In patients with generalized vasculitis, the withdrawal of cyclophosphamide and the substitution of azathioprine after remission did not increase the rate of relapse. Thus, the duration of exposure to cyclophosphamide may be safely reduced.

Interdialytic hemodialysis catheter-locking solutions could contribute to a reduction of catheter-related complications, especially infections. However, they can cause side effects because of leakage from the tip of the catheter. Recently, trisodium citrate (TSC) has been advocated because of its antimicrobial properties and local anticoagulation. In a multicenter, doubleblind, randomized, controlled trial, TSC 30% was compared with unfractionated heparin 5000 U/ml for prevention of catheter-related infections, thrombosis, and bleeding complications. The study was stopped prematurely because of a difference in catheter-related bacteremia (CRB; P < 0.01). Of 363 eligible patients, 291 could be randomized. The study included 98 tunneled cuffed catheters and 193 untunneled. There were no significant differences in patient and catheter characteristics on inclusion. In the heparin group, 46% of catheters had to be removed because of any complication compared with 28% in the TSC group (P ‫؍‬ 0.005). CRB rates were 1.1 per 1000 catheter-days for TSC versus 4.1 in the heparin group (P < 0.001). For tunneled cuffed catheters, the risk reduction for CRB was 87% (P < 0.001) and for untunneled catheters was 64% (P ‫؍‬ 0.05). Fewer patients died from CRB in the TSC group (0 versus 5; P ‫؍‬ 0.028). There were no differences in catheter flow problems and thrombosis (P ‫؍‬ 0.75). No serious adverse events were encountered. Major bleeding episodes were significantly lower in the TSC group (P ‫؍‬ 0.010). TSC 30% improves overall patency rates and reduces catheter-related infections and major bleeding episodes for both tunneled and untunneled hemodialysis catheters. Flow problems are not reduced.

A self-administered health-assessment questionnaire (HAQ) was completed by 38 Dutch rheumatoid arthritis (RA) patients and the results compared to those obtained objectively when the same subjects were interviewed and asked to perform standardised tasks included in the HAQ. The results of the interview and the questionnaire showed a high degree of overall correlation and inter-component correlation. The correlation was comparable in outpatients with milder disease and in patients with more severe disease and was not influenced by age. The questionnaire offers a valid approach to the assessment of the functional disability of RA patients.

The conceptual framework finds support in transition psychology and notions from organizational socialization literature. It provides insight into the transition from resident to attending physician that can inform measures to smooth the intense transition.

Objectives-Antibodies against Clq (CIqAb)

Both HADS and BDI are valid screening instruments for the diagnosis depression in ESRD patients but there is no statistical difference found between both rating scales.

These findings illustrate the relevance of generic competencies for new hospital consultants. Furthermore, social support facilitates this intense and stressful stage within the medical career.

BackgroundDepressive symptoms have been reported to be associated with adverse clinical outcome in patients with chronic kidney disease (CKD) not on dialysis. This association has not been examined in Europe. Anxiety and depressive symptoms often co-occur. However, as yet there are no data concerning a possible association of anxiety symptoms with adverse clinical outcome. We examined the association of depressive and anxiety symptoms with adverse clinical outcome in Dutch CKD patients not on dialysis.MethodsIn this 3-year follow-up prospective cohort study, CKD patients not on dialysis with an estimated glomerular filtration rate (eGFR) ≤ 35 ml/min/1.73 m2 from an urban teaching hospital were selected. Symptoms of depression and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Cox proportional hazards models were used to calculate hazard ratio’s (HRs) with a composite event of death, initiation of dialysis, and hospitalization as outcome. HRs were adjusted for age, gender, diabetes, cardiovascular disease and eGFR.ResultsOf 100 included CKD patients depressive and anxiety symptoms were present in 34 and 31 %, respectively. Adjusted HRs for the composite event for patients with depressive and anxiety symptoms were 2.0 (95 % confidence interval (CI) 1.2–3.5) and 1.6 (95 % CI 0.9–2.7), respectively. Twenty three patients had both depressive and anxiety symptoms of whom adjusted HRs were 2.2 (95 % CI 1.2–4.0) for a composite event.ConclusionsDepressive and anxiety symptoms are common in patients with CKD in The Netherlands. Depressive symptoms are associated with an increased risk of poor clinical outcome. Anxiety symptoms show a trend for an increased risk of poor clinical outcome. There seems to be no additive effect of anxiety symptoms in addition to depressive symptoms with regard to poor clinical outcome.