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Abstract. It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development or progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance, 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) or 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis; the patients were randomized to receive epoetin ␣ as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 Ϯ 9 to 121 Ϯ 14 g/L, mean Ϯ SD) and decreased for group B (from 112 Ϯ 8 to 108 Ϯ 13 g/L) (P Ͻ 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 Ϯ 20 g/m 2 for group A versus 4.5 Ϯ 20 g/m 2 for group B, P ϭ NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 Ϯ 14 versus 138 Ϯ 13 mmHg) or diastolic BP (80 Ϯ 6 versus 79 Ϯ 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 Ϯ 9 versus 6 Ϯ 8 ml/min per 1.73 m 2 ). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function.Chronic kidney disease (CKD) is widespread in the community, with a prevalence far exceeding previous estimates (1). Many studies examining mortality and morbidity rates among patients with CKD have identified high rates of cardiovascular events. When even mild renal insufficiency is associated with other risk factors for cardiovascular disease, the risk of subsequent cardiovascular events is significantly increased (2-10). The effect of mild renal insufficiency (serum creatinine levels of Ͼ124 M) on cardiovascular risk is possibly also independent of other known risk factors and treatment (11)(12)(13)(14)(15). For patients established on dialysis, cardiovascular disease is responsible for up to 50% of the all-cause mortality rate (16,17). It is therefore important to attempt to reduce the incidence of cardiovascular events with risk factor modification before the onset of dialysis.Left ventricular (LV) hypertrophy (LVH) is recognized as a powerful independent predictor of death and morbidity in the dialysis population, together with anemia, hypertension, malnutrition, hyperparathyroidism, and an elevated calcium-phos-

Several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF), but no rigorous controlled evaluation has hitherto been performed. For comparing icodextrin and 4.25% dextrose during the long dwell of automated peritoneal dialysis, a multicenter, randomized, double-blind trial was conducted in 92 patients (control, 45; icodextrin, 47) with 4-h dialysate to plasma ratio creatinine >0.70 and D/D 0 glucose <0.34. Long-dwell net UF and the UF efficiency ratio (net UF volume per gram of dialysate carbohydrate absorbed) were determined at baseline, week 1, and week 2. The control and treatment groups were comparable at baseline (all patients using 4.25% dextrose for the long dwell) with regard to mean (؎SEM) net UF (201.7 ؎ 103.1 versus 141.6 ؎ 75.4 ml, respectively; P ‫؍‬ 0.637) and the percentage of patients with negative net UF (control, 37.8%; treatment, 42.6%; P ‫؍‬ 0.641). During the study period, net UF was unchanged from baseline in the control group but increased significantly (P < 0.001) in the icodextrin group from 141.6 ؎ 75.4 to 505.8 ؎ 46.8 ml at week 1 and 540.2 ؎ 46.8 ml at week 2. In the icodextrin group, the incidence of negative net UF was significantly lower (P < 0.0001) than in the control group. Findings were similar for UF efficiency ratio. Rash was reported significantly more often in the icodextrin group. This study showed that in high-average and high transporters, icodextrin is superior to 4.25% dextrose for long-dwell fluid and solute removal.

Four experiments investigated the role of imagery in the recollection of autobiographical memories. The first two experiments examined the effects of word imageability and word frequency on the retrieval of personal memories in a cued autobiographical memory task. They showed that the imageability of cues (but not frequency) mediates specificity in the recall of personal memories. Experiment 2 explored how different imagery modalities (visual, olfactory, tactile, auditory, and motor) influence autobiographical retrieval. Consistent with research on imagery modalities in verbal learning paradigms, visual imageability emerged as the most significant predictor of specificity. Experiments 3 and 4 examined how far a knowledge-based account of imagery effects might account for these effects, using predicability as a measure of semantic richness of a cue. Results found that visual imageability of cues accounted for more variance in specificity of recall than did predicability. The results are explained in terms of the way images represent the most efficient form of summarizing the information that can be used at each stage of the recollection process: setting the retrieval plan, strategic search, and evaluation of candidate episodes.

This study suggests that a single-dose protocol of Clexane is an effective and very convenient alternative to sodium heparin, but currently direct costs are about 16% more. We recommend an initial dose of 0.70 mg/kg.

Chronic kidney disease is now recognized to be a worldwide problem associated with significant morbidity and mortality and there is a steep increase in the number of patients reaching end-stage renal disease. In many parts of the world, the disease affects younger people without diabetes or hypertension. The costs to family and society can be enormous. Early recognition of CKD may help prevent disease progression and the subsequent decline in health and longevity. Surveillance programs for early CKD detection are beginning to be implemented in a few countries. In this article, we will focus on the challenges and successes of these programs with the hope that their eventual and widespread use will reduce the complications, deaths, disabilities, and economic burdens associated with CKD worldwide.

The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research. Implications for Rehabilitation The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities. Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches. Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately. Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

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