pdf/kdoqi-clinical-practice-guideline-for-nutrition-in-ckd-2020-ju76c0vphn.pdf

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update

Bone and mineral disorders in chronic kidney disease: implications for cardiovascular health and ageing in the general population

Prevention and treatment of hyperphosphatemia in chronic kidney disease.

Background In patients with end stage kidney disease (ESKD) on dialysis, treatment non-adherence is common and results in poor health outcomes. However, the clinical benefits of interventions to improve adherence in dialysis patients are difficult to evaluate since trialled interventions and reported outcomes are highly diverse/ heterogeneous. This review summarizes existing literature on randomized controlled trials (RCTs) evaluating adherence interventions in ESKD patients focusing on the intervention category, outcome efficacy and persistence of benefit beyond the intervention. Methods We performed electronic database searches in Medline, Embase & Cochrane CENTRAL upto 1st July 2018 for RCTs evaluating interventions to improve diet, fluid, medication or dialysis adherence in ESKD patients. Study characteristics including category of interventions, outcomes, efficacy and follow-up were assessed. Meta-analysis was used to compute pooled estimates of the effects on the commonest reported outcome measures. Results From 1311 citations, we included 36 RCTs (13 cluster-randomized trials), recruiting a total of 3510 dialysis patients (mean age 55.1 ± 5.8 years, males 58.1%). Overall risk of bias was ‘high’ for 24 and of ‘some concern’ for 12 studies. Most interventions (33 trials, 92%) addressed patient related factors, and included educational/cognitive (N = 11), behavioural / counselling (N = 4), psychological/affective (N = 4) interventions or a combination (N = 14) of the above. A majority of (28/36) RCTs showed improvement in some reported outcomes. Surrogate measures like changes in phosphate (N = 19) and inter-dialytic weight gain (N = 15) were the most common reported outcomes and both showed significant improvement in the meta-analysis. Sixteen trials reported follow-up (1–12 months) beyond intervention and the benefits waned or were absent in nine trials within 12 months post-intervention. Conclusions Interventions to improve treatment adherence result in modest short-term benefits in surrogate outcome measures in dialysis patients, but significant improvements in trial design and outcome reporting are warranted to identify strategies that would achieve meaningful and sustainable clinical benefits. Limitations Poor methodological quality of trials. Frequent use of surrogate outcomes measures. Low certainly of evidence.

/pdf/strategies-to-improve-dietary-fluid-dialysis-or-medication-2ipahvwu0f.pdf

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials.

Strategies to enhance knowledge of and adherence to dietary guidelines for management of hyperphosphatemia in hemodialysis patients have been studied extensively over the past decade. This review is the first to compile all of them (2003–2013) and conduct a meta-analysis through calculation of effect size, with the aim of identifying the optimal nutrition education methods for effective management of hyperphosphatemia in hemodialysis patients. The following strategies were identified as being effective in changing dietary behavior: 1) use of self-evaluation and self-regulation techniques within educational tools, along with easy-to-apply skills; 2) individualized counseling by a renal dietitian provided just before the hemodialysis session; 3) high-intensity education; and 4) long duration of interventions. Future studies should focus on conducting randomized controlled trials with powered samples to help generate stronger evidence.

Dietary educational interventions for management of hyperphosphatemia in hemodialysis patients: a systematic review and meta-analysis

BACKGROUND Elevated serum phosphorus has been identified as a cardiovascular risk factor. This study aimed to assess the effectiveness of dietary intervention to reduce phosphorus intake and to improve the calcium-phosphorus metabolism in hemodialysis patients. DESIGN Patients were included in a 6-month, 2-group experimental study if their previous 3-month average serum phosphorus was over 5.5 mg/dl. Patients were allocated to intensive dietary intervention or usual dietary recommendations. The clinical end-points were the multivariate-adjusted change in serum phosphorus and the number of patients who achieved serum phosphorus levels of < 5.5 mg/dl and serum phosphorus levels of < 5 mg/dl. RESULTS 80 dialysis patients completed the study, 41 in the experimental group and 39 in the control group. After 6 months, phosphorus intake (702 ± 168 vs. 872 ± 242 mg/24 h; p = 0.002) was lower in the experimental group than in the control group, with no inter-group differences in protein-caloric intake. Serum phosphorus decreased 1.67 mg/dl in the experimental group and 0.58 mg/dl in the control group (multivariate-adjusted difference 0.93 mg/ dl; 95% CI 0.34 - 1.52; p = 0.003). Serum phosphorus < 5.5 mg/dl and serum phosphorus < 5 mg/dl were attained more frequently in the experimental group (51 vs. 18%, p = 0.002 and 31.7 vs. 15.4%, p = 0.08 respectively). CONCLUSIONS Intensive dietary intervention focusing on phosphorus intake may be useful to reduce phosphorus retention and to improve calcium-phosphorus metabolism in hemodialysis patients.

Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia.

Potential geological hazard assessment has been carried out in the area where the Prestige vessel was sunk using a broad database that comprises: multibeam, high and ultra-high resolution seismic profiles, gravity cores, onland seismicity stations and Ocean Bottom Seismometers (OBS). The main results of this study indicate that among the geologic factors that can be considered as potential hazards, four main categories can be differentiated based on their origin: morphologic, sedimentary, tectonic, and seismicity. Hazards of morphologic origin include steep gradients; the morphologic features suggest the occurrence of mass-wasting instabilities. Hazards of sedimentary origin also includes the occurrence of slope instability processes in form of single slides and a great variety of erosive and depositional gravity flows (debris and turbidity flows). Hazards of tectonic and seismic origin are important because the sinking area straddles the Calida Bank which is a structural seamount with a moderate tectonic activity that results in a latent seismicity of low to moderate magnitude. The interaction of these factors leads to consider to the risk as medium, and the degree of exposure of the bow and stern as high. Several general and specific recommendations are made in order to increase the geological and geophysics knowledgement in the Prestige sinking area and Spanish continental margins and deep sea areas. These recommendations also should be used to elaborate the options for reducing the hazard and loss.

Identificación de riesgos geoambientales y su valoración en la zona de hundimiento del buque Prestige

Aernnova developed a methodology for structural health monitoring (SHM) by use of multiple ultrasonic wave-based PAMELA SHM™ system wirelessly controlled. The possibility to perform automated NDT tests with no human presence required enables a large number of inspections and total test time reduction. The capability of this system to detect and characterize the effects on ultrasonic wave responses of several types of damages on different materials as metallic or composite structures is utmost importance for efficient and reliable SHM during structure life cycle. A study of this capability, tools descriptions, and damage detection results are presented in the paper, with the recommendations for future actions, aimed to make easier interpretation and identification of these structural damages. Several different damage detection methodologies and algorithms will be addressed attending to describe the advantages and particularities of each applied to both materials metallic and composites.

PAMELA SHM System Implementation on Composite Wing Panels

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Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia.

Identificación de riesgos geoambientales y su valoración en la zona de hundimiento del buque Prestige

PAMELA SHM System Implementation on Composite Wing Panels