physical role score and pain score in SF 36 of entire patients were significantly lower than controls (p=0.0001, 0.0001, 0.001, respectively). The frequency of depression was similar between patients and controls (p>0.05). When SF 36 tests of male and female patients were compared, general health status, vitality and mental health status were significantly better in male patients (p=0.005, 0.016, 0.035, respectively). SF 36 scores of female patients were significantly lower than female controls (p=0.0001). The frequency of erectile dysfunction (ED) was similar between male patients (84%) and controls (75%) (p=0.62). On the

  17. What is depression?

    DEFF Research Database (Denmark)

    Davidsen, Annette Sofie; Fosgerau, Christina Fogtmann


    The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners' (GPs') treatment of ...

  18. Sadness and Depression (United States)

    ... What Happens in the Operating Room? Sadness and Depression KidsHealth > For Kids > Sadness and Depression A A ... big difference in your life. When Sadness Is Depression When you're in a sad mood, it ...

  19. Depression Strikes…Anyone (United States)

    ... of this page please turn JavaScript on. Feature: Depression Depression Strikes… Anyone Winter 2017 Table of Contents Anyone can suffer from depression. And almost everyone has a friend or family ...

  20. Depression and College Students (United States)

    ... depression and other mental health issues? Reference Share Depression and College Students Download PDF Download ePub Order ... Answers to college students’ frequently asked questions about depression Feeling moody, sad, or grouchy? Who doesn’t ...

  1. Sadness and Depression (United States)

    ... dientes Video: Getting an X-ray Sadness and Depression KidsHealth > For Kids > Sadness and Depression Print A ... big difference in your life. When Sadness Is Depression When you're in a sad mood, it ...

  2. Postpartum Depression Facts (United States)

    ... Where can I find more information? Share Postpartum Depression Facts Download PDF Download ePub Download Mobi Order ... for herself or her family. What is postpartum depression? Postpartum depression is a mood disorder that can ...

  3. Recognizing teen depression (United States)

    ... Recognizing teen depression To use the sharing features on this page, ... life. Be Aware of the Risk for Teen Depression Your teen is more at risk for depression ...

  4. Men and Depression (United States)

    ... in crisis? For more information Share Men and Depression Download PDF Download ePub Order a free hardcopy ... If so, you may have depression. What is depression? Everyone feels sad or irritable sometimes, or has ...

  5. Various forms of depression




    The current subtyping of depression is based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM-IV-TR) categorical division of bipolar and depressive disorders. Current evidence, however, supports a dimensional approach to depression, as a continuum/spectrum of overlapping disorders, ranging from bipolar I depression to major depressive disorder. Types of depression which have recently been the focus of most research will be reviewed ; bipolar II depressi...

  6. [Depressive symptoms and sexuality]. (United States)

    Porto, Robert


    The mutually reinforcing dyad of depressive symptoms and erectile dysfunction is scientifically established. The cure of depression improves sexual dysfunction (SD) and the treatment of SD induces improvement of depression. Most of anti-depressants induce negative sexual side effects that lead to non-compliance of these treatments. The knowledge of interrelation between depression, anti-depressants and sexuality is of great importance in clinical practice. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. Prevalence of Metformin Use and the Associated Risk of Metabolic Acidosis in US Diabetic Adults With CKD: A National Cross-Sectional Study. (United States)

    Kuo, Chin-Chi; Yeh, Hung-Chieh; Chen, Bradley; Tsai, Ching-Wei; Lin, Yu-Sheng; Huang, Chiu-Ching


    The use of metformin in chronic kidney disease (CKD) population has been intensely debated with conflicting evidence. Large population studies are needed to inform risk assessment and therapeutic decision-making. We evaluated the associations among metformin, metabolic acidosis, and CKD in a 10-year nationally representative noninstitutionalized civilian population in the United States.In this cross-sectional study, a total of 2279 diabetic adults aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012 were included and had measurements of serum bicarbonate, sodium, potassium, and chloride. The exposure was metformin use. The outcome was subclinical and severe metabolic acidosis defined by serum bicarbonate 16mEq/L and by serum bicarbonate 60 mL/min/1.73 m was also observed. In multiple linear regression analysis, metformin was significantly associated with decreased serum bicarbonate levels (β = -0.45, 95% CI: -0.73, -0.17) and increased serum anion gap levels (β = 0.40, 95% CI: 0.19, 0.61). The adjusted odds ratio of subclinical high anion gap and severe metabolic acidosis for metformin users was 1.68 (95% CI: 1.11, 2.55) and 1.31 (0.49, 3.47), respectively. The association between metformin and serum bicarbonate was significantly modified by CKD status. No interaction was found between metformin and CKD stages for serum anion gap and acidosis.Metformin is associated with subclinical metabolic acidosis but not with severe metabolic acidosis. The propensity of serum bicarbonate-lowering effect was intensified in advanced CKD; however, such tendency was not associated with the risk of clinically defined acidosis. Our findings highlight a potential of cautious expansion of metformin use among CKD-3b patients with diabetes meriting further investigations.

  8. Enzymatic creatinine assays allow estimation of glomerular filtration rate in stages 1 and 2 chronic kidney disease using CKD-EPI equation. (United States)

    Kuster, Nils; Cristol, Jean-Paul; Cavalier, Etienne; Bargnoux, Anne-Sophie; Halimi, Jean-Michel; Froissart, Marc; Piéroni, Laurence; Delanaye, Pierre


    The National Kidney Disease Education Program group demonstrated that MDRD equation is sensitive to creatinine measurement error, particularly at higher glomerular filtration rates. Thus, MDRD-based eGFR above 60 mL/min/1.73 m² should not be reported numerically. However, little is known about the impact of analytical error on CKD-EPI-based estimates. This study aimed at assessing the impact of analytical characteristics (bias and imprecision) of 12 enzymatic and 4 compensated Jaffe previously characterized creatinine assays on MDRD and CKD-EPI eGFR. In a simulation study, the impact of analytical error was assessed on a hospital population of 24084 patients. Ability using each assay to correctly classify patients according to chronic kidney disease (CKD) stages was evaluated. For eGFR between 60 and 90 mL/min/1.73 m², both equations were sensitive to analytical error. Compensated Jaffe assays displayed high bias in this range and led to poorer sensitivity/specificity for classification according to CKD stages than enzymatic assays. As compared to MDRD equation, CKD-EPI equation decreases impact of analytical error in creatinine measurement above 90 mL/min/1.73 m². Compensated Jaffe creatinine assays lead to important errors in eGFR and should be avoided. Accurate enzymatic assays allow estimation of eGFR until 90 mL/min/1.73 m² with MDRD and 120 mL/min/1.73 m² with CKD-EPI equation.

  9. Screening of chronic kidney disease (CKD in general population on world kidney day on three consecutive years: A single day data

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    Pradeep Kumar Rai


    Full Text Available Objective: Chronic kidney disease (CKD is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease and reduce the risk of cardiovascular disease (CVD. Currently, screening for CKD is accepted practice only in patients with hypertension or diabetes, but more widespread screening is increasingly proposed. We screened a sample of population on World Kidney Day on three consecutive years for detecting patients with CKD and to describe the natural course of the disease. Materials and Methods: Everyone aged ≥18 was invited to participate. The study population was general population from Varanasi were screened in OPAL hospital. The survey comprised an extensive questionnaire and a brief clinical examination, including analysis of serum creatinine concentration in all participants. We screened all the participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD. Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. Results: A total of 547 participants were enrolled of which all 547 subjects were included in the analyses. The mean serum creatinine was 0.9525 mg/dL (0.900 to 1.0050. A high serum creatinine level was demonstrated in 16 participants (2.92 %, and 191 (34.91 % were demonstrated to have proteinuria. There was a significant correlation between CKD and age, DM, urine protein and serum creatinine. There was no significant correlation between serum creatinine level and urinary protein excretion (P = .001. There were no significant differences between CKD and gender. Conclusion: The study demonstrates that increasing age, diabetes mellitus, Serum creatinine and urinary protein were found

  10. Estimating glomerular filtration rate using the new CKD-EPI equation and other equations in patients with autosomal dominant polycystic kidney disease

    DEFF Research Database (Denmark)

    Orskov, Bjarne; Strandgaard, Svend; Ørskov, Bjarne;


    (CKD-EPI) equation, the Cockcroft-Gault equation adjusted for body surface area and the MDRD equation with cystatin C. Performance was evaluated by mean bias, precision and accuracy. RESULTS: The MDRD equation with cystatin C had 97% of GFR estimates within 30% of measured GFR (accuracy). Both the CKD......-EPI and Cockcroft-Gault equations had an accuracy of 90% whereas the MDRD equation had an accuracy of 83%. This difference of accuracy was especially marked with GFR >60 ml/min/1.73 m(2). CONCLUSION: For estimating GFR in ADPKD patients the MDRD equation with cystatin C incorporated had the best performance...

  11. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. (United States)

    Imai, Enyu; Horio, Masaru; Iseki, Kunitoshi; Yamagata, Kunihiro; Watanabe, Tsuyoshi; Hara, Shigeko; Ura, Nobuyuki; Kiyohara, Yutaka; Hirakata, Hideki; Moriyama, Toshiki; Ando, Yasuhiro; Nitta, Kosaku; Inaguma, Daijo; Narita, Ichiei; Iso, Hiroyasu; Wakai, Kenji; Yasuda, Yoshinari; Tsukamoto, Yusuke; Ito, Sadayoshi; Makino, Hirofumi; Hishida, Akira; Matsuo, Seiichi


    The number of patients with end-stage renal disease (ESRD) in Japan has continuously increased in the past three decades. In 2005, 36,063 patients whose average age was 66 years entered a new dialysis program. This large number of ESRD patients could be just the tip of the iceberg of an increasing number of patients with chronic kidney disease (CKD). However, to date, a nationwide epidemiological study has not been conducted yet to survey the CKD population. Data for 527,594 (male, 211,034; female, 316,560) participants were obtained from the general adult population aged over 20 years who received annual health check programs in 2000-2004, from seven different prefectures in Japan: Hokkaido, Fukushima, Ibaraki, Tokyo, Osaka, Fukuoka, and Okinawa prefectures. The glomerular filtration rate (GFR) for each participant was estimated from the serum creatinine values, using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation modified by the Japanese coefficient. The prevalences of CKD stage 3 in the study population, stratified by age groups of 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89 years, were 1.4%, 3.6%, 10.8%, 15.9%, 31.8%, 44.0%, and 59.1%, respectively, predicting 19.1 million patients with stage 3 CKD in the Japanese general adult population of 103.2 million in 2004. CKD stage 4 + 5 was predicted in 200,000 patients in the Japanese general adult population. Comorbidity of hypertension, diabetes, and proteinuria increased as the estimated GFR (eGFR) decreased. The prevalence of concurrent CKD was significantly higher in hypertensive and diabetic populations than in the study population overall when CKD was defined as being present with an eGFR of less than 40 ml/min per 1.73 m(2) instead of less than 60 ml/min per 1.73 m(2). About 20% of the Japanese adult population (i.e., approximately 19 million people) are predicted to have stage 3 to 5 CKD, as defined by a GFR of less than 60 ml/min per 1.73 m(2).

  12. Report of the Asian Forum of Chronic Kidney Disease Initiative (AFCKDI) 2007. "Current status and perspective of CKD in Asia": diversity and specificity among Asian countries. (United States)

    Tsukamoto, Yusuke; Wang, HaiYan; Becker, Gavin; Chen, Hung-Chun; Han, Dae-Suk; Harris, David; Imai, Enyu; Jha, Vivekanand; Li, Philip K T; Lee, Evan J C; Matsuo, Seiichi; Tomino, Yasuhiko; Tungsanga, Kriang; Yamagata, Kunihiro; Hishida, Akira


    The Japanese Society of Nephrology (JSN) sponsored the Asian Forum of CKD Initiative (AFCKDI) 2007 with the support of the International Society of Nephrology-Commission for Global Advancement in Nephrology (ISN-COMGAN), Asian Pacific Society of Nephrology (APSN), the Kidney Disease: Improving Global Outcome (KDIGO) and other national societies of nephrology in the Asian Pacific region on 27-28 May 2007 in Hamamatsu City, Japan. An international organising committee was established by leading experts of the CKD initiative. The main objective of this forum was to clarify the current status and perspectives of CKD and to promote coordination, collaboration and integration of initiatives in the Asian Pacific region. The forum received 56 papers from 16 countries; it began with the symposium "A Challenge to CKD in the world" and was followed by the ISN-COMGAN affiliated workshop "Current status and perspective of CKD in Asia". The second day was dedicated to discussion on the evaluation, surveillance and intervention in CKD in this area. At the end of the forum, we decided on the future plan as follows: (1) The AFCKDI will provide opportunities annually or biannually for every person who promotes CKD initiatives in the Asian Pacific region to join together and build consensus for action; (2) the second forum will be held in Kuala Lumpur on 4 May 2008 at the time of the 11th Asian Pacific Congress of Nephrology (APCN). Zaki Morad, President of the 11th APCN, will host the second forum; (3) the International Organising Committee (IOC) of the 1st AFCKDI will continue its function by adding other experts, including the organisers of the APCN; (4) the AFCKDI is not an organisation by itself, nor does it belong to any society, but is organised by each host national society of nephrology. The IOC will assist the domestic committee for the success of the forum and will assure the continuation of the mission; (5) in order to organise the forum and promote CKD initiatives in the

  13. Chronic Kidney Disease-Mineral Bone Disorder in Korean Patients: a Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). (United States)

    Kim, Chang Seong; Bae, Eun Hui; Ma, Seong Kwon; Han, Seung Hyeok; Lee, Kyu Beck; Lee, Joongyub; Oh, Kook Hwan; Chae, Dong Wan; Kim, Soo Wan


    This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, -0.64 ± 1.67; total hip, -0.49 ± 1.21; femur neck, -1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.

  14. Contamination status and accumulation profiles of organotins in sea otters (Enhydra lutris) found dead along the coasts of California, Washington, Alaska (USA), and Kamchatka (Russia). (United States)

    Murata, Satoko; Takahashi, Shin; Agusa, Tetsuro; Thomas, Nancy J; Kannan, Kurunthachalam; Tanabe, Shinsuke


    Organotin compounds (OTs) including mono- to tri-butyltins, -phenyltins, and -octyltins were determined in the liver of adult sea otters (Enhydra lutris) found dead along the coasts of California, Washington, and Alaska in the USA and Kamchatka, Russia. Total concentrations of OTs in sea otters from California ranged from 34 to 4100ng/g on a wet weight basis. The order of concentrations of OTs in sea otters was total butyltins>total octyltins> or = total phenyltins. Elevated concentrations of butyltins (BTs) were found in some otters classified under 'infectious-disease' mortality category. Concentrations of BTs in few of these otters were close to or above the threshold levels for adverse health effects. Total butyltin concentrations decreased significantly in the livers of California sea otters since the 1990s. Based on the concentrations of organotins in sea otters collected from 1992 to 2002, the half-lives of tributyltin and total butyltins in sea otters were estimated to be approximately three years.

  15. The nexus of soil radon and hydrogen dynamics and seismicity of the northern flank of the Kuril-Kamchatka subduction zone

    Directory of Open Access Journals (Sweden)

    O. P. Malysheva


    Full Text Available The comparison of kinematics and dynamic parameters of radon and molecular hydrogen concentration in subsoil air on the stations network at the Petropavlovsk-Kamchatsky geodynamic proving ground with seismicity of the northern flank of the Kuril-Kamchatka subduction zone was fulfilled in the period from July till August 2004. On the basis of correlation analysis of the regional seismicity and variations of radon flux density calculated using the data of gas-discharge counters of STS-6 type and SSNTDs it was shown that the radon mass transfer abnormal variations are conditioned by both regional seismicity in total and the subduction zone of proving ground. The azimuths of «geodeformation waves» coming to the registration points are calculated during clearly expressed anomaly beginnings, which coincide with directions to earthquake epicenters taking place at the same time. The geochemical anomalies recorded are presumptively deformative by nature and can be conditioned by processes of «quasi-viscous» flow of the lithosphere during rearrangement of tectonic stress fields of the subduction zone. The short-term (predicted time ? <14 days precursor of the earthquakes swarm was revealed in hydrogen dynamics on August, 4-5 (four earthquakes had M?5.3 and epicentral distance about 130 km from the Paratunka base station.

  16. Evolutionary relationships among sympatric life history forms of Dolly Varden inhabiting the landlocked Kronotsky Lake, Kamchatka, and a neighboring anadromous population (United States)

    Ostberg, C.O.; Pavlov, S.D.; Hauser, L.


    We investigated the evolutionary relationships among five sympatric morphs of Dolly Varden Salvelinus malma (white, Schmidti, longhead, river, and dwarf) inhabiting landlocked Kronotsky Lake on the Kamchatka Peninsula, Russia, and an anadromous population below the barrier waterfall on the outflowing Kronotsky River. Morphological analyses indicated phenotypic differentiation corresponding to preferred habitat, the longhead (a limnetic piscivorous morph) having a fusiform body, long jaw, and short fins and the Schmidti (a benthic morph) having a robust body, small jaw, and long fins. Analysis of molecular variance among the Kronotsky Lake morphs indicated that contemporary gene flow is restricted both among morphs within locations and among locations within morphs. Gene flow from Kronotsky Lake into the anadromous population also appears to be restricted. Our findings indicate that there are two divergent evolutionary lineages, one consisting of the white, Schmidti, river, and dwarf morphs and the other of the longhead morph and the anadromous population, which suggests that Kronotsky Lake was subject to separate waves of immigration. The Kronotsky Lake Dolly Varden morphs may represent an example of ecological speciation in progress, and we present a working hypothesis for the diversification of morphs within Kronotsky Lake.

  17. Accumulation reconstruction and water isotope analysis for 1735–1997 of an ice core from the Ushkovsky volcano, Kamchatka, and their relationships to North Pacific climate records

    Directory of Open Access Journals (Sweden)

    T. Sato


    Full Text Available To investigate past climate change in the Northwest Pacific region, an ice core was retrieved in June 1998 from the Gorshkov crater glacier at the top of the Ushkovsky volcano, in central Kamchatka. Hydrogen isotope (δD analysis and past accumulation reconstructions were conducted to a depth of 140.7 m, dated to 1735. Two accumulation reconstruction methods were applied with the Salamatin and the Elmer/Ice ice flow models. Reconstructed accumulation rates and δD were significantly correlated with North Pacific surface temperature. This, and a significant correlation of δD with the North Pacific Gyre Oscillation (NPGO index implies that NPGO data is contained in this record. Wavelet analysis shows that the ice core records have significant multi-decadal power spectra up to the late 19th century. The multi-decadal periods of reconstructed accumulation rates change at around 1850 in the same way as do Northeast Pacific ice core and tree ring records. The loss of multi-decadal scale power spectra of δD and the 6‰ increase in its average value occurred around 1880. Thus the core record confirms that the periodicity of precipitation for the entire North Pacific changed between the end of the Little Ice Age through the present due to changes in conditions in the North Pacific Ocean.

  18. Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study (United States)

    Muntner, Paul; Anderson, Amanda; Charleston, Jeanne; Chen, Zhen; Ford, Virginia; Makos, Gail; O’Connor, Andrew; Perumal, Kalyani; Rahman, Mahboob; Steigerwalt, Susan; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wright, Jackson T


    Background A low rate of blood pressure control has been reported among patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness. Study Design Cross-sectional Setting & Participants Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612) were analyzed. Participants with an estimated glomerular filtration rate of 20 to 70 ml/min/1.73m2 were identified from physician offices and review of laboratory databases. Outcomes Prevalence and awareness of hypertension, treatment patterns, control rates and factors associated with hypertension control. Measurements Following a standardized protocol, blood pressure was measured three times by trained staff and hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported antihypertensive medication use. Patients’ awareness and treatment of hypertension were defined using self-report and two levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 mmHg and <130/80 mmHg. Results The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis, 98.3% were treated with medications while 67.1% and 46.1% had their hypertension controlled to <140/90 mmHg and <130/80 mmHg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26% and 32% were taking one, two, three and four or more antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, those with higher urinary albumin excretion were less likely while participants taking ACE-inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 mmHg and <130/80 mmHg. Limitations Data were derived from a single study visit. Conclusions Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of

  19. The clinical the rapeutic effect of Chinese Caterpilar Fungus on treaing Chronic kidney disease(CKD3)%人工虫草治疗慢性肾脏病(CKD3期)的临床观察

    Institute of Scientific and Technical Information of China (English)

    孙健; 王胜蓝


    目的:探讨人工虫草(金水宝胶囊)治疗慢性肾脏病(CKD3期)的临床疗效。方法:将65例患者随机分为常规治疗组(对照组)和金水宝治疗组(治疗组),疗程8周,观察治疗前后肌酐清除率(Ccr)、血尿酸(UA)、低密度脂蛋白(LDL-C)、尿蛋白定量(Upr)。结果:金水宝治疗组Ccr、UA、LDL-C、Upr较常规治疗组都有下降(p<0.05).结论:人工虫草可减少尿蛋白排泄,调脂、降低血尿酸,改善肾功能。%To investigate the clinical effect of Chinese Caterpilar Fungus(Jin shui capsule) on treaing Chronic kidney disease(CKD3).Methods:adopt 65 copd patient is divided into the conventional treatment group (control group) and the Jin shui capsule treatment group (treatment group) at random. The course of treatment was 8 weeks. They were observed before and after treatment that were creatinine clearance rate (Ccr), blood uric acid (UA), low density lipoprotein (LDL-C), urinary protein ration (Upr).Resute:The Jin shui capsule treatment group Ccr, UA, LDL-C, Upr than the conventional treatment group are down (p<0.05).Conclusion:Chinese Caterpilar Fungus can decrease the excretion of urine protein, lipid, decreasing blood uric acid, renal function.

  20. Renoprotection and the Bardoxolone Methyl Story - Is This the Right Way Forward A Novel View of Renoprotection in CKD Trials: A New Classification Scheme for Renoprotective Agents

    Directory of Open Access Journals (Sweden)

    Macaulay Onuigbo


    Full Text Available In the June 2011 issue of the New England Journal of Medicine, the BEAM (Bardoxolone Methyl Treatment: Renal Function in CKD/Type 2 Diabetes trial investigators rekindled new interest and also some controversy regarding the concept of renoprotection and the role of renoprotective agents, when they reported significant increases in the mean estimated glomerular filtration rate (eGFR in diabetic chronic kidney disease (CKD patients with an eGFR of 20-45 ml/min/1.73 m2 of body surface area at enrollment who received the trial drug bardoxolone methyl versus placebo. Unfortunately, subsequent phase IIIb trials failed to show that the drug is a safe alternative renoprotective agent. Current renoprotection paradigms depend wholly and entirely on angiotensin blockade; however, these agents [angiotensin converting enzyme (ACE inhibitors and angiotensin receptor blockers (ARBs] have proved to be imperfect renoprotective agents. In this review, we examine the mechanistic limitations of the various previous randomized controlled trials on CKD renoprotection, including the paucity of veritable, elaborate and systematic assessment methods for the documentation and reporting of individual patient-level, drug-related adverse events. We review the evidence base for the presence of putative, multiple independent and unrelated pathogenetic mechanisms that drive (diabetic and non-diabetic CKD progression. Furthermore, we examine the validity, or lack thereof, of the hyped notion that the blockade of a single molecule (angiotensin II, which can only antagonize the angiotensin cascade, would veritably successfully, consistently and unfailingly deliver adequate and qualitative renoprotection results in (diabetic and non-diabetic CKD patients. We clearly posit that there is this overarching impetus to arrive at the inference that multiple, disparately diverse and independent pathways, including any veritable combination of the mechanisms that we examine in this review

  1. Effects of different phosphate lowering strategies in patients with CKD on laboratory outcomes: A systematic review and NMA (United States)

    Angeliki Veroniki, Argie; Thabane, Lehana; Busse, Jason W.; Akhtar-Danesh, Noori; Iorio, Alfonso; Cruz Lopes, Luciane; Guyatt, Gordon H.


    Background Chronic kidney disease-mineral and bone disorder (CKD-MBD), a complication of chronic kidney disease, has been linked to reduced quality and length of life. High serum phosphate levels that result from CKD-MBD require phosphate-lowering agents, also known as phosphate binders. The objective of this systematic review is to compare the effects of available phosphate binders on laboratory outcomes in patients with CKD-MBD. Methods Data sources included MEDLINE and EMBASE from January 1996 to April 2016, and the Cochrane Register of Controlled Trials up to April 2016. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility, and subsequently abstracted data and assessed risk of bias in eligible randomized controlled trials (RCTs). Eligible trials enrolled patients with CKD-MBD and randomized them to receive calcium-based phosphate binders (delivered as calcium acetate, calcium citrate or calcium carbonate), non-calcium-based phosphate binders (NCBPB) (sevelamer hydrochloride, sevelamer carbonate, lanthanum carbonate, sucroferric oxyhydroxide and ferric citrate), phosphorus restricted diet (diet), placebo or no treatment and reported effects on serum levels of phosphate, calcium and parathyroid hormone. We performed Bayesian network meta-analyses (NMA) to calculate the effect estimates (mean differences) and 95% credible intervals for serum levels of phosphate, calcium and parathyroid hormone. We calculated direct, indirect and network meta-analysis estimates using random-effects models. We applied the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to rate the quality of evidence for each pairwise comparison. Results Our search yielded 1108 citations; 71 RCTs were retrieved for full review and 16 proved eligible. Including an additional 13 studies from a previous review, 29 studies that enrolled 8335 participants proved

  2. [Causes of depression]. (United States)

    Fernández, Francisco Alonso


    This paper describes four nosological categories of depressive disorder according to the fundamental or prime cause: endogen depression, situative depression, psychogen depression and somatogen (also pharmacogen or addictive) depression. Recent advances in neurobiology provide the commun pathogenic mechanism distribuited in neurochemical, neuroendocrine and neuroinmune factors, with at the end a cellular and molecular sequence beyond the synapse. There is an increased risk of depression multiplied by three or four in the elderly, obese, unemployed and inmigrant and it is very frequent in terminally ill patients with a pervasive desire for death. Finally, eight personalized preventive guidelines enable to decrease the individual risk of depression in more than a fifty per cent.

  3. Geochemistry and Microbiology of Hot Springs in Kamchatka,Russia%俄罗斯勘察加半岛热泉的地球化学和微生物学

    Institute of Scientific and Technical Information of China (English)

    赵为东; Christopher S. Romanek; Gary Mills; Juergen Wiegel; 张传伦


    Kamchatka is one of the most active regions of volcanism in the world because it is located in the transitional zone where the Eurasian plate, North American plate and Pacific plates meet. As a result, Kamchatka has numerous hydrothermal systems, which constantly release geothermal gases and fluids out to the earth surface. Geothermal gases such as N2 and CO2 may prevail in the outflows but H2, CH4 and H2S occur frequently. Hot spring waters in Kamchatka may have multiple origins including meteoric and magmatic water. The temperature of these hot springs ranges from ~20 ℃ to greater than 90 ℃. Water chemistry also varies dramatically with pH ranging from 3.1 to 9.8. Hydrothermal fluids are sodium chloride water dominant and may contain various dissolved constituents including K+, H3BO3, H4SiO4, Ca2+, and SO42-. Volcanic ore-formation prevails in the high thermal activity regions in Kamchatka and precipitates may be dominated by silica crusts, sulfur and Hg-Sb-As-FeS deposits. Oils are also generated in the region and dominated by n-alkanes.More than 24 novel thermophilic microorganisms have been isolated from hot springs in Kamchatka. Most of these isolates are heterotrophs; however, autotrophs may be equally abundant depending on the spring conditions. Collectively, these organisms may play important roles in biogeochemical cycling of carbon, sulfur and iron in the hydrothermal system. Culture-independent approaches and quantitative methods are now employed to enhance our understanding of the ecology and biogeochemical functions of microorganisms in Kamchatka hot springs.%勘察加半岛位于欧洲板块、北美板块和太平洋板块交汇的过渡带上,是世界火山活动最活跃的地区之一.其众多的热液系统不断的向地表释放地热气体和流体.以N2和CO2为主的地热气体也经常含有高浓度的H2,CH4和H2S.大气水和熔岩水构成了勘察加热泉水的主要源,水体温度从20 ℃到>90 ℃不等.水化学性质

  4. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients. (United States)

    Scalone, Luciana; Borghetti, Francesca; Brunori, Giuliano; Viola, Battista Fabio; Brancati, Barbara; Sottini, Laura; Mantovani, Lorenzo Giovanni; Cancarini, Giovanni


    Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD). An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged >or=70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean euro/patient (patient-year). The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 euro/patient in the first, 6500 euro/patient in the second and 682 euro/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in a worst-case hypothesis. The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.

  5. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. (United States)

    Kelly, Jaimon T; Palmer, Suetonia C; Wai, Shu Ning; Ruospo, Marinella; Carrero, Juan-Jesus; Campbell, Katrina L; Strippoli, Giovanni F M


    Patients with CKD are advised to follow dietary recommendations that restrict individual nutrients. Emerging evidence indicates overall eating patterns may better predict clinical outcomes, however, current data on dietary patterns in kidney disease are limited. This systematic review aimed to evaluate the association between dietary patterns and mortality or ESRD among adults with CKD. Medline, Embase, and reference lists were systematically searched up to November 24, 2015 by two independent review authors. Eligible studies were longitudinal cohort studies reporting the association of dietary patterns with mortality, cardiovascular events, or ESRD. A total of seven studies involving 15,285 participants were included. Healthy dietary patterns were generally higher in fruit and vegetables, fish, legumes, cereals, whole grains, and fiber, and lower in red meat, salt, and refined sugars. In six studies, healthy dietary patterns were consistently associated with lower mortality (3983 events; adjusted relative risk, 0.73; 95% confidence interval, 0.63 to 0.83; risk difference of 46 fewer (29-63 fewer) events per 1000 people over 5 years). There was no statistically significant association between healthy dietary patterns and risk of ESRD (1027 events; adjusted relative risk, 1.04; 95% confidence interval, 0.68 to 1.40). Healthy dietary patterns are associated with lower mortality in people with kidney disease. Interventions to support adherence to increased fruit and vegetable, fish, legume, whole grain, and fiber intake, and reduced red meat, sodium, and refined sugar intake could be effective tools to lower mortality in people with kidney disease. Copyright © 2017 by the American Society of Nephrology.

  6. Association of CKD-MBD Markers with All-Cause Mortality in Prevalent Hemodialysis Patients: A Cohort Study in Beijing (United States)

    Li, Duo; Zhang, Ling; Zuo, Li; Jin, Cheng Gang; Li, Wen Ge; Chen, Jin-Bor


    The relationships between all-cause mortality and serum intact parathyroid hormone (iPTH), calcium, and phosphate are fairly diverse in patients on maintenance hemodialysis according to prior studies. This study evaluated the association of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers with all-cause mortality in prevalent hemodialysis patients from 2007 to 2012 in Beijing, China. A cohort, involving 8530 prevalent hemodialysis patients who had undergone a 6–70 months follow-up program (with median as 40 months) was formed. Related data was recorded from the database in 120 hemodialysis centers of Beijing Health Bureau (2007 to 2012). Information regarding baseline demographics, blood CKD-MBD markers and all-cause mortality was retrospectively reviewed. By using multivariate Cox regression model analysis, patients with a low iPTH level at baseline were found to have greater risk of mortality (<75pg/ml, HR = 1.36, 95% confidence interval (CI) 1.16–1.60) than those with a baseline iPTH level within 150–300 pg/ml. Similarly, death risk showed an increase when the baseline serum calcium presented a low level (<2.1mmol/L, HR = 1.54; 95% CI 1.37–1.74). Levels of baseline serum phosphorus were not associated with the risk of death. Similar results appeared through the baseline competing risks regression analysis. Patients with a lower level of serum iPTH or calcium are at a higher risk of all-cause mortality compared with those within the range recommended by Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. PMID:28045985

  7. Therapieresistente Depression

    Directory of Open Access Journals (Sweden)

    Holsboer-Trachsler E


    Full Text Available In der Behandlung einer Depression wird ein Nichtansprechen auf zwei adäquate Antidepressivatherapien während je 6–8 Wochen als Therapieresistenz bezeichnet. Da häufig zu geringe Dosierungen oder eine zu kurze Behandlungsdauer die Ursache für ein Nichtansprechen sind, sollte in einem ersten Schritt die medikamentöse Therapie hinsichtlich Dauer und Dosierung, eventuell unter Einbezug von Plasmaspiegelbestimmungen, überprüft und optimiert werden. Als pharmakologische Maßnahmen werden zunächst ein Wechsel des Antidepressivums und danach eine Kombination von verschiedenen Antidepressiva mit unterschiedlichem biochemischem Wirkungsansatz empfohlen. Zeigen beide nicht den gewünschten Erfolg, so sollte zusätzlich zur bestehenden Antidepressivabehandlung eine Augmentationstherapie, primär mit Lithium und/oder dem Schilddrüsenhormon T3, durchgeführt werden. Ein neuer, vielversprechender Behandlungsansatz ist eine Augmentationstherapie mit atypischen Neuroleptika. Als akut wirkende nichtpharmakologische Zusatzmaßnahme hat sich der partielle Schlafentzug bewährt. Weitere nichtpharmakologische Strategien umfassen Psychotherapie, Elektrokrampftherapie und Vagusnervstimulationsbehandlung.

  8. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP)

    NARCIS (Netherlands)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kuehne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; de Zeeuw, Dick


    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design Cost-

  9. Changes in fat mass correlate with changes in soluble sCD163, a marker of mature macrophages, in patients with CKD

    DEFF Research Database (Denmark)

    Axelsson, Jonas; Møller, Holger Jon; Witasp, Anna


    BACKGROUND: Recently, adipose tissue was shown to contain macrophages capable of contributing to systemic inflammation and cardiovascular disease (CVD). Here, we investigate this putative relationship in patients with chronic kidney disease (CKD) by using the novel macrophage marker soluble (s)CD...

  10. Designing a web-application to support home-based care of childhood CKD stages 3-5: qualitative study of family and professional preferences. (United States)

    Swallow, Veronica M; Hall, Andrew G; Carolan, Ian; Santacroce, Sheila; Webb, Nicholas J A; Smith, Trish; Hanif, Noreen


    There is a lack of online, evidence-based information and resources to support home-based care of childhood CKD stages 3-5. Qualitative interviews were undertaken with parents, patients and professionals to explore their views on content of the proposed online parent information and support (OPIS) web-application. Data were analysed using Framework Analysis, guided by the concept of Self-efficacy. 32 parents, 26 patients and 12 professionals were interviewed. All groups wanted an application that explains, demonstrates, and enables parental clinical care-giving, with condition-specific, continously available, reliable, accessible material and a closed communication system to enable contact between families living with CKD. Professionals advocated a regularly updated application to empower parents to make informed health-care decisions. To address these requirements, key web-application components were defined as: (i) Clinical care-giving support (information on treatment regimens, video-learning tools, condition-specific cartoons/puzzles, and a question and answer area) and (ii) Psychosocial support for care-giving (social-networking, case studies, managing stress, and enhancing families' health-care experiences). Developing a web-application that meets parents' information and support needs will maximise its utility, thereby augmenting parents' self-efficacy for CKD caregiving, and optimising outcomes. Self-efficacy theory provides a schema for how parents' self-efficacy beliefs about management of their child's CKD could potentially be promoted by OPIS.

  11. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP)

    NARCIS (Netherlands)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kuehne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; de Zeeuw, Dick

    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design

  12. Arterial aging and arterial disease : interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease

    NARCIS (Netherlands)

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Zoccali, Carmine


    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premat

  13. The effect of magnesium supplementation on vascular calcification in chronic kidney disease-a randomised clinical trial (MAGiCAL-CKD)

    DEFF Research Database (Denmark)

    Bressendorff, Iain; Hansen, Ditte; Schou, Morten


    INTRODUCTION: Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease and mortality, which is thought to be caused by increased propensity towards vascular calcification (VC). Magnesium (Mg) inhibits phosphate-induced VC in vitro and in animal models and serum ...

  14. Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

    NARCIS (Netherlands)

    W.M. Michels; D.C. Grootendorst; M. Verduijn; E.G. Elliott; F.W. Dekker; R.T. Krediet


    Background and objectives: We compared the estimations of Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to a gold standard GFR measurement using I-125-iothalamate, within strata of GFR, gender, age, body weigh

  15. Development of a LC-MS/MS method for the determination of CKD-712 in rat plasma: Application to a pharmacokinetic study in rats. (United States)

    Chae, Jung-Woo; Yun, Hwi-Yeol; Eom, Han Young; Jeong, Eun Ju; Koo, Tae-Sung; Kwon, Kwang-Il; Lee, Jong-Hwa


    CKD-712 is a potential treatment for sepsis, as it exhibits protective effects against lipopolysaccharide-mediated platelet aggregation, inducible nitric oxide synthase expression, and cecum-ligation puncture-induced septic mortality in mice. In this study, we develop a rapid and sensitive LC-MS/MS method for determining CKD-712 in rat plasma. CKD-712 and papaverine hydrochloride (an internal standard) were analyzed using an LC-MS/MS system consisting of an Agilent HPLC system (HP-1100) equipped with an Atlantis HILIC Silica (2.1×50mm, 3μm) column and a API 4000 (Applied Biosystems/MDS Sciex, USA) in a positive ESI mode. We utilized multiple reaction monitoring (MRM) at m/z transitions of 306.2-164.0 to analyze CKD-712, and 340.3-202.1 m/z for IS, with a mobile phase of acetonitrile (0.025% trifluoroacetic acid):20mM ammonium acetate (94:6, v/v) at a flow rate of 0.25mL/min. The lower limit of quantification (LLOQ) was 5ng/mL, with a linearity ranging from 5 to 1000ng/mL (r>0.999). Validation parameters including specificity, precision, accuracy, matrix effect, recovery, dilution effect and stability results were well within acceptance criteria, and applied successfully on a pharmacokinetic study in rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. 氯沙坦对伴血尿酸升高的早期 CKD 大鼠心脏病变影响%The influence of losartan on heart disease of early CKD rats with elevated serum uric acid

    Institute of Scientific and Technical Information of China (English)



    Objective To observe the influence of losartan on heart disease of early chronic kidney disease ( CKD) rats with elevated serum uric acid ( SUA) and explore the possible mechanism .Methods The experimental rats were divided into group A (sham operation group),group B ( CKD group),group C ( CKD with elevated SUA group,CKD+OXO),group D (CKD with elevated SUA,CKD+OXO+losartan),each of 15 cases.Prepared the male early CKD SD rats with elevated SUA model by right kidney resection and OXO continuous irrigation stomach method ,the dose of OXO was 800 mg/kg/time,2 times/d.The dose of losartan in group D was 20mg/kg/time,1 time/d.All the the rats were killed after 16 weeks.The serum creatinine (Scr),SUA,oxidized low density lipoprotein (ox LDL) and superoxide dismutase (SOD) were detected.The renal pathologic changes were observed by HE and PAS staining ,and the HE staining was used to observe cardiac pathological chan-ges too.The expression of myocardial collagen type I ( ColI) was determinated by immunohistochemical method .Results (1) There were no significant different of Scr between 4 groups.The SUA of group C was higher than that of the other 3 groups. Compared with group A,the other 3 groups had only mild mesangial proliferation in HE、PAS staining of the renal tissue.(2) There was no obvious morphological change in the HE staining of heart in group A ,and there was small amount deposition of myocardial ColI .In group B,a small amount of scattered inflammatory cells was between the myocardial cells .The deposition of myocardial ColI increased a little .A large number of inflammatory cells were infiltrated in group C ,and interstitial hyperemia , fibrosis;the fibroblast appeared in the wall of small vessels;The deposition of myocardial ColI increased significantly .The le-sions of Group D were similar to group C ,But the degree of lesion significantly reduced ,only a small amount of inflammatory cell infiltration ,occasionally seen inflammatory cells in the vascular

  17. Results of low-dose human atrial natriuretic peptide infusion in nondialysis patients with chronic kidney disease undergoing coronary artery bypass grafting: the NU-HIT (Nihon University working group study of low-dose HANP Infusion Therapy during cardiac surgery) trial for CKD

    National Research Council Canada - National Science Library

    Sezai, Akira; Hata, Mitsumasa; Niino, Tetsuya; Yoshitake, Isamu; Unosawa, Satoshi; Wakui, Shinji; Kimura, Haruka; Shiono, Motomi; Takayama, Tadateru; Hirayama, Atsushi


    ...). CKD is an important risk factor for cardiac surgery. This was a randomized controlled study of 303 patients with CKD who underwent CABG, and were divided into a group who received carperitide infusion and another group without carperitide...

  18. Baseline Cardiovascular Characteristics of Adult Patients with Chronic Kidney Disease from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). (United States)

    Kim, Hyoungnae; Yoo, Tae Hyun; Choi, Kyu Hun; Oh, Kook Hwan; Lee, Joongyub; Kim, Soo Wan; Kim, Tae Hee; Sung, Suah; Han, Seung Hyeok


    Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). We report the baseline cardiovascular characteristics of 2,238 participants by using the data of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) study. The cohort comprises 5 subcohorts according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), polycystic kidney disease (PKD), and unclassified. The average estimated glomerular filtration rate (eGFR) was 50.5 ± 30.3 mL/min⁻¹/1.73 m⁻² and lowest in the DN subcohort. The overall prevalence of previous CVD was 14.4% in all patients, and was highest in the DN followed by that in the HTN subcohort. The DN subcohort had more adverse cardiovascular risk profiles (higher systolic blood pressure [SBP], and higher levels of cardiac troponin T, left ventricular mass index [LVMI], coronary calcium score, and brachial-ankle pulse wave velocity [baPWV]) than the other subcohorts. The HTN subcohort exhibited less severe cardiovascular risk profiles than the DN subcohort, but had more severe cardiovascular risk features than the GN and PKD subcohorts. All these cardiovascular risk profiles were inversely correlated with eGFR. In conclusion, this study shows that the KNOW-CKD cohort exhibits high cardiovascular burden, as other CKD cohorts in previous studies. Among the subcohorts, the DN subcohort had the highest risk for CVD. The ongoing long-term follow-up study up to 10 years will further delineate cardiovascular characteristics and outcomes of each subcohort exposed to different risk profiles.

  19. Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations (United States)

    Ji, Misuk; Lee, Yoon-Hee; Kim, Hyesun; Cho, Han-Ik; Yang, Hyun Suk; Navarin, Silvia; Di Somma, Salvatore


    Background Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. Methods The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m2. Results For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m2) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPICysC and -20.5 for CKD-EPICr-CysC). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPICysC). Conclusions Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings. PMID:27578504

  20. Neural network approach to the prediction of seismic events based on low-frequency signal monitoring of the Kuril-Kamchatka and Japanese regions

    Directory of Open Access Journals (Sweden)

    Irina Popova


    Full Text Available Very-low-frequency/ low-frequency (VLF/LF sub-ionospheric radiowave monitoring has been widely used in recent years to analyze earthquake preparatory processes. The connection between earthquakes with M ≥5.5 and nighttime disturbances of signal amplitude and phase has been established. Thus, it is possible to use nighttime anomalies of VLF/LF signals as earthquake precursors. Here, we propose a method for estimation of the VLF/LF signal sensitivity to seismic processes using a neural network approach. We apply the error back-propagation technique based on a three-level perceptron to predict a seismic event. The back-propagation technique involves two main stages to solve the problem; namely, network training, and recognition (the prediction itself. To train a neural network, we first create a so-called ‘training set’. The ‘teacher’ specifies the correspondence between the chosen input and the output data. In the present case, a representative database includes both the LF data received over three years of monitoring at the station in Petropavlovsk-Kamchatsky (2005-2007, and the seismicity parameters of the Kuril-Kamchatka and Japanese regions. At the first stage, the neural network established the relationship between the characteristic features of the LF signal (the mean and dispersion of a phase and an amplitude at nighttime for a few days before a seismic event and the corresponding level of correlation with a seismic event, or the absence of a seismic event. For the second stage, the trained neural network was applied to predict seismic events from the LF data using twelve time intervals in 2004, 2005, 2006 and 2007. The results of the prediction are discussed.

  1. [Depression in schizophrenia]. (United States)

    Rigaud, A S


    Depressive symptoms are frequent during schizophrenia. Depression occurs in the course of a schizo affective psychose or in the course of a schizophrenia (either with acute psychotic symptoms, either without acute psychotic symptoms). Differentiating depression from negative symptoms of schizophrenia or from antipsychotic drug induced side effects can be difficult. The question to know whether depression is intrinsic to the disease process itself whether it is secondary to the schizophrenic process is still a matter of inquiry. Efficacy of antidepressive drugs during depression in schizophrenia remains a matter of controversy. Depression increases the risk for pejorative evolution and for suicide in schizophrenia.

  2. Hydro-epidemiology of Chronic Kidney Disease(CKD) in Sri Lanka and Its Similarities to the CKD Epidemic in Meso-America.Sarath Gunatilake M.D, Dr. P.H, Professor, California State University, Long Beach California (United States)

    Illangasekera, T.; Gunatilake, S.


    Over 2000 years ago Sri Lanka was known as the granary of the east. This distinction was achieved with a massive rice production aided by an efficient irrigation system. The basic structural unit of this irrigation system -with thousands of man-made lakes- was a large reservoir collecting rain water from tributaries and redistributing it to a cascade of rice paddy farms. The rice cultivation used organic fertilizer and natural pesticides made from ancient Ayurvedic recipes. The sociopolitical changes initiated in the county in 1977 resulted in a modernized agricultural economy with the renovation of the old irrigation system. Heavy use of pesticides, mostly Glyphosate (brand name "Round Up") with government subsidized cheap synthetic fertilizer (mostly triple phosphate) contaminated with heavy metals, including Arsenic and Cadmium, became a common practice. As a result, the shallow aquifers in the lowest lying areas, recharged by the irrigation water, was contaminated with Calcium, Magnesium phosphates, and the heavy metals, rendering the drinking water from shallow wells in these areas, extremely hard and unpalatable. The practice of drinking water from the shallow wells in low lying areas, most of which are abandoned now, and the use and spraying of pesticides particularly Glyphosate (often without proper personal protective equipment) have been identified in a case control study, as the main risk factors responsible for a massive epidemic of Chronic Kidney Disease (CKD) affecting 450,000 young farmers, resulting in 23,000 deaths. It is hypothesized that the Glyphosate chelates heavy metals delivering it to the kidney, with contaminated drinking water and food, causing progressive kidney damage. The same irrigation system that contributed to past prosperity has now become a scourge within the realm of a modernized agriculture. Climatic variations, global warming and severe dehydration also have been identified as contributory factors. Similar CKD epidemic killing

  3. Memory training in depression

    NARCIS (Netherlands)

    Becker, E.S.; Vanderhasselt, M.A.; Vrijsen, J.N.


    Memory biases, that is, general memory impairments as well as specific mood-congruent memory biases, are important vulnerability factors in depression. Recently, computerized memory trainings have been developed to target these biases, reducing rumination and lightening depressive symptoms. This

  4. Depression and Suicide Risk (United States)

    Depression and Suicide Risk (2014) Definition: A mood disorder that causes a persistent feeling of sadness and ... i Prevalence: 1. Ranges of lifetime risk for depression: from 6.7% overall to 40% in men, ...

  5. Depression and Pregnancy (United States)

    ... best live chat Live Help Fact Sheets Share Depression Thursday, 01 September 2016 In every pregnancy, a ... risk. This sheet talks about whether exposure to depression may increase the risk for birth defects over ...

  6. Heart disease and depression (United States)

    ... gov/ency/patientinstructions/000790.htm Heart disease and depression To use the sharing features on this page, ... a heart attack or heart surgery Signs of Depression It is pretty common to feel down or ...

  7. Learning about depression (United States)

    ... Learning about depression To use the sharing features on this page, ... trigger or reason. What are the Signs of Depression? You may notice some or all of the ...

  8. Depression - stopping your medicines (United States)

    ... this page: // Depression - stopping your medicines To use the sharing features ... prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are ...

  9. Depression and Pregnancy (United States)

    ... best live chat Live Help Fact Sheets Share Depression Thursday, 01 September 2016 In every pregnancy, a ... risk. This sheet talks about whether exposure to depression may increase the risk for birth defects over ...

  10. Depression Disturbs Germany

    Institute of Scientific and Technical Information of China (English)


    The suicide of Robert Enke,the goalkeeper of the Germany national football team who had battled depression for years,stunned the country and cast depression into the national spotlight as a disturbing disease.

  11. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP) (United States)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; Collins, R.; Baigent, C.; Landray, M.J.; Bray, C.; Chen, Y.; Baxter, A.; Young, A.; Hill, M.; Knott, C.; Cass, A.; Feldt-Rasmussen, B.; Fellström, B.; Grobbee, D.E.; Grönhagen-Riska, C.; Haas, M.; Holdaas, H.; Hooi, L.S.; Jiang, L.; Kasiske, B.; Krairittichai, U.; Levin, A.; Massy, Z.A.; Tesar, V.; Walker, R.; Wanner, C.; Wheeler, D.C.; Wiecek, A.; Dasgupta, T.; Herrington, W.; Lewis, D.; Mafham, M.; Majoni, W.; Reith, C.; Emberson, J.; Parish, S.; Simpson, D.; Strony, J.; Musliner, T.; Agodoa, L.; Armitage, J.; Chen, Z.; Craig, J.; de Zeeuw, D.; Gaziano, J.M.; Grimm, R.; Krane, V.; Neal, B.; Ophascharoensuk, V.; Pedersen, T.; Sleight, P.; Tobert, J.; Tomson, C.


    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, plus ezetimibe (2015 UK £1.19 per day) during 4.9 years’ median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations High-intensity statin-alone regimens were not studied in SHARP. Conclusions Simvastatin plus

  12. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP). (United States)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J; Baigent, Colin


    Simvastatin, 20mg, plus ezetimibe, 10mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. In SHARP, the proportional reductions per 1mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. High-intensity statin-alone regimens were not studied in SHARP. Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are

  13. Preventing Depression in Adults With Subthreshold Depression

    DEFF Research Database (Denmark)

    Buntrock, Claudia; Berking, Matthias; Smit, Filip


    BACKGROUND: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. OBJECTIVE: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD......) in people with subthreshold depression (sD). METHODS: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web......-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs...

  14. Depression in cerebrovascular diseases


    Voskresenskaya, Tatyana


    The paper discusses the topical problem of depression in cerebrovascular diseases. It shows its possible causes, mechanisms of occurrence, clinical picture and negative impact on the course of cerebrovascular disease and recovery of neurological functions. There is a bilateral association between stroke and depression: on the one hand, stroke is a risk factor for the development of depression and, on the other, depression is a both direct and indirect risk factor for the development of stroke...

  15. [Multiple mechanisms of depression]. (United States)

    Liu, Chun-Lin; Ruan, Ke-Feng; Gao, Jun-Wei; Wu, Fei; Zhang, Ji-Quan


    Depression is a grievous mental disease with an increasing high morbidity year by year and a serious social harm. The pathogenesises of depression is complicated and involves with multi-mechanisms and multi-organs. Recent studies demondtrate that in the nerval system and endocrine system there are many types of neurotransmitters and hormones, as well as their receptors, involved in depression. This paper reviews the research progress of depression in recent years.

  16. Method of treating depression

    Energy Technology Data Exchange (ETDEWEB)

    Henn, Fritz


    Methods for treatment of depression-related mood disorders in mammals, particularly humans are disclosed. The methods of the invention include administration of compounds capable of enhancing glutamate transporter activity in the brain of mammals suffering from depression. ATP-sensitive K.sup.+ channel openers and .beta.-lactam antibiotics are used to enhance glutamate transport and to treat depression-related mood disorders and depressive symptoms.

  17. Method of treating depression (United States)

    Henn, Fritz [East Patchogue, NY


    Methods for treatment of depression-related mood disorders in mammals, particularly humans are disclosed. The methods of the invention include administration of compounds capable of enhancing glutamate transporter activity in the brain of mammals suffering from depression. ATP-sensitive K.sup.+ channel openers and .beta.-lactam antibiotics are used to enhance glutamate transport and to treat depression-related mood disorders and depressive symptoms.

  18. Clinical Judgments of Depression. (United States)

    Jackson, Douglas N.; And Others


    Investigated degree to which judges could simulate Basic Personality Inventory (BPI) responses of a clinically depressed patient group. Judgmental profiles of depressed patients indicated very high reliabilities across information conditions, a high association with actual profiles of clinically depressed patients, and differentiation from other…

  19. Depression (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Depression KidsHealth > For Parents > Depression A A A What's ... to Help en español Comprender la depresión About Depression It's normal for kids to feel sad, down, ...

  20. Handling Depression | Smokefree 60+ (United States)

    Everyone feels blue now and then. It's a part of life. But if your feelings last more than few days and interfere with your normal daily activities, you may be suffering from depression. On this page: Symptoms of depression Who gets depressed and why?

  1. Depression and Aging. (United States)

    Hamilton, Marshall, Ed.


    Contains four articles related to depression and aging. Compares normal adults with those having a major depressive disorder. Focuses on life satisfaction in the elderly, describing an individualized measure of life satisfaction. Describes similarities and differences between grief and depression. Contains a psychometric analysis of the Zung…

  2. Depression (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Depression KidsHealth > For Parents > Depression Print A A A ... to Help en español Comprender la depresión About Depression It's normal for kids to feel sad, down, ...

  3. Measuring psychotic depression

    DEFF Research Database (Denmark)

    Østergaard, Søren Dinesen; Meyers, B S; Flint, A J

    Psychotic depression (PD) is a highly debilitating condition, which needs intensive monitoring. However, there is no established rating scale for evaluating the severity of PD. The aim of this analysis was to assess the psychometric properties of established depression rating scales and a number...... of new composite rating scales, covering both depressive and psychotic symptoms, in relation to PD....

  4. Measuring psychotic depression

    DEFF Research Database (Denmark)

    Østergaard, Søren Dinesen; Meyers, B S; Flint, A J

    Psychotic depression (PD) is a highly debilitating condition, which needs intensive monitoring. However, there is no established rating scale for evaluating the severity of PD. The aim of this analysis was to assess the psychometric properties of established depression rating scales and a number...... of new composite rating scales, covering both depressive and psychotic symptoms, in relation to PD....

  5. Therapeutics of postpartum depression. (United States)

    Thomson, Michael; Sharma, Verinder


    Postpartum depression is a prevalent disorder affecting many women of reproductive age. Despite increasing public awareness, it is frequently underdiagnosed and undertreated leading to significant maternal morbidity and adverse child outcomes. When identified, postpartum depression is usually treated as major depressive disorder. Many studies have identified the postpartum as a period of high risk for first presentations and relapses of bipolar disorder. Areas covered: This article reviews the acute and prophylactic treatment of postpartum major depressive disorder, bipolar depression and major depressive disorder with mixed features. The safety of antidepressant and mood stabilizing medications in pregnancy and breastfeeding will also be reviewed. Expert commentary: Differentiating postpartum major depressive disorder and postpartum bipolar depression can be difficult given their clinical similarities but accurate identification is vital for initiating proper treatment. Antidepressants are the mainstay of drug treatment for postpartum major depressive disorder, yet randomized controlled trials have shown conflicting results. A paucity of evidence exists for the effectiveness of antidepressant prophylaxis in the prevention of recurrences of major depressive disorder. Mood stabilizing medications reduce the risk of postpartum bipolar depression relapse but no randomized controlled trials have examined their use in the acute or prophylactic treatment of postpartum bipolar depression.

  6. Importance of Depression in Diabetes. (United States)

    Lustman, Patrick J.; Clouse, Ray E.; Anderson, Ryan J.

    Depression doubles the likelihood of comorbid depression, which presents as major depression in 11% and subsyndromal depression in 31% of patients with the medical illness. The course of depression is chronic, and afflicted patients suffer an average of one episode annually. Depression has unique importance in diabetes because of its association…

  7. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD. (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David; Henley, Charles M


    Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH.

  8. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD (United States)

    Taler, Sandra J.; Agarwal, Rajiv; Bakris, George L.; Flynn, Joseph T.; Nilsson, Peter M.; Rahman, Mahboob; Sanders, Paul W.; Textor, Stephen C.; Weir, Matthew R.; Townsend, Raymond R.


    In response to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for blood pressure management in patients with chronic kidney disease not on dialysis, the National Kidney Foundation organized a group of US experts in hypertension and transplant nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The overriding message was the dearth of clinical trial evidence to provide strong evidence-based recommendations. For patients with CKD with normal to mildly increased albuminuria, goal blood pressure has been relaxed to ≤140/90 mm Hg for both diabetic and nondiabetic patients. In contrast, KDIGO continues to recommend goal blood pressure ≤130/80 mm Hg for patients with chronic kidney disease with moderately or severely increased albuminuria and for all renal transplant recipients regardless of the presence of proteinuria, without supporting data. The expert panel thought the KDIGO recommendations were generally reasonable but lacking in sufficient evidence support and that additional studies are greatly needed. PMID:23684145

  9. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David


    Background. Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. Methods. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Results. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. Conclusions. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH. PMID:22036941

  10. Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study. (United States)

    Selistre, Luciano; Rabilloud, Muriel; Cochat, Pierre; de Souza, Vandréa; Iwaz, Jean; Lemoine, Sandrine; Beyerle, Françoise; Poli-de-Figueiredo, Carlos E; Dubourg, Laurence


    Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (interquartile range [IQR] of the ratio) and accuracy (percentage of estimated GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR). In the whole sample, the mean ratio with the CKD-EPI equation was significantly higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08 [95% CI 1.07; 1.09], p Schwartz equation were closer to 1 than the mean ratios with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus 1.15 [95% CI 1.13; 1.16], p Schwartz equation had a better precision and was also more accurate than the CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28; 0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8 [95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all patients aged ≥65 y, the CKD-EPI equation performed better than the Schwartz equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30: 77.6 [95% CI 75.7; 79

  11. Carboplatin dose calculation in lung cancer patients with low serum creatinine concentrations using CKD-EPI and Cockcroft-Gault with different weight descriptors. (United States)

    Kaag, Dieter


    Carboplatin dosing using the Calvert and Cockcroft-Gault formulae in patients with low serum creatinine levels is discussed controversially. We conducted a retrospective analysis applying the CKD-EPI formula and the alternate size descriptors adjusted body weight and predicted normal weight in the Cockcroft-Gault equation for calculating the carboplatin dose. Data were collected retrospectively from 128 lung cancer patients with serum creatinine obese patients they were superior in reducing mean overdose from 24% to roughly 15% (predicted normal weight, CKD-EPI) and 10% (adjusted body weight) and from 25% to 9%, 8% and 4%, respectively. Best performed the combination of Cockcroft-Gault with adjusted body weight. The results show that application of the alternate size descriptor adjusted body weight in the Cockcroft-Gault equation can improve dosing accuracy especially in overweight and obese patients with low serum creatinine levels. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. Understanding childhood depression. (United States)

    Malhotra, Savita; Das, Partha Pratim


    Major depressive disorder in children is a severe and a chronically disabling disorder. This population appears to be a special group in terms of consequences of poor psychosocial and academic outcome and increased risk of substance abuse, and suicide. Studies have revealed several major findings in genetic, familial, psychological, and biological aspects of such depression, some of which have explored into the issue of its relationship with adult depression. Considerable advances have been made now in the area of childhood depression providing a better understanding of its nature. We review literature available on historical aspect, epidemiology, clinical characteristics, and aetiology of childhood depression.

  13. Ozone therapy could attenuate tubulointerstitial injury in adenine-induced CKD rats by mediating Nrf2 and NF-κB

    Directory of Open Access Journals (Sweden)

    Gang Yu


    Full Text Available Objective(s: This study aims to determine the effects of ozone therapy on restoring impaired Nrf2 activation to ameliorate chronic tubulointerstitial injury in rats with adenine-induced CKD. Materials and Methods: Sprague–Dawley rats were fed with 0.75% adenine-containing diet to induce CKD and chronic tubulointerstitial injury. Ozone therapy was administered by rectal insufflation. After 4 weeks, serum and kidney samples were collected and analyzed. Renal function and systemic electrolyte level were detected. Pathological changes in kidney were assessed by hematoxylin–eosin staining and Masson trichrome staining. Nrf2 activation was detected by immunohistochemistry and Western blot analyses. The levels of SOD, CAT, GSH, PCO, and MDA were detected in the kidney. Immunohistochemistry, Western blot, and real-time PCR analyses were performed to evaluate the activation of the nuclear factor kappa B (NF-κB P65 pathway and inflammation infiltration in the tubulointerstitium of the rats. Results: Ozone therapy improved severe renal insufficiency and tubulointerstitial morphology injury as well as restored Nrf2 activation and inhibited the NF-κB pathway in rats with adenine-induced CKD. Ozone therapy also up-regulated anti-oxidation enzymes (SOD, CAT, and GSH and down-regulated oxidation products (PCO and MDA, as well as inflammatory cytokines (IL-1β, IL-6, TNF-α, and ICAM-1 in the kidney. Conclusion:These findings indicated that ozone therapy could attenuate tubulointerstitial injury in rats with adenine-induced CKD by mediating Nrf2 and NF-κB.

  14. Ozone therapy could attenuate tubulointerstitial injury in adenine-induced CKD rats by mediating Nrf2 and NF-κB (United States)

    Yu, Gang; Liu, Xiuheng; Chen, Zhiyuan; Chen, Hui; Wang, Lei; Wang, Zhishun; Qiu, Tao; Weng, Xiaodong


    Objective(s): This study aims to determine the effects of ozone therapy on restoring impaired Nrf2 activation to ameliorate chronic tubulointerstitial injury in rats with adenine-induced CKD. Materials and Methods: Sprague–Dawley rats were fed with 0.75% adenine-containing diet to induce CKD and chronic tubulointerstitial injury. Ozone therapy was administered by rectal insufflation. After 4 weeks, serum and kidney samples were collected and analyzed. Renal function and systemic electrolyte level were detected. Pathological changes in kidney were assessed by hematoxylin–eosin staining and Masson trichrome staining. Nrf2 activation was detected by immunohistochemistry and Western blot analyses. The levels of SOD, CAT, GSH, PCO, and MDA were detected in the kidney. Immunohistochemistry, Western blot, and real-time PCR analyses were performed to evaluate the activation of the nuclear factor kappa B (NF-κB) P65 pathway and inflammation infiltration in the tubulointerstitium of the rats. Results: Ozone therapy improved severe renal insufficiency and tubulointerstitial morphology injury as well as restored Nrf2 activation and inhibited the NF-κB pathway in rats with adenine-induced CKD. Ozone therapy also up-regulated anti-oxidation enzymes (SOD, CAT, and GSH) and down-regulated oxidation products (PCO and MDA), as well as inflammatory cytokines (IL-1β, IL-6, TNF-α, and ICAM-1) in the kidney. Conclusion: These findings indicated that ozone therapy could attenuate tubulointerstitial injury in rats with adenine-induced CKD by mediating Nrf2 and NF-κB. PMID:27872711

  15. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. (United States)

    Bellorin-Font, Ezequiel; Ambrosoni, Pablo; Carlini, Raúl G; Carvalho, Aluizio B; Correa-Rotter, Ricardo; Cueto-Manzano, Alfonso; Jara, Aquiles; Jorgetti, Vanda; Negri, Armando L; Negri, Armando; Olaizola, Inés; Salusky, Isidro; Slatopolsky, Eduardo; Weisinger, José R


    The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.

  16. A Genetic Biomarker of Oxidative Stress, the Paraoxonase-1 Q192R Gene Variant, Associates with Cardiomyopathy in CKD: A Longitudinal Study

    Directory of Open Access Journals (Sweden)

    E. Dounousi


    Full Text Available Background. Oxidative stress is a hallmark of CKD and this alteration is strongly implicated in LV hypertrophy and in LV dysfunction. Methods and Patients. We resorted to the strongest genetic biomarker of paraoxonase-1 (PON1 activity, the Q192R variant in the PON1 gene, to unbiasedly assess (Mendelian randomization the cross-sectional and longitudinal association of this gene-variant with LV mass and function in 206 CKD patients with a 3-year follow-up. Results. The R allele of Q192R polymorphism associated with oxidative stress as assessed by plasma 8-isoPGF2α (P=0.03 and was dose-dependently related in a direct fashion to LVMI (QQ: 131.4 ± 42.6 g/m2; RQ: 147.7 ± 51.1 g/m2; RR: 167.3 ± 41.9 g/m2; P=0.001 and in an inverse fashion to systolic function (LV Ejection Fraction (QQ: 79 ± 12%; RQ: 69 ± 9%; RR: 65 ± 10% P=0.002. On longitudinal observation, this gene variant associated with the evolution of the same echocardiographic indicators [LVMI: 13.40 g/m2 per risk allele, P=0.005; LVEF: −2.96% per risk allele, P=0.001]. Multivariate analyses did not modify these associations. Conclusion. In CKD patients, the R allele of the Q192R variant in the PON1 gene is dose-dependently related to the severity of LVH and LV dysfunction and associates with the longitudinal evolution of these cardiac alterations. These results are compatible with the hypothesis that oxidative stress is implicated in cardiomyopathy in CKD patients.

  17. The Association Between Unhealthy Lifestyle Behaviors and the Prevalence of Chronic Kidney Disease (CKD in Middle-Aged and Older Men

    Directory of Open Access Journals (Sweden)

    Ryoma Michishita


    Full Text Available Background: This cross-sectional study evaluated the association between unhealthy lifestyle behaviors and the prevalence of chronic kidney disease (CKD in middle-aged and older men. Methods: The subjects included 445 men without a history of cardiovascular disease, stroke, or dialysis treatment, who were not taking medications. Unhealthy lifestyle behaviors were evaluated using a standardized selfadministered questionnaire and were defined as follows: 1 lack of habitual moderate exercise, 2 lack of daily physical activity, 3 slow walking speed, 4 fast eating speed, 5 late-night dinner, 6 bedtime snacking, and 7 skipping breakfast. The participants were divided into four categories, which were classified into quartile distributions based on the number of unhealthy lifestyle behaviors (0–1, 2, 3, and ≥4 unhealthy behaviors. Results: According to a multivariate analysis, the odds ratio (OR for CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 and/or proteinuria was found to be significantly higher in the ≥4 group than in the 0–1 group (OR 4.67; 95% confidence interval [CI], 1.51–14.40. Moreover, subjects’ lack of habitual moderate exercise (OR 3.06; 95% CI, 1.13–8.32 and presence of late-night dinner (OR 2.84; 95% CI, 1.40–5.75 and bedtime snacking behaviors (OR 2.87; 95% CI, 1.27–6.45 were found to be significantly associated with the prevalence of CKD. Conclusions: These results suggest that an accumulation of unhealthy lifestyle behaviors, especially those related to lack of habitual moderate exercise and presence of late-night dinner and bedtime snacking may be associated with the prevalence of CKD.

  18. Depression in geriatric patients. (United States)

    Abbas Asghar-Ali, A; Braun, U K


    While the most serious of depressive illnesses in the elderly is major depressive disorder, patients' quality of life can be significantly impacted by dysthmic disorder, sub-threshold depression (minor depression), or a depressive disorder due to a general medical condition, all of which have been shown to be more prevalent than major depression in the community dwelling population of older adults. Older adults are also more likely to develop grief reaction and frequently deal with issues of bereavement. This review will discuss the diagnoses of all relevant depressive diagnoses that primary care physicians are likely to encounter. Among the many different assessment tools that screen for depression the briefest instruments are a two-question screening tool recommended by the U.S. Preventive Services Task Force and, specifically developed for older adults, the Geriatric Depression Scale (GDS) that is available in a short 15- Yes/No-question version. Many medical illnesses are associated with depressive symptoms. The focus in this review is on dementing illnesses/cerebrovascular disease, dementia of the Alzheimer's type, and Parkinson disease. First-line pharmacological therapy of depression includes selective serotonin inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Side effects of particular drugs can often be geared towards achieving additional benefits, e.g. weight gain associated with the use of some SSRISs may be helpful for patients with dementia.

  19. Depression in adolescence (United States)

    Thapar, Anita; Collishaw, Stephan; Pine, Daniel S; Thapar, Ajay K


    Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with sub stantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising. PMID:22305766

  20. [Depression and neurological diseases]. (United States)

    Piber, D; Hinkelmann, K; Gold, S M; Heesen, C; Spitzer, C; Endres, M; Otte, C


    In many neurological diseases a depressive syndrome is a characteristic sign of the primary disease or is an important comorbidity. Post-stroke depression, for example, is a common and relevant complication following ischemic brain infarction. Approximately 4 out of every 10 stroke patients develop depressive disorders in the course of the disease which have a disadvantageous effect on the course and the prognosis. On the other hand depression is also a risk factor for certain neurological diseases as was recently demonstrated in a meta-analysis of prospective cohort studies which revealed a much higher stroke risk for depressive patients. Furthermore, depression plays an important role in other neurological diseases with respect to the course and quality of life, such as Parkinson's disease, multiple sclerosis and epilepsy. This article gives a review of the most important epidemiological, pathophysiological and therapeutic aspects of depressive disorders as a comorbidity of neurological diseases and as a risk factor for neurological diseases.

  1. Number of ablated spots in the course of renal sympathetic denervation in CKD patients with uncontrolled hypertension: EnligHTN vs. Standard irrigated cardiac ablation catheter. (United States)

    Kiuchi, M G; Chen, S; Rodrigues Paz, L M; Pürerfellner, H


    Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability. The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation. Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (Prenal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Lava emplacements at Shiveluch volcano (Kamchatka) from June 2011 to September 2014 observed by TanDEM-X SAR-Interferometry (United States)

    Heck, Alexandra; Kubanek, Julia; Westerhaus, Malte; Gottschämmer, Ellen; Heck, Bernhard; Wenzel, Friedemann


    As part of the Ring of Fire, Shiveluch volcano is one of the largest and most active volcanoes on Kamchatka Peninsula. During the Holocene, only the southern part of the Shiveluch massive was active. Since the last Plinian eruption in 1964, the activity of Shiveluch is characterized by periods of dome growth and explosive eruptions. The recent active phase began in 1999 and continues until today. Due to the special conditions at active volcanoes, such as smoke development, danger of explosions or lava flows, as well as poor weather conditions and inaccessible area, it is difficult to observe the interaction between dome growth, dome destruction, and explosive eruptions in regular intervals. Consequently, a reconstruction of the eruption processes is hardly possible, though important for a better understanding of the eruption mechanism as well as for hazard forecast and risk assessment. A new approach is provided by the bistatic radar data acquired by the TanDEM-X satellite mission. This mission is composed of two nearly identical satellites, TerraSAR-X and TanDEM-X, flying in a close helix formation. On one hand, the radar signals penetrate clouds and partially vegetation and snow considering the average wavelength of about 3.1 cm. On the other hand, in comparison with conventional InSAR methods, the bistatic radar mode has the advantage that there are no difficulties due to temporal decorrelation. By interferometric evaluation of the simultaneously recorded SAR images, it is possible to calculate high-resolution digital elevation models (DEMs) of Shiveluch volcano and its surroundings. Furthermore, the short recurrence interval of 11 days allows to generate time series of DEMs, with which finally volumetric changes of the dome and of lava flows can be determined, as well as lava effusion rates. Here, this method is used at Shiveluch volcano based on data acquired between June 2011 and September 2014. Although Shiveluch has a fissured topography with steep slopes

  3. Recognizing subtle evidence for silicic magma derivation from petrochemically-similar arc crust: Isotopic and chemical evidence for the bimodal volcanic series of Gorely Volcanic Center, Kamchatka, Russia (United States)

    Seligman, A. N.; Bindeman, I. N.; Ellis, B. S.; Ponomareva, V.; Leonov, V.


    The Kamchatka Peninsula is home to some of the most prolific subduction related volcanic activity in the world. Gorely caldera and its central volcano are located in the rear of its currently active Eastern Volcanic Front. Recent work determined the presence of explosive ignimbrite eruptions sourced from Gorely volcano during the Pleistocene. We studied 32 eruptive units, including tephrochronologically-dated Holocene tephra, stratigraphically-arranged ignimbrites, as well as pre- and post-caldera lavas. We analyzed oxygen isotope ratios of pyroxene and plagioclase grains by laser fluorination, and major and trace element compositions of whole rocks. In addition, we determined 87Sr/86Sr and 143Nd/144Nd ratios of caldera-forming ignimbrite eruptions. Chemical compositions show that Gorely eruptive units range from basalt to basaltic andesite in the "Pra-Gorely" stages prior to caldera formation and the modern Gorely stages forming its current edifice. In contrast, eruptive material from earlier ignimbrites exposed at Opasny Ravine consists primarily of dacite. Whole rock analyses for Gorely indicate that silicic rocks and ignimbrites volumetrically dominate all other products, forming separate bimodal peaks in our SiO2-frequency diagram. In addition, trace element concentrations and ratios define two trends, one for more silicic and another for more mafic material. δ18Omelt values range from a low of 4.85 up to 6.22‰, where the lowest value was found in the last caldera forming eruption, suggesting incorporation of hydrothermally-altered material from earlier eruptions. 87Sr/86Sr and 143Nd/144Nd ratios range from 0.70328 to 0.70351 and from 0.51303 to 0.51309 respectively, with higher and more diverse values being characteristic of earlier ignimbrite units; again suggesting incorporation of surrounding crustal material. In contrast to these results, MELTS modeling using a variety of likely primitive basalts from Gorely shows it is possible to obtain silicic

  4. 怡肾丸治疗慢性肾衰竭(CKD2~4期)临床回顾性研究∗%Clinic Retrospective Study on Treating Chronic Renal Failure (CKD2~4) with Yishen Pills

    Institute of Scientific and Technical Information of China (English)

    彭亚军; 胡淑娟; 何泽云; 李旭华; 廖春来; 何雅琴


    目的::通过怡肾丸对慢性肾衰竭( CKD2~4期)临床治疗的回顾性研究,评价怡肾丸治疗慢性肾衰竭( CKD 2~4期)的临床疗效与安全性。方法:以2012年6月~2014年3月间,湖南中医药大学第一附属医院肾内科住院及门诊接受怡肾丸治疗的慢性肾衰竭( CKD2~4期)患者为研究对象,分别观察怡肾丸组与对照组治疗慢性肾衰竭( CKD2~4期)临床疗效、中医证候指标及安全性。结果:两组中医证候疗效、中医证候积分、西医疗效评定、肾功能及血红蛋白的影响比较中均较治疗前改善,且差异有统计学意义(P<0.05);在治疗后分别组间比较中,发现怡肾丸组在中医证候疗效、中医证候积分、西医疗效、肾功能及血红蛋白的影响中优于对照组,且差异有统计学意义(P<0.05),同时未发现不良反应。结论:怡肾丸可有效延缓慢性肾衰竭( CKD3~4期)进展,同时可改善患者临床症状,提高患者生活质量,且具有一定安全性。%Objective:Through the Yishen pills for chronic renal failure (CKD2~4) clinical retrospective study, evaluation of Yishen pills for the treatment of chronic renal failure ( CKD2 ~4 ) clinical efficacy and safety. Methods:In June 2012 ~March 2014, the First Affiliated Hospital of Hunan University of TCM Renal medical inpatient and outpatient accept Yishen pill treatment of patients with chronic renal failure (CKD2~4) as the research object, respectively to observe Yishen pill group and control group in the treatment of chronic renal failure (CKD2~4) clinical efficacy, TCM syndrome indicators, and security. Results:Two groups of TCM syndrome efficacy, TCM syndrome integral, western medicine curative effect evaluation, the influence of hemoglobin and renal function comparison was improved, the and the difference was statist ically significant (P<0. 05); After treatment, respectively, comparisons between groups, found Yishen pill group in TCM

  5. iConnect CKD - Virtual Medical Consulting: a web-based Chronic Kidney Disease, Hypertension and Diabetes Integrated Care Program. (United States)

    Katz, Ivor J; Pirabhahar, Saiyini; Williamson, Paula; Raghunath, Vishwas; Brennan, Frank; O'Sullivan, Anthony; Youssef, George; Lane, Cathie; Jacobson, Gary; Feldman, Peter; Kelly, John


    Chronic kidney disease (CKD) patients overwhelm specialist services and can potentially be managed in the primary care (PC). Opportunistic screening of high risk (HR) patients and follow-up in PC is the most sustainable model of care. A 'virtual consultation' (VC) model instead of traditional face to face (F2F) consultations was used, aiming to assess efficacy and safety of the model. Seventy patients were recruited from PC sites and hospital clinics, and followed for one year. The HR patients (eGFR 30 mg/mmol/L) were randomised to either VC or F2F. Patients were monitored 6 monthly by a Clinical Nurse Specialist (CNS). The specialist team provided virtual or clinical support and included a Nephrologist, Endocrinologist, Cardiologist and Renal 'Palliative' Supportive Care. Sixty one (87%) patients were virtually tracked or consulted with 14 (23%) being HR. At 12 months there was no difference in outcomes between VC and F2F patients. All patients were successfully monitored. GPs reported high level of satisfaction and supported the model, but found software integration challenging. Patients found the system attractive and felt well managed. Specialist consults occurred within a week and if a second specialist opinion was required it took another two weeks. The program demonstrated safe, expedited and efficient follow up with a clinical and web based program. Support from the GPs and patients was encouraging, despite logistical issues. Ongoing evaluation of VC services will continue and feasibility to larger networks and more chronic diseases remains the long term goal. This article is protected by copyright. All rights reserved.

  6. Standardization of depression measurement

    DEFF Research Database (Denmark)

    Wahl, Inka; Löwe, Bernd; Bjørner, Jakob


    comparisons among included measures. Large differences were found in their measurement precision and range, providing a rationale for instrument selection. Published scale-specific threshold scores of depression severity showed remarkable consistencies across different questionnaires. CONCLUSION: An IRT-based......OBJECTIVES: To provide a standardized metric for the assessment of depression severity to enable comparability among results of established depression measures. STUDY DESIGN AND SETTING: A common metric for 11 depression questionnaires was developed applying item response theory (IRT) methods. Data...... instrument-independent metric for depression severity enables direct comparisons among established measures. The "common ruler" simplifies the interpretation of depression assessment by identifying key thresholds for clinical and epidemiologic decision making and facilitates integrative psychometric research...

  7. Depression and attachment problems.


    Pettem, O; M. West; Mahoney, A; Keller, A.


    This study investigated the characteristics related to attachment of 42 depressed psychiatric patients and 42 non-depressed psychiatric controls. The depressed subjects demonstrated an anxious pattern of attachment, characterized by either intense care-seeking in relation to their attachment figure or angry withdrawal from their attachment figure when their desire for security was frustrated. The results are discussed in terms of Bowlby's attachment construct.


    Directory of Open Access Journals (Sweden)

    Koralia Todorova


    Full Text Available Depressive disorders are the most frequent psychiatric comorbidity in epilepsy but very often remain unrecognized and untreated. We examined 103 epileptic patients, aged 18-60 years, 40 males and 63 females, for the presence of interictal depressive disorder. All subjects underwent clinical psychiatric examination, including evaluation on Hamilton Depression Rating Scale (HAM-D-17. A questionnaire for demographic and seizure-related variables was also completed. Concurrent depressive disorder (clinically presented according to ICD-10 diagnostic criteria affected 28.3% of all evaluated patients. Based on HAM-D-17 scores depression was defined as mild - 80% of all depressed patients, moderate - 17% and severe - 3%. Atypical presentation of interictal depressive disorder was frequent. Depression has a tremendous effect on one’s family, social and psychological functioning, even more than the actual seizure frequency and severity. Diagnostic difficulties come through the atypical mode of presentation of depressive disorders in epilepsy. Proper neuropsychiatric evaluation is essential for improving treatment and quality of life for patients with epilepsy.

  9. Depression after myocardial infarction. (United States)

    Ziegelstein, R C


    Depression is an independent risk factor for increased postmyocardial infarction morbidity and mortality, even after controlling for the extent of coronary artery disease, infarct size, and the severity of left ventricular dysfunction. This risk factor takes on added significance when one considers that almost half of patients recovering from a myocardial infarction have major or minor depression and that major depression alone occurs in about one in five of these individuals. Despite the well-documented risk of depression, questions remain about the mechanism of the relationship between mood disturbance and adverse outcome. The link may be explained by an association with lower levels of social support, poor adherence to recommended medical therapy and lifestyle changes intended to reduce the risk of subsequent cardiac events, disturbances in autonomic tone, enhanced platelet activation and aggregation, and systemic immune activation. Unfortunately, questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction, this practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients.

  10. Nutritional Aspects of Depression

    Directory of Open Access Journals (Sweden)

    Undine E. Lang


    Full Text Available Several nutrition, food and dietary compounds have been suggested to be involved in the onset and maintenance of depressive disorders and in the severity of depressive symptoms. Nutritional compounds might modulate depression associated biomarkers and parallel the development of depression, obesity and diabetes. In this context, recent studies revealed new mediators of both energy homeostasis and mood changes (i.e. IGF-1, NPY, BDNF, ghrelin, leptin, CCK, GLP-1, AGE, glucose metabolism and microbiota acting in gut brain circuits. In this context several healthy foods such as olive oil, fish, fruits, vegetables, nuts, legumes, poultry, dairy and unprocessed meat have been inversely associated with depression risk and even have been postulated to improve depressive symptoms. In contrast, unhealthy western dietary patterns including the consumption of sweetened beverage, refined food, fried food, processed meat, refined grain, and high fat diary, biscuits, snacking and pastries have been shown to be associated with an increased risk of depression in longitudinal studies. However, it is always difficult to conclude a real prospective causal relationship from these mostly retrospective studies as depressed individuals might also change their eating habits secondarily to their depression. Additionally specific selected nutritional compounds, e.g. calcium, chromium, folate, PUFAs, vitamin D, B12, zinc, magnesium and D-serine have been postulated to be used as ad-on strategies in antidepressant treatment. In this context, dietary and lifestyle interventions may be a desirable, effective, pragmatical and non-stigmatizing prevention and treatment strategy for depression. At last, several medications (pioglitazone, metformin, exenatide, atorvastatin, gram-negative antibiotics, which have traditionally been used to treat metabolic disorders showed a certain potential to treat depression in first randomized controlled clinical trials.

  11. Nutritional aspects of depression. (United States)

    Lang, Undine E; Beglinger, Christoph; Schweinfurth, Nina; Walter, Marc; Borgwardt, Stefan


    Several nutrition, food and dietary compounds have been suggested to be involved in the onset and maintenance of depressive disorders and in the severity of depressive symptoms. Nutritional compounds might modulate depression associated biomarkers and parallel the development of depression, obesity and diabetes. In this context, recent studies revealed new mediators of both energy homeostasis and mood changes (i.e. IGF-1, NPY, BDNF, ghrelin, leptin, CCK, GLP-1, AGE, glucose metabolism and microbiota) acting in gut brain circuits. In this context several healthy foods such as olive oil, fish, fruits, vegetables, nuts, legumes, poultry, dairy and unprocessed meat have been inversely associated with depression risk and even have been postulated to improve depressive symptoms. In contrast, unhealthy western dietary patterns including the consumption of sweetened beverage, refined food, fried food, processed meat, refined grain, and high fat diary, biscuits, snacking and pastries have been shown to be associated with an increased risk of depression in longitudinal studies. However, it is always difficult to conclude a real prospective causal relationship from these mostly retrospective studies as depressed individuals might also change their eating habits secondarily to their depression. Additionally specific selected nutritional compounds, e.g. calcium, chromium, folate, PUFAs, vitamin D, B12, zinc, magnesium and D-serine have been postulated to be used as ad-on strategies in antidepressant treatment. In this context, dietary and lifestyle interventions may be a desirable, effective, pragmatical and non-stigmatizing prevention and treatment strategy for depression. At last, several medications (pioglitazone, metformin, exenatide, atorvastatin, gram-negative antibiotics), which have traditionally been used to treat metabolic disorders showed a certain potential to treat depression in first randomized controlled clinical trials.

  12. Negative attributional style, hopelessness depression and endogenous depression. (United States)

    Joiner, T E


    The hopelessness theory of depression [Abramson, L. Y., Metalsky, G. I. & Alloy, L. B. (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358-372.] postulates that a negative attributional style represents a risk factor for a particular constellation of depressive symptoms, termed 'hopelessness depression'. Four studies tested the relation of negative attributional style to hopelessness depression symptoms versus endogenous depression symptoms. Despite the considerable overlap of hopelessness and endogenous depression symptoms, negative attributional style was more related to the former than the latter, consistent with hopelessness theory.

  13. Depression During and After Pregnancy (United States)

    ... Depression during and after pregnancy fact sheet ePublications Depression during and after pregnancy fact sheet This information in Spanish (en español) Print this fact sheet Depression during and after pregnancy fact sheet (PDF, 260 ...

  14. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... 3 items) Institute Announcements (24 items) Symptoms and Treatment of Depression February 1, 2010 People with depression ... why it affects some people but not others. Treatments for depression do work. One type of effective ...

  15. St. John's Wort and Depression (United States)

    ... W X Y Z St. John's Wort and Depression: In Depth Share: On This Page Introduction Key ... will help ensure coordinated and safe care. About Depression Depression is a medical condition that affects about ...

  16. Symptoms and Treatment of Depression

    Medline Plus

    Full Text Available ... 3 items) Institute Announcements (24 items) Symptoms and Treatment of Depression February 1, 2010 People with depression ... why it affects some people but not others. Treatments for depression do work. One type of effective ...

  17. Testosterone and Depression

    Directory of Open Access Journals (Sweden)

    Şükrü Kartalcı


    Full Text Available Androgens have various effects on human body and mood. Testosterone, a hormone mainly secreted from testes and adrenals, is one of the most potent androgens. Multiple studies have found that testosterone plays a role in regulating sexual activity, libido, social behaviors, aggression, cognitive functions, sleep control and well-being in men and women. Testosterone deficiency in hypogonadic or elderly men leads to neuropsychiatric problems, such as fatigue, loss of libido, irritability, insomnia and depressive mood. Testosterone replacement therapy consistently reverses these sequel in men. On the other hand, hyperandrogenic states in women are related to aggression and antisocial behavior, which might lead to depressive mood. Low testosterone levels may also result in depression among oophorectomized women. Because of such effects, a relationship between testosterone and depression has long been an issue of speculation, but yet very few studies have addressed this relation. Along with clinical studies, experimental and epidemiological studies show that testosterone is related to depression in men and women. But studies of testosterone concentrations in depression have yielded inconsistent results reporting low as well as high testosterone levels associated with depression. In this article, the physiological and psychological effects of testosterone and evidence regarding its relationship to depressive disorders and possible gender differences have been reviewed.

  18. Depression in older adults. (United States)

    Fiske, Amy; Wetherell, Julie Loebach; Gatz, Margaret


    Depression is less prevalent among older adults than among younger adults, but it can have serious consequences. More than half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and are more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are depressed younger adults. Risk factors leading to the development of late-life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late-life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but are too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

  19. Depression Begets Depression: Comparing the Predictive Utility of Depression and Anxiety Symptoms to Later Depression (United States)

    Keenan, Kate; Feng, Xin; Hipwell, Alison; Klostermann, Susan


    Background: The high comorbidity between depressive and anxiety disorders, especially among females, has called into question the independence of these two symptom groups. It is possible that childhood anxiety typically precedes depression in girls. Comparing of the predictive utility of symptoms of anxiety with the predictive utility of symptoms…

  20. [Hashimoto encephalitis and depression]. (United States)

    Veltman, E M; Rhebergen, D; van Exel, E; Stek, M L


    Hashimoto encephalitis (he) is an auto-immune disease, with 40-50% of patients developing psychopathology. This could require targeted treatment. HE and prednison could both cloud the identification of a concurrent depressive disorder. We saw a 78-year-old woman with he and a severe depression, and treated her succesfully with ect.

  1. Depression (For Teens) (United States)

    ... these simple actions. They can have a powerful effect on mood and help with depression: eat healthy foods get the right amount of ... dance, and find creative self-expression through art, music, or journaling. ... and well-being. Depression can be treated if you take the right ...

  2. Sleep deprivation and depression

    NARCIS (Netherlands)

    Elsenga, Simon


    The association between depression and sleep disturbances is perhaps as old as makind. In view of the longstanding experience with this association it is amazing that only some 20 years ago, a few depressed patients attracted attention to the fact that Total Sleep Deprivation (TSD) had

  3. Sleep deprivation and depression

    NARCIS (Netherlands)

    Elsenga, Simon


    The association between depression and sleep disturbances is perhaps as old as makind. In view of the longstanding experience with this association it is amazing that only some 20 years ago, a few depressed patients attracted attention to the fact that Total Sleep Deprivation (TSD) had antidepressan


    Directory of Open Access Journals (Sweden)

    Peter Pregelj


    There is a grooving evidence that dysfunction in circadian rhythm regulation andmelatonergic system function is involved in depression pathogenesis. It is known thatclinically used antidepressants have influence on melatonergic system, probably throughchanged ratio between melatonergic type 1 and 2 receptors. With the clinical use of newcompounds like agomelatine that directly regulates melatonergic system new opportunities in depression treatment emerged

  5. Depression - older adults (United States)

    ... slowly than in younger adults. To better manage depression at home: Exercise regularly, if the provider says it is OK. Surround yourself with caring, positive people and do fun activities. ... signs of depression, and know how to react if these occur. ...

  6. Depression and ionizing radiation. (United States)

    Loganovsky, K N; Vasilenko, Z L


    The objective of this at issue paper is the analysis of published data in correlation with the results of own research on the potential role of ionizing radiation in the genesis of depressive disorders. Depression is one of the most significant and long-term effect of the atomic bombings, nuclear testing and radiation emergences. The participants of the accident at the Chornobyl nuclear power plant increased prevalence of depression (18.0% and 13.1% in controls) and suicide rates. Depression is mainly observed in the structure of an organic mental disorder against cerebrovascular disease. The clinical pattern is dominated by asthenoadynamic and asthenoapathetic depression. Depressive disorders in radiation emergencies are multifactorial, that is the result of exposure to the complex psychogenic and radiological accident's factors, impact of traditional risk factors, somatic and neurological diseases, genetic predisposition, predisposition, etc. At the same time, exposure to ionizing radiation is a factor in the genesis of depression. This impact can be direct (to the Central Nervous System), and indirectly through the somatic and neurological abnormalities (multiorgan dysfunction) as well as by a variety of pathogenic mechanisms of ionizing radiation on the brain that have been discovered recently. It is strongly necessary analytical clinical and epidemiological studies with verification of depression and evidence-based establishment of the role of radiation and non-radiation risk factors. Loganovskyj K. N., Vasylenko Z. L., 2013.

  7. Cooperation and depressive symptoms. (United States)

    Brendan Clark, C; Thorne, Christopher B; Hardy, Sonya; Cropsey, Karen L


    Deficits in pro-social cooperation are common in many individuals with mental illnesses such as depression. For decades, researchers have used economic game paradigms to compare cross-cultural cooperative behavior. However, research using economic games to assess cooperative behavior in clinical populations is in the early stages. We hypothesized that individuals with greater depressive symptoms would struggle to maintain reciprocity in iterative games, but not in single-iteration games measuring personal values. Participants (n=41) played four computer-based economic games (prisoner's dilemma, the public goods game, the ultimatum game, and the trust game) measuring different aspects of cooperation. Participants completed the Depression Anxiety and Stress Scale (DASS) and other measures of personality and demographics. Analyses assessed the relationships between game performance and psychological distress as measured by the DASS. Significant correlations were found between game performance and depressive symptoms, but not symptoms of anxiety or stress. Performance in the prisoner's dilemma and public goods game was significantly related to depression in a linear regression even when known associations with depressive affect such as age, gender, race, education, marital status, and neuroticism were controlled for. Depressive symptoms were associated with an inability to sustain reciprocal cooperation. Participants showed the predicted deficits in cooperation in these economic games. Economic games show the potential for assessing the social deficits associated with depressive symptoms. © 2013 Elsevier B.V. All rights reserved.

  8. Chlorine and fluorine partition coefficients and abundances in sub-arc mantle xenoliths (Kamchatka, Russia): Implications for melt generation and volatile recycling processes in subduction zones (United States)

    Bénard, A.; Koga, K. T.; Shimizu, N.; Kendrick, M. A.; Ionov, D. A.; Nebel, O.; Arculus, R. J.


    We report chlorine (Cl) and fluorine (F) abundances in minerals, interstitial glasses, and melt inclusions in 12 andesite-hosted, spinel harzburgite xenoliths and crosscutting pyroxenite veins exhumed from the sub-arc lithospheric mantle beneath Avacha volcano in the Kamchatka Arc (NE Russia). The data are used to calculate equilibrium mineral-melt partition coefficients (D mineral / melt) for Cl and F relevant to subduction-zone processes and unravel the history of volatile depletion and enrichment mechanisms in an arc setting. Chlorine is ∼100 times more incompatible in pyroxenes (DClmineral/melt = 0.005-0.008 [±0.002-0.003]) than F (DFmineral/melt = 0.50-0.57 [±0.21-0.24]), which indicates that partial melting of mantle sources leads to strong depletions in Cl relative to F in the residues. The data set in this study suggests a strong control of melt composition on DCl,Fpyroxene/melt, in particular H2O contents and Al/(Al + Si), which is in line with recent experiments. Fluorine is compatible in Ca-amphibole in the 'wet' sub-arc mantle (DFamphibole/melt = 3.5-3.7 [±1.5]) but not Cl (DClamphibole/melt = 0.03-0.05 [±0.01-0.03]), indicating that amphibole may fractionate F from Cl in the mantle wedge. The inter-mineral partition coefficients for Cl and F in this study are consistent amongst different harzburgite samples, whether they contain glass or not. In particular, disseminated amphibole hosts much of the Cl and F bulk rock budgets of spinel harzburgites (DClamphibole/pyroxene up to 14 and DFamphibole/pyroxene up to 40). Chlorine and fluorine are variably enriched (up to 1500 ppm Cl and 750 ppm F) in the parental arc picrite and boninite melts of primitive pyroxenite veins (and related melt inclusions) crosscutting spinel harzburgites. Based on the data in this study, the main inferences on the behaviour of Cl and F during melting and metasomatic processes in the sub-arc mantle are as follow: (i) Melting models show that most depleted mantle protoliths

  9. Steklite, KAl(SO4)2: A finding at the Tolbachik Volcano, Kamchatka, Russia, validating its status as a mineral species and crystal structure (United States)

    Murashko, M. N.; Pekov, I. V.; Krivovichev, S. V.; Chernyatyeva, A. P.; Yapaskurt, V. O.; Zadov, A. E.; Zelensky, M. E.


    Steklite KAl(SO4)2 has been found in sublimates of the Yadovitaya (Poisonous) fumarole at the second cinder cone of the northern breach of the Great Fissure Tolbachik Eruption, Tolbachik volcano, Kamchatka Peninsula, Russia. Steklite was approved as a valid mineral species by the Commission on New Minerals, Nomenclature, and Mineral Classification of the International Mineralogical Association on June 2, 2011 (IMA no. 2011-041). The name steklite is left for this mineral, as it was named by Chesnokov et al. (1995) for its technogenic analog from a burnt dump of coal mine no. 47 at Kopeisk, the Southern Urals, Russia. It is named after the Russian word steklo, meaning glass, in allusion to the visual similarity of its lamellae to thin glass platelets. At Tolbachik, steklite is associated with alumoklyuchevskite, langbeinite, euchlorine, fedotovite, chalcocyanite, hematite, and lyonsite. It occurs as hexagonal or irregular-shaped lamellar crystals with the major form {001} reaching 30 μm in thickness and 0.2 mm (occasionally up to 1 mm) in width. The crystals are frequently split. They are combined into openwork aggregates or thin crusts up to 1.5 × 2.5 cm in area. Steklite is transparent and colorless, with vitreous luster. The cleavage is perfect, parallel to (001). The mineral is brittle. The Mohs' hardness is 2.5. D calc is 2.797 g/cm3. Steklite is optically uniaxial, (-), ω = 1.546(2), ɛ = 1.533(3). The chemical composition (wt %, electron-microprobe data) is as follows: 0.09 Na2O, 18.12 K2O, 0.08 CaO, 0.03 MnO, 2.02 Fe2O3, 18.18 Al2O3, 61.80 SO3. The total is 100.37. The empirical formula calculated on the basis of eight O atoms is: (K0.997Na0.008Ca0.004)Σ1.009(Al0.925Fe{0.066/3+}Mg0.003Mn0.001)Σ0.995S2.01O8. Steklite is trigonal, space group P321, a = 4.7281(3), c = 7.9936(5) Å, V = 154.76(17)Å3, Z =1. The strongest reflections in the X-ray powder diffraction pattern ( d, Å- I[ hkl]) are: 8.02-34[001], 4.085-11[100], 3.649-100[011, 101], 2

  10. New volcanogenic-eruptive genetic type of diamond occurrence (based on studying the 2012-2013 Fissure Tolbachik Eruption in Kamchatka) (United States)

    Karpov, Gennady; Anikin, Leonid; Filatov, Stanislav; Silaev, Valery; Petrovsky, Vitaly; Zolotarev, Andrey; Dunin-Barkovsky, Romuald; Volynets, Anna


    the instance considered. The above can indicate that Tolbachik diamonds were never affected by mantle anneal. Generally, by their spectroscopic properties, Kamchatka diamonds correspond to the Ib-type whose occurrence among natural diamonds does not exceed 2%. Reported are isolated twinned crystals. Tiny grains of blue moissanite, single grains of pink garnet and pink and blue corundum were found within the association accompanying diamonds (commonly in basalt pores). Often found are thin laminae and filaments of native elements (Fe, Al, Cu), blades or lumpy grains of Cu-Sn (Zn) alloy. Tolbachik diamonds bear no evidence of magmatic corrosion. Data obtained allow us to state the discovery of a new genetic type of diamond occurrence that we suggest to call "volcanogenic-eruptive", or Tolbachik type.

  11. New Paleoclimate Records from the Russian Far East: Carbon Accumulation Rates and Ecological Change Over the Last 13,000 Years from Western and Central Kamchatka (United States)

    Bochicchio, C. J.; Loisel, J.; Yu, Z.; Beilman, D.; Dirksen, V.; Dirksen, O.; Nichols, J. E.


    The Kamchatka peninsula lies along the confluence of the Pacific Ocean, and the Bering and Okhotsk Seas (OS). Its location is ideal to record shifts in regional ocean and atmospheric circulation and contains vast stores of carbon-rich peatlands, yet paleoclimate records from this area are scarce. This research aims to provide new paleo-proxy records that document carbon dynamics, precipitation, and temperature over the Holocene. We focus on site C4 (54.02 N, 156.13 E) located 18 km from OS coast at 91 m elevation and draw comparisons with site C1 (54.91 N, 156.60 E) which is 62 km from the coast at 256 m elevation, both in the Western Lowland (WL) region. Cores C1 and C4 are 450 and 375 cm in length, respectively. C4 and C1 were analyzed for organic matter (OM) content; while C4 received additional δ-deuterium (δD), plant macrofossil, and fossil pollen analysis. Both cores cover the last 13,000 years from the Western Lowlands (WL); prior to this study no such records existed from the WL or the eastern OS coastline. Chronologies are based on radiocarbon dating of fine fraction bulk peat and Sphagnum plant macrofossils. At both sites, peat accumulation began 11 ka (1 ka = 1000 calibrated years before present), is continuous to the surface, interlayered with tephra, and overlays a clay unit with 20% OM. OM density measured at 1 cm intervals show similar means of 0.1 g cm-3 over the last 11 ka and, despite the close proximity of the sites (103 km), they show two opposing OM trends: Period 1) From 5.8 to 3.5 ka, C1 OM density decreased ~0.10 to 0.06 g cm-3 while C4 increased from ~0.10 to 0.19 g cm-3, and Period 2) from 3.5 to 0.9 ka, C1 OM density increased to ~0.18 g cm-3 while C4 decreased to ~0.11 cm-3. Peat carbon accumulation rate (PCAR) is similar for both periods in C1 and C4 at 20.1 and 14.1 g m-2 yr-1, respectively. Prior to 5.8 ka PCAR in C1 and C4 is ~30 g m-2 yr-1 in the early Holocene, decreasing to 19 g m-2 yr-1 in the Mid- Late Holocene. C4 shows large

  12. Adolescent depression: a metasynthesis. (United States)

    Dundon, Edith Emma


    Concerns about the adequate assessment and treatment of adolescent depression have been in the forefront of pediatric mental health literature in the recent past. While quantitative studies have provided valuable information, the voice of the adolescent has been lacking in the development of theory and treatment of this prevalent disorder. Using approach, a metasynthesis of six qualitative studies was conducted. This process revealed six themes that outline the course of adolescents who struggle with depression: (a) beyond the blues, (b) spiraling down and within, (c) breaking points, (d) seeing and being seen, (e) seeking solutions, and (f) taking control. Knowledge of the experience of adolescent depression will aid practitioners in recognition and early intervention for the increasing number of adolescents suffering with depression, as well as guide educational initiatives to provide needed information on the symptoms of depression and available resources for getting help.

  13. [Depression and suicide prevention]. (United States)

    Yamada, Mitsuhiko


    Suicide is a major public health problem and the number of suicide victims has exceeded 30,000 a year since 1998 in Japan. The rates of depression are extremely high in suicide victims. Social and environmental factors, such as the slow recovery of Japanese economy, could have a strong effect on depression and suicide, especially in middle-aged men. To reduce the number of suicide victims, we need to use both population-based and high-risk approaches, targeting individuals with high psychological and socioeconomic risks of suicide, especially depressed patients. On the other hand, the role of antidepressants in suicide prevention is a major question given the high prevalence of both depression and depression-related suicidality. Because treatment and prevention of suicide are complex and encompass many factors, success will need multi-sector collaboration.

  14. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær


    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  15. Measuring psychotic depression

    DEFF Research Database (Denmark)

    Østergaard, Søren Dinesen; Meyers, B S; Flint, A J


    OBJECTIVE: Psychotic depression (PD) is a highly debilitating condition, which needs intensive monitoring. However, there is no established rating scale for evaluating the severity of PD. The aim of this analysis was to assess the psychometric properties of established depression rating scales...... and a number of new composite rating scales, covering both depressive and psychotic symptoms, in relation to PD. METHOD: The psychometric properties of the rating scales were evaluated based on data from the Study of Pharmacotherapy of Psychotic Depression. RESULTS: A rating scale consisting of the 6-item......'s correlation coefficient between change in HAMD-BPRS11 and Clinical Global Impression - Improvement (CGI-I) scores = -0.74--0.78) and unidimensionality (Loevinger's coefficient of homogeneity = 0.41) in the evaluation of PD. The HAM-D6 fulfilled the same criteria, whereas the full 17-item Hamilton Depression...

  16. Depression and Political Participation* (United States)

    Ojeda, Christopher


    In this paper, I propose that depression is a political phenomenon insofar as it has political sources and consequences. I then investigate one aspect of this argument—whether depression reduces participation. I hypothesize that individuals with depression lack the motivation and physical capacity to vote and engage in other forms of political participation due to somatic problems and feelings of hopelessness and apathy. Moreover, I examine how depression in adolescence can have downstream consequences for participation in young adulthood. The analyses, using both cross-sectional and longitudinal data, show that voter turnout and other forms of participation decrease as the severity of depressed mood increases. These findings are discussed in light of disability rights and potential efforts to boost participation among this group. PMID:26924857

  17. Depression and Political Participation. (United States)

    Ojeda, Christopher


    In this paper, I propose that depression is a political phenomenon insofar as it has political sources and consequences. I then investigate one aspect of this argument-whether depression reduces participation. I hypothesize that individuals with depression lack the motivation and physical capacity to vote and engage in other forms of political participation due to somatic problems and feelings of hopelessness and apathy. Moreover, I examine how depression in adolescence can have downstream consequences for participation in young adulthood. The analyses, using both cross-sectional and longitudinal data, show that voter turnout and other forms of participation decrease as the severity of depressed mood increases. These findings are discussed in light of disability rights and potential efforts to boost participation among this group.

  18. [Severe depression : psychoanalysis]. (United States)

    Bouvet de la Maisonneuve, O


    The indication for psychoanalysis in severe depression is not clear. And yet, demands for this type of intervention are increasing, despite the absence of any form of consensus on the subject. Freud considered depression as a failure of analytical efforts and, based on this observation, revised his theory, in particular to include the notions of narcissism and the death drive. Many analysts have been reluctant to follow his teachings on this last point and provide depressed patients with analytical-type therapies aimed at restoring narcissism. Melanie Klein pushed Freud's ideas about depression even further and brought such therapies back to the heart of analytical practice. Jacques Lacan took the debate to another level by proposing an overhaul of the principles on which analysis has been based. Today, while following certain precautionary rules, true psychoanalyses can be proposed to patients with severe depression, whether of the bipolar, recurring or even neurotic type that can reach this level of severity.

  19. Transcriptional analysis of kidneys during repair from AKI reveals possible roles for NGAL and KIM-1 as biomarkers of AKI-to-CKD transition. (United States)

    Ko, Gang Jee; Grigoryev, Dmitry N; Linfert, Douglas; Jang, Hye Ryoun; Watkins, Tonya; Cheadle, Chris; Racusen, Lorraine; Rabb, Hamid


    Acute kidney injury (AKI) is being increasingly shown to be a risk factor for chronic kidney disease (CKD), but little is known about the possible mechanistic links. We hypothesized that analysis of the genomic signature in the repair stage after AKI would reveal pathways that could link AKI and CKD. Unilateral renal pedicle clamping for 45 min was performed in male C57BL/6J mice. Mice were euthanized at 3, 10, and 28 days after ischemia-reperfusion injury (IRI). Total RNA was isolated from kidney and analyzed using an Illumina mouse array. Among 24,600 tested genes, 242, 146, and 46 genes were upregulated at days 3, 10, and 28 after IRI, and 85, 35, and 0 genes were downregulated, respectively. Gene ontology analysis showed that gene expression changes were primarily related to immune and inflammatory pathways both early and late after AKI. The most highly upregulated genes late after AKI were hepatitis A virus cellular receptor 1 (Havcr1) and lipocalin 2 (Lcn2), which code for kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), respectively. This was unexpected since they are both primarily potential biomarkers of the early stage of AKI. Furthermore, increases observed in gene expression in amiloride binding protein 1, vascular cell adhesion molecule-1, and endothelin 1 could explain the salt-sensitive hypertension that can follow AKI. These data suggested that 1) persistent inflammation and immune responses late after AKI could contribute to the pathogenesis of CKD, 2) late upregulation of KIM-1 and NGAL could be a useful marker for sustained renal injury after AKI, and 3) hypertension-related gene changes could underlie mechanisms for persistent renal and vascular injury after AKI.

  20. GFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration. (United States)

    Levey, Andrew S; Inker, Lesley A; Matsushita, Kunihiro; Greene, Tom; Willis, Kerry; Lewis, Edmund; de Zeeuw, Dick; Cheung, Alfred K; Coresh, Josef


    The US Food and Drug Administration currently accepts halving of glomerular filtration rate (GFR), assessed as doubling of serum creatinine level, as a surrogate end point for the development of kidney failure in clinical trials of kidney disease progression. A doubling of serum creatinine level generally is a late event in chronic kidney disease (CKD); thus, there is great interest in considering alternative end points for clinical trials to shorten their duration, reduce sample size, and extend their conduct to patients with earlier stages of CKD. However, the relationship between lesser declines in GFR and the subsequent development of kidney failure has not been well characterized. The National Kidney Foundation and Food and Drug Administration sponsored a scientific workshop to critically examine available data to determine whether alternative GFR-based end points have sufficiently strong relationships with important clinical outcomes of CKD to be used in clinical trials. Based on a series of meta-analyses of cohorts and clinical trials and simulations of trial designs and analytic methods, the workshop concluded that a confirmed decline in estimated GFR of 30% over 2 to 3 years may be an acceptable surrogate end point in some circumstances, but the pattern of treatment effects on GFR must be examined, specifically acute effects on estimated GFR. An estimated GFR decline of 40% may be more broadly acceptable than a 30% decline across a wider range of baseline GFRs and patterns of treatment effects on GFR. However, there are other circumstances in which these end points could lead to a reduction in statistical power or erroneous conclusions regarding benefits or harms of interventions. We encourage careful consideration of these alternative end points in the design of future clinical trials.

  1. Contrast-Induced Nephropathy After Computed Tomography in Stable CKD Patients With Proper Prophylaxis: 8-Year Experience of Outpatient Prophylaxis Program. (United States)

    Park, Sehoon; Kim, Myoung-Hee; Kang, Eunjeong; Park, Seokwoo; Jo, Hyung Ah; Lee, Hajeong; Kim, Sun Moon; Lee, Jung Pyo; Oh, Kook-Hwan; Joo, Kwon Wook; Kim, Yon Su; Kim, Dong Ki


    Conflicting data have been reported on the clinical significance of contrast-induced nephropathy after CT scan (CT-CIN). In addition, the epidemiologic characteristics and clinical outcomes of CT-CIN following proper prophylactic intervention remain elusive.We examined the incidence, risk factors, and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data collected from our outpatient CT-CIN prophylaxis program conducted between 2007 and 2014. The program recruited patients with an estimated glomerular filtration rate (eGFR) pop-up alert system and provided an identical protocol of CIN prophylaxis to all patients.A total of 1666 subjects were included in this study, and 61 of the 1666 subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline eGFR, diabetes mellitus, and low serum albumin were significant risk factors for CT-CIN. The generalized additive model analysis revealed a nonlinear relationship between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of CT-CIN began to increase below an eGFR threshold of 36.8 mL/min/1.73 m. To assess the outcomes of CT-CIN, patients with and without CT-CIN were compared after propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate of patients. However, patients with CT-CIN were significantly more likely to start dialysis within 6 months of follow-up, but not after those initial 6 months.CT-CIN developed in only a small number of stable CKD patients who received proper prophylactic intervention, and the risk of CT-CIN was increased in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a non-negligible risk for the initiation of dialysis in the acute period, even after prophylaxis.

  2. Plant Protein Intake Is Associated with Fibroblast Growth Factor 23 and Serum Bicarbonate in Patients with CKD: The Chronic Renal Insufficiency Cohort Study (United States)

    Scialla, Julia J.; Appel, Lawrence J; Wolf, Myles; Yang, Wei; Zhang, Xiaoming; Sozio, Stephen M.; Miller, Edgar R.; Bazzano, Lydia A.; Cuevas, Magdalena; Glenn, Melanie J.; Lustigova, Eva; Kallem, Radhakrishna R.; Porter, Anna C.; Townsend, Raymond R.; Weir, Matthew R.; Anderson, Cheryl A.M.


    Background Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD), due to lower bioavailability of phosphate and lower nonvolatile acid load. Study Design Observational cross-sectional study. Setting & Participants 2938 participants with chronic kidney disease and information on dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors Percentage of total protein from plant sources (% plant protein) was determined by scoring individual food items from the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH), and hemoglobin. Measurements We modeled the association between % plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes, body mass index, eGFR, income, smoking, total energy intake, total protein intake, 24 hour urinary sodium, use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers and use of diuretics. Results Higher % plant protein was associated with lower FGF23 (p=0.05) and higher HCO3 (p=0.01), but not with serum phosphate or PTH (p=0.9 and 0.5, respectively). Higher % plant protein was not associated with higher serum potassium (p=0.2), lower serum albumin (p=0.2) or lower hemoglobin (p=0.3). The associations of % plant protein with FGF23 and HCO3 did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5) or total protein intake (≤ 0.8 g/kg/d vs. >0.8 g/kg/d) (p-interaction > 0.10 for each). Limitations Cross-sectional study; Determination of % plant protein using the DHQ has not been validated. Conclusions Consumption of a higher percentage of protein from plant sources may lower FGF23 and raise HCO3 in patients with CKD. PMID:22480598

  3. Management of bipolar depression

    Directory of Open Access Journals (Sweden)

    Jae Seung Chang


    Full Text Available Patients with bipolar disorder spend more time in a depressed than manic state, even with individualized treatment. To date, bipolar depression is often misdiagnosed and ineffectively managed both for acute episodes and residual symptoms. This review attempts to summarize the current status of available treatment strategies in the treatment of bipolar depression. For acute and prophylactic treatment, a substantial body of evidence supports the antidepressive efficacy of lithium for bipolar disorders and its antisuicidal effects. Among numerous anticonvulsants with mood-stabilizing properties, valproate and lamotrigine could be first-line options for bipolar depression. Due to receptor profile, mood-stabilizing properties of second-generation antipsychotics have been explored, and up to date, quetiapine and olanzapine appear to be a reasonable option for bipolar depression. The usefulness of antidepressants in bipolar depression is still controversial. Current guidelines generally recommend the cautious antidepressant use in combination with mood stabilizers to reduce the risk of mood elevation or cycle acceleration. Results from clinical trials on psychosocial intervention are promising, especially when integrated with pharmacotherapy. Most patients with bipolar depression need individualized and combined treatment, although the published evidence on this type of treatment strategy is limited. Future studies on the utility of currently available agents and modalities including psychosocial intervention are required.

  4. Behandlingsresistent depression kan behandles

    DEFF Research Database (Denmark)

    Vinberg, Maj; Levinsen, Mette Frandsen; Kessing, Lars Vedel


    Depression is considered resistant when two treatment attempts with antidepressants from different classes fail to produce significant clinical improvement. In cases of treatment-resistant depression, it is recommended to reevaluate the diagnosis, clarify comorbidity, substance abuse and lack...... of compliance. Regarding treatment, evidence is sparse, but switching to a different antidepressant, and combination or augmentation with another agent, admission and treatment with ECT are the options. The choice of treatment must be based on the characteristics of the depression, the severity of treatment...

  5. Depression and erectile dysfunction. (United States)

    Makhlouf, Antoine; Kparker, Ashay; Niederberger, Craig S


    Depression and erectile dysfunction (ED) clearly are associated. Although urologists and psychiatrists have long recognized that antidepressant medications affect erectile function negatively, the interplay between the two conditions remains underappreciated. Psychiatrists may be reluctant to question a patient in detail about ED, and urologists seldom perform a formal assessment of the presence of depression in patients who have ED. This article gives a quick overview of the relationship between these two conditions and provides the clinician with the knowledge required to effectively manage ED with comorbid depression.

  6. In patients with chronic kidney disease (CKD kidney tissues PAI 1 clinical research%CKD患者肾组织中PAI-1的临床研究

    Institute of Scientific and Technical Information of China (English)




  7. Neuroticism in remitted major depression

    DEFF Research Database (Denmark)

    Gade, Anders; Kristoffersen, Marius; Kessing, Lars Vedel


    BACKGROUND: The personality trait of neuroticism is strongly related to depression, but depression is etiologically heterogeneous. Late-onset depression (LOD) may be more closely related to vascular factors, and previous studies of neuroticism in LOD versus early-onset depression (EOD) have not b...

  8. Do You Have Major Depression? (United States)

    ... of this page please turn Javascript on. Feature: Depression Do You Have Major Depression? Past Issues / Fall 2009 Table of Contents Simple ... member may have major depression. —NIMH Types of Depression Just like other illnesses, such as heart disease, ...

  9. Vision in depressive disorder

    DEFF Research Database (Denmark)

    Bubl, E.; Tebartz Van Elst, L.; Ebert, D.


    Background. Reduced dopaminergic transmission has been implicated in the pathophysiology of major depression. Furthermore, dopaminergic neurotransmission plays an important role in the physiology of visual contrast sensitivity (CS). To test the hypothesis that altered dopaminergic neurotransmissi...

  10. Telomere length and depression

    DEFF Research Database (Denmark)

    Wium-Andersen, Marie Kim; Ørsted, David Dynnes; Rode, Line


    BACKGROUND: Depression has been cross-sectionally associated with short telomeres as a measure of biological age. However, the direction and nature of the association is currently unclear. AIMS: We examined whether short telomere length is associated with depression cross-sectionally as well...... as prospectively and genetically. METHOD: Telomere length and three polymorphisms, TERT, TERC and OBFC1, were measured in 67 306 individuals aged 20-100 years from the Danish general population and associated with register-based attendance at hospital for depression and purchase of antidepressant medication....... RESULTS: Attendance at hospital for depression was associated with short telomere length cross-sectionally, but not prospectively. Further, purchase of antidepressant medication was not associated with short telomere length cross-sectionally or prospectively. Mean follow-up was 7.6 years (range 0...

  11. Doxepin (Depression, Anxiety) (United States)

    Doxepin is used to treat depression and anxiety. Doxepin is in a class of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain ...

  12. [Depression and myocardial infaction]. (United States)

    Testuz, A


    Several works show an association between depression and the occurence of a first myocardial infarction. Depression after myocardial infarction seems to be a marker of poorer outcome, regardless of other risk factors or severity of the myocardial infarction. Dysautonomia and alteration of platelet activation are a few physiopathological changes shared by both affections, through which they might be related. Treatment of depression is not associated with better cardiovascular outcome, but selective serotonin reuptake inhibitors have been shown safe and efficient among patients with coronary heart disease. Cognitivo-comportemental approach and cardiovascular rehabilitation program after myocardial infarction also play a role in improving quality of life of the depressed patient with coronary heart disease.

  13. Depression (For Teens) (United States)

    ... people overcome depression. Talk therapy works by helping people to: understand their emotions, put feelings into words, and feel understood and supported build the confidence to deal with life's struggles work out problems ...

  14. Depression in Older Adults (United States)

    ... the Printable Report Election Year: Mental Health and Politics Glossary and Citations Prevalence Data Ranking Guidelines Ranking ... Mental Health. “The Many Dimensions of Depression in Women: Women at Risk,” Accessed June 1999. Netscape: http:// ...

  15. The psychoneuroimmunology of depression. (United States)

    Leonard, Brian E; Myint, Ayemu


    Chronic stress, by initiating changes in the hypothalamic-pituitary-adrenal (HPA) axis and the immune system, acts as a trigger for anxiety and depression. There is experimental and clinical evidence that the rise in the concentration of pro-inflammatory cytokines and glucocorticoids, which occurs in a chronically stressful situation and also in depression, contribute to the behavioural changes associated with depression. A defect in serotonergic function is associated with these hormonal and immune changes. Neurodegenerative changes in the hippocampus, prefrontal cortex and amygdalae are the frequent outcome of the changes in the HPA axis and the immune system. Such changes may provide evidence for the link between chronic depression and dementia in later life.

  16. Depression and codependency in women. (United States)

    Hughes-Hammer, C; Martsolf, D S; Zeller, R A


    Seven million American women are depressed, and 40 million Americans, primarily women, have been labeled as codependent. This study aimed to identify the prevalence of codependency in women undergoing treatment for depression, examine the relationship between codependency and depression, and determine which of the symptoms of codependency are most highly predictive of depression scores. Depression and codependency were measured in a sample of 105 depressed women by using the Beck Depression Inventory and the Codependency Assessment Tool. Descriptive statistics, Pearson's Product Moment Correlation, and multiple regression were used for analysis. Of these depressed women, 36% were moderately to severely codependent. Depression and codependency were strongly related, with the significant gamma = .92 (P codependency subscales, Low Self-Worth and Hiding Self correlate most strongly with depression; Other Focus/Self-Neglect added the least-independent--explanatory power. Thus, future research should be directed toward the relationship of codependency to power, alienation of self, and personality disorders.

  17. Identifying Depression on Twitter


    Nadeem, Moin


    Social media has recently emerged as a premier method to disseminate information online. Through these online networks, tens of millions of individuals communicate their thoughts, personal experiences, and social ideals. We therefore explore the potential of soci