In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.
IntroductionAdults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the “DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study,” a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries.Methods and analysisDIET-HD will recruit approximately 10 000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA2LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation.Ethics and disseminationThe study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.
Summary
Aerobic capacity and fitness was studied in three different horse breeds (Andalusian, Arabian and Anglo‐Arabian) using a four‐level exercise test of gradually increasing intensity (15, 20, 25 and 30 km/h). The lactate concentration at the first three exercise levels was significantly lower for Arabian and Anglo‐Arabian horses relative to Andalusian horses, but similar for the three breeds at the last level. Arabian and Anglo‐Arabian horses reached a higher rate than Andalusian horses at plasma lactate concentration of 2 mmol/l (VLA2) and 4 mmol/l (VLA4).
Andalusian horses exhibited a significantly lower heart rate at rest than the other two breeds, but the differences virtually disappeared at 15 km/h. At 20 km/h, Andalusian horses reached a higher heart rate than Arabian and Anglo‐Arabian horses; at 25 km/h, however, their heart rate only exceeded that of Anglo‐Arabian horses. Finally, no significant differences between breeds were observed at 30 km/h.
No differences between breeds as regards heart rate were found if this was expressed as a function of lactate plasma concentrations of 2 mmol/l (HRLA2) and 4 mmol/l (HRLA4). At a heart rate of 150 (VHR150) and 200 beat/min (VHR200), Andalusian horses achieved the lowest speeds.
A 28-year-old woman was referred to closure of a residual shunt produced through a percutaneous device previously implanted in the atrial septum. The imaging protocol to guide the procedure included 2D TEE and real time 3D (RT3D) transesophageal echocardiography (TEE) imaging. RT3D TEE facilitated the evaluation of the defect morphology, and the relationship with the previous device, allowing a proper understanding of the mechanism responsible for the residual shunt. It was also a useful tool for guiding device deployment, providing clear intraprocedural information about catheter position and the spatial relationship with the previous device. In conclusion, RT3D TEE and 2D TEE are complementary techniques for the evaluation and guidance of transcatheter closure of complex atrial septal defects.
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