SP603Understanding the impact on mortality of long term serum phosphorus control using a 6 month area under the curve approach in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract Background and Aims Chronic kidney disease mineral and bone disorder (CKD-MBD) is characterized by abnormalities in serum calcium, phosphorus, and parathyroid hormone (PTH) and associated with morbidity and mortality. Previous publications from the Dialysis Outcomes and Practice Patterns Study (DOPPS) have demonstrated country differences in the prevalence and treatment of CKD-MBD among hemodialysis patients in participating European countries. We aim to compare the distribution of CKD-MBD related labs and treatments across countries in a contemporary population of European hemodialysis patients. Method DOPPS is an international prospective cohort study of hemodialysis patients ≥18 years of age. Patients are enrolled randomly from a representative sample of dialysis facilities within each nation at the start of each study phase. The current analysis includes n=1,701 patients from 91 facilities in the initial prevalent cross section of Europe DOPPS phase 7 (2019-present; Belgium, Germany, Italy, Spain, Sweden, UK). Results from Belgium should be considered preliminary as initial questionnaire completion is ongoing. Results The % of patients with a high PTH (>600 pg/mL) ranged from 6% in Italy to 24% in the UK, with 12-17% having high PTH in all other countries. Mean serum total calcium ranged from 8.7 in Germany to 9.1 mg/dL in the UK (Table). Mean serum phosphorus varied from 4.5 in Belgium to 5.3 mg/dL in Germany. Dialysate calcium of 2.5 mEq/L was predominant in Germany, Sweden, and the UK while 3.0 mEq/L was the most common prescription in Belgium, Italy, and Spain. Calcimimetic prescription ranged from 13% in the UK to 32% in Spain. Etelcalcetide prescription ranged from 1% in the UK to 12% in Spain and 14% in Italy. Active vitamin D prescription ranged from 27% in Belgium to 75% in Sweden. Nearly all vitamin D prescriptions were administered intravenously in Spain versus about half in Italy; in all other countries, the route of active vitamin D administration was primarily oral. Patient age and dialysis vintage varied by country, potentially contributing to some of the observed country differences in MBD marker levels and treatment practices. Conclusion CKD-MBD related abnormalities in PTH, serum phosphorus and calcium remain common in European dialysis patients, with prevalence varying considerably by country. Substantial international variation in CKD-MBD treatments was also observed in prescription of vitamin D and calcimimetics. Uptake of the relatively new calcimimetic, etelcalcetide, varied considerably by country. A detailed understanding of the effect of treatment variation on CKD-MBD marker levels and patient outcomes is needed to provide important insights for the European HD community in optimizing management of secondary hyperparathyroidism.

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Regional variation in the treatment and prevention of peritoneal dialysis-related infections in the Peritoneal Dialysis Outcomes and Practice Patterns Study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy204 ◽

2018 ◽

Vol 34 (12) ◽

pp. 2118-2126 ◽

Cited By ~ 14

Author(s):

Neil Boudville ◽

David W Johnson ◽

Junhui Zhao ◽

Brian A Bieber ◽

Ronald L Pisoni ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Infection Prevention ◽

Practice Patterns ◽

Antibiotic Administration ◽

Exit Site ◽

Prevention And Treatment ◽

The Usa ◽

Dialysis Outcomes ◽

The Uk ◽

The Impact

AbstractBackgroundPeritoneal dialysis (PD)-related infections lead to significant morbidity. The International Society for Peritoneal Dialysis (ISPD) guidelines for the prevention and treatment of PD-related infections are based on variable evidence. We describe practice patterns across facilities participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).MethodsPDOPPS, a prospective cohort study, enrolled nationally representative samples of PD patients in Australia/New Zealand (ANZ), Canada, Thailand, Japan, the UK and the USA. Data on PD-related infection prevention and treatment practices across facilities were obtained from a survey of medical directors’.ResultsA total of 170 centers, caring for >11 000 patients, were included. The proportion of facilities reporting antibiotic administration at the time of PD catheter insertion was lowest in the USA (63%) and highest in Canada and the UK (100%). Exit-site antimicrobial prophylaxis was variably used across countries, with Japan (4%) and Thailand (28%) having the lowest proportions. Exit-site mupirocin was the predominant exit-site prophylactic strategy in ANZ (56%), Canada (50%) and the UK (47%), while exit-site aminoglycosides were more common in the USA (72%). Empiric Gram-positive peritonitis treatment with vancomycin was most common in the UK (88%) and USA (83%) compared with 10–45% elsewhere. Empiric Gram-negative peritonitis treatment with aminoglycoside therapy was highest in ANZ (72%) and the UK (77%) compared with 10–45% elsewhere.ConclusionsVariation in PD-related infection prevention and treatment strategies exist across countries with limited uptake of ISPD guideline recommendations. Further work will aim to understand the impact these differences have on the wide variation in infection risk between facilities and other clinically relevant PD outcomes.

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Heat Treatment of Milk: A Rapid Review of the Impacts on Postprandial Protein and Lipid Kinetics in Human Adults

Frontiers in Nutrition ◽

10.3389/fnut.2021.643350 ◽

2021 ◽

Vol 8 ◽

Author(s):

Mona Fatih ◽

Matthew P. G. Barnett ◽

Nicola A. Gillies ◽

Amber M. Milan

Keyword(s):

Heat Treatment ◽

Assessment Tool ◽

Area Under The Curve ◽

Peripheral Circulation ◽

Heat Treatments ◽

Risk Of Bias ◽

Rapid Review ◽

Healthy Human ◽

The Impact

Background: Most milk consumed by humans undergoes heat treatment to ensure microbiological safety and extend shelf life. Although heat treatment impacts the structure and physiochemical properties of milk, effects on nutrient absorption in humans are unclear. Therefore, a rapid review was performed to identify studies conducted on healthy human adult subjects that have assessed the impacts of heat treatment of milk on protein and fat digestion and metabolism in the postprandial period (up to 24 h).Methods: Relevant databases (Medline, EMBASE, Cochrane, Scopus) were systematically screened for intervention studies on healthy adult men and women that assessed the impact of consuming heat-treated milk on the postprandial kinetics or appearance in peripheral circulation or urine of ingested proteins and/or lipids. The risk-of-bias assessment tool 2 was used for quality assessment.Results: Of 511 unique database records, 4 studies were included encompassing 6 study treatments (n = 57 participants, 20–68 years). Three studies evaluated pasteurization, two evaluated ultra-high temperature (UHT) treatment, and one evaluated oven-heated milk. Protein and lipid appearances in peripheral blood were reported in two sets of two studies. None of the studies used the same heat treatments and outcome measures, limiting generalization of effects. Protein appearance (ng/mL or area under the curve) (as plasma amino acids - lysine) was reduced when milk was oven-heated for 5 h in one study (n = 7 participants), while the other study reported a reduced retention of dietary N with UHT milk (n = 25 participants). Overall plasma triacylglycerol responses were unaffected by milk heat treatments reported, but plasma fatty acid composition differed. The studies observed higher plasma myristic and palmitic acid abundance with successive heat treatment at 2 h (n = 11 participants; pasteurized) and 4 h (n = 14 participants; UHT) after ingestion; other differences were inconsistent. All studies had moderate-high risk of bias, which should be taken into consideration when interpreting findings.Discussion: This review identified few studies reporting the effects of milk heat treatment on postprandial nutrient responses in adults. Although the findings suggest that milk heat treatment likely affects postprandial protein and lipid dynamics, generalization of the findings is limited as treatments, outcomes, and methods differed across studies. Because of the study variability, and the acute post-prandial nature of the studies, it is also difficult to draw conclusions regarding potential long-term health outcomes. However, the possibility that altered digestive kinetics may influence postprandial protein retention and anabolic use of dietary N suggests heat treatment of milk may impact outcomes such as long-term maintenance of muscle mass.

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Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa054 ◽

2020 ◽

Vol 35 (10) ◽

pp. 1794-1801

Author(s):

Marcelo Barreto Lopes ◽

Angelo Karaboyas ◽

Brian Bieber ◽

Ronald L Pisoni ◽

Sebastian Walpen ◽

...

Keyword(s):

Cox Regression ◽

Reference Group ◽

Area Under The Curve ◽

Information Criterion ◽

Phosphorus Level ◽

Real World Data ◽

Phosphorus Control ◽

Kdigo Guidelines ◽

Dialysis Outcomes ◽

Additional Value

Abstract Background Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain. Methods We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion. Results Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90–1.40] for AUC > 0–0.5, 1.26 (95% CI 0.99–1.62) for AUC > 0.5–1, 1.44 (95% CI 1.11–1.86) for AUC > 1–2 and 2.03 (95% CI 1.53–2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target). Conclusions We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO’s recommendation of serial assessment of phosphorus to guide clinical decisions.

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Management of muscle-invasive bladder cancer with bladder preservation in Russia: A survey-based analysis of current practice and the impact of an educational workshop on clinical expertise.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.10509 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 10509-10509

Author(s):

Natalia Dengina ◽

Marina Chernich ◽

Sergey Usychkin ◽

Catherine Degnin ◽

Yiyi Chen ◽

...

Keyword(s):

Bladder Cancer ◽

Smoking Cessation ◽

Practice Patterns ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Bladder Preservation ◽

Mcnemar Test ◽

Muscle Invasive ◽

The Impact

10509 Background: Trimodality bladder preservation (BP) is an accepted alternative to radical cystectomy for patients with muscle-invasive bladder cancer (MIBC). The global utilization of BP is variable, and practice patterns have not been previously studied in Russia. During the Russian Annual Oncology Congress, organized by the Russian Society of Clinical Oncology in November 2018, our group has conducted a contouring workshop for Russian radiation oncologists (ROs). We sought to elucidate the contemporary practice patterns in Russia and determine the impact of this workshop on attitudes of Russian ROs towards BP. Methods: Pre- and post-workshop IRB-approved surveys were analyzed to determine baseline clinical experience and patterns of care among Russian ROs. The effect of the contouring workshop on participants’ knowledge and attitudes was performed using tests for paired nominal data. Results: We analyzed 77 pre-workshop and 32 matched post-workshop questionnaires. 56% (43 out of 77) of respondents treated MIBC patients with bladder-directed radiation therapy (RT). Of these, 40% (17 out of 43) treated only inoperable patients, and 60% treated both operable and inoperable MIBC patients. 14% offered RT alone to their patients, while the rest offered concurrent chemoRT. 63% (26 out of 41) offered suboptimal concurrent systemic agents, such as single agents carboplatin or paclitaxel. 63% of respondents felt that BP can only be done in specialized centers with established expertise, but only 10% felt uncomfortable offering an MIBC patient a BP option in their clinic. Prior to workshop, 40% of respondents estimated universal poor bladder and erectile functions after BP. The workshop resulted in dramatic change in participants’ attitudes towards BP long-term urinary (Stuart-Maxwell-test, p < 0.01), and sexual (exact McNemar test, p < 0.01) side-effects. Prior to workshop, only 52% of respondents routinely discussed smoking cessation (SC) with their patients, whereas after workshop almost 90% agreed that SC discussion is mandatory (exact McNemar test, p = 0.04). Conclusions: Bladder preservation is commonly used in Russia in the management of MIBC patients. Our contouring workshop resulted in dramatically improved understanding of long-term BP toxicities and inspired Russian ROs to incorporate smoking cessation counseling into routine clinical practice. International educational efforts are critical to improve multi-disciplinary management of MIBC patients.

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Suppressed, but Not Forgotten

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000033 ◽

2011 ◽

Vol 70 (1) ◽

pp. 5-11 ◽

Cited By ~ 8

Author(s):

Beat Meier ◽

Anja König ◽

Samuel Parak ◽

Katharina Henke

Keyword(s):

Memory Trace ◽

Thought Suppression ◽

Test Phase ◽

Indirect Test ◽

Final Test ◽

Test Experiment ◽

And Control ◽

Cue Words ◽

The Impact

This study investigates the impact of thought suppression over a 1-week interval. In two experiments with 80 university students each, we used the think/no-think paradigm in which participants initially learn a list of word pairs (cue-target associations). Then they were presented with some of the cue words again and should either respond with the target word or avoid thinking about it. In the final test phase, their memory for the initially learned cue-target pairs was tested. In Experiment 1, type of memory test was manipulated (i.e., direct vs. indirect). In Experiment 2, type of no-think instructions was manipulated (i.e., suppress vs. substitute). Overall, our results showed poorer memory for no-think and control items compared to think items across all experiments and conditions. Critically, however, more no-think than control items were remembered after the 1-week interval in the direct, but not in the indirect test (Experiment 1) and with thought suppression, but not thought substitution instructions (Experiment 2). We suggest that during thought suppression a brief reactivation of the learned association may lead to reconsolidation of the memory trace and hence to better retrieval of suppressed than control items in the long term.

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