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The UV absorption spectrum of all-trans-octatetraene is reinvestigated theoretically, focussing on the strongly dipole-allowed 1 A g – 1 B u transition. The dynamical calculations rely on ab initio multistate CASPT2 (MS-CASPT2) computations of the underlying potential energy surfaces and coupling elements, and the multiconfiguration time-dependent Hartree (MCTDH) method for solving the time-dependent Schrödinger equation for the nuclear motion. The vibronic structure of the absorption band near 2700 Å is well reproduced, better than ever before by a purely ab initio approach. The C–C single bond and C = C double bond stretching modes dominate the vibrational structure of the transition. While the latter resembles nearly harmonic motion on weakly coupled potential energy surfaces, the time-dependent calculations reveal a subpicosecond electronic population transfer from the 1 B u state to the lower-lying 2 A g state proceeding on a time scale of ∼ 50 fs . The details of this internal conversion process and its relation to the conical intersection between the two excited states are discussed, paying particular attention to the impact of the 1 B u – 2 A g energy gap on the dynamics. [ABSTRACT FROM AUTHOR]

Purpose: Mortality among first-year hemodialysis (HD) patients remains unacceptably high. To address this problem, we estimate the proportions of early HD deaths that are potentially preventable by modifying known risk factors. Methods: We included 15,891 HD patients (within 60 days of starting HD) from 21 countries in the Dialysis Outcomes and Practice Patterns Study (1996– 2015), a prospective cohort study. Using Cox regression adjusted for potential confounders, we estimated the fraction of first-year deaths attributable to one or more of twelve modifiable risk factors (the population attributable fraction, AF) identified from the published literature by comparing predicted survival based on risk factors observed vs counterfactually set to reference levels. Results: The highest AFs were for catheter use (22%), albumin < 3.5 g/dL (19%), and creatinine < 6 mg/dL (12%). AFs were 5%-9% for no pre-HD nephrology care, no residual urine volume, systolic blood pressure < 130 or ≥ 160 mm Hg, phosphorus < 3.5 or ≥ 5.5 mg/dL, hemoglobin < 10 or ≥ 12 g/dL, and white blood cell count > 10,000/μL. AFs for ferritin, calcium, and PTH were < 3%. Overall, 65% (95% CI: 59%-71%) of deaths were attributable to these 12 risk factors. Additionally, the AF for C-reactive protein > 10 mg/L was 21% in facilities where it was routinely measured. Conclusion: A substantial proportion of first-year HD deaths could be prevented by successfully modifying a few risk factors. Highest priorities should be decreasing catheter use and limiting malnutrition/inflammation whenever possible. [ABSTRACT FROM AUTHOR]

Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field. Innovations and research in this area will be pivotal in further promoting a higher acceptance rate of home HD as the renal replacement therapy of choice. [ABSTRACT FROM AUTHOR]

Patient selection and training is arguably the most important step toward building a successful home hemodialysis ( HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field. Innovations and research in this area will be pivotal in further promoting a higher acceptance rate of home HD as the renal replacement therapy of choice. [ABSTRACT FROM AUTHOR]

Background The relationship between severity of depressive symptoms reported by incident dialysis patients and first-year outcomes is not known. Methods We evaluated the association between self-report of depressive symptoms in incident hemodialysis patients admitted at Fresenius Medical Care North America facilities between 1 January and 31 December 2006 and mortality or withdrawal from dialysis for up to 1 year after the initial survey. The impact of depression scores calculated from two Short Form-36 (SF-36) questionnaires was determined independently of the mental and physical component scores, case-mix and laboratory variables using stepwise Cox models. Results We received 6415 SF-36 responses within 46 ± 24 days of first dialysis from a cohort with a mean age of 62.3 ± 15.2 years; 58% were diabetic, 45% were female and 69% were Caucasian. A 1-point increase in depression score was associated with unadjusted hazard ratio (HR) of 1.09 (1.03, 1.15) for mortality and 1.15 (1.05, 1.26) for withdrawal from dialysis. After adjustment, a 1-point increase in depression score had a mortality HR of 1.08 (1.01, 1.14) and for withdrawal 1.19 (1.08, 1.31). Conclusions Depressive symptoms reported within the first 90 days of dialysis were associated with greater dialysis withdrawal and mortality risk over the succeeding year. Whether further evaluation for and treatment of depression during this early vulnerable period may improve symptoms, increase survival and decrease premature withdrawal from dialysis requires confirmation in prospective clinical trials. [ABSTRACT FROM PUBLISHER]

The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to study practices and outcomes associated with the use of hemodialysis (HD) regimens of increased frequency and/or duration. The IQDR grew out of the initiative that lead to the randomized prospective studies of nocturnal HD and short hours daily dialysis vs. conventional thrice weekly HD that are conducted by the Frequent Hemodialysis Network sponsored by the National Institutes of Health. These 2 separate studies are drawing to a close and the first results are expected to be reported later this year. These studies use surrogate outcomes for their primary endpoints as they are not powered to look at outcomes of mortality and hospitalization. The IQDR attempts to aggregate long-term follow-up data from centers utilizing alternative HD regimens worldwide and will have adequate statistical power to examine those important outcomes. To date, the IQDR has enrolled patients from Canada, the United States, Australia, New Zealand, and France and has linked with commercial databases and national registries. This sixth annual report of the IQDR describes: (1) An update on the governance structure; (2) The recommendations made at the first general meetings of the IQDR Scientific Committee and Advisory Board; (3) The status of those recommendations; (4) A summary of current data sources and participating registries; (5) The status of recruitment to date; (6) The creation of a specific Canadian IQDR data set and; (7) The current research agenda. [ABSTRACT FROM AUTHOR]

The International Quotidian Dialysis Registry (IQDR) is a global initiative designed to study practices and outcomes associated with the use of hemodialysis regimens of increased frequency and/or duration. Several small studies suggest that compared with conventional hemodialysis (HD), short-daily, nocturnal, and long conventional HD regimens may improve surrogate endpoints and quality of life. However, methodologically robust comparisons on hard outcomes are sorely lacking. The IQDR represents the first-ever attempt to aggregate long-term follow-up data from centers utilizing alternative HD regimens worldwide, and will have adequate statistical power to examine the effects of these regimens on multiple clinical endpoints, including mortality. To date, the IQDR has enrolled patients from Canada, the United States, Australia, and New Zealand, with plans in place to begin linking with additional commercial databases and national registries. This fifth annual report of the IQDR describes (1) a proposed governance structure that will facilitate international collaboration, stakeholder input and funding; (2) data sources and participating registries; (3) recruitment to date and patient baseline characteristics; and (4) an agenda for future research. [ABSTRACT FROM AUTHOR]

Alternative hemodialysis (HD) schedules, including short-daily and nocturnal HD, continue to proliferate, with the hope of offering improved patient outcomes. Three nights per week and every other night, nocturnal HD are now being provided to more patients worldwide, both at home and in-center. However, alternative HD schedules are still experimental in most centers, and studies establishing the efficacy of these therapies with respect to major clinical outcomes are needed. Endorsed by the National Institutes of Health, the International Quotidian Dialysis Registry is an international collaboration that was established in 2002 to prospectively study large numbers of patients treated with alternate HD schedules. The Registry will ultimately allow alternate HD modalities to be compared to conventional thrice-weekly HD with respect to clinical endpoints, including mortality, using a prospective cohort study. To date, the Registry has enrolled 182, 1193, and 740 subjects from Canada, the United States, and Australia, respectively. This report is the fourth annual update and describes recruitment progress, baseline characteristics of enrolled patients, and worldwide prescription patterns. [ABSTRACT FROM AUTHOR]

Biomarkers of inflammation, especially C-reactive protein (CRP), have been consistently shown to predict poor outcomes in chronic hemodialysis (CHD) patients. However, the determinants of CRP and the value of its monitoring in CHD patients have not been well defined. We conducted a retrospective cohort study to evaluate possible determinants of the inflammatory response in CHD patients with a focus on dialysis catheter utilization. Monthly CRP were measured in 128 prevalent CHD patients (mean age 56.6 years [range 19–90], 68% African Americans, 39% diabetics [DM]) over a mean follow-up of 12 months (range 2–26 months). There were a total of 2405 CRP measurements (median 5.7 mg/L; interquartile range [IQR] 2.4–16.6 mg/L). The presence of a dialysis catheter (p<0.002), cardiovascular disease (p=0.01), male gender (p=0.005), higher white blood cell count (p<0.0001), elevated phosphorus (p=0.03), and lower cholesterol (p=0.02) and albumin (p<0.0001) concentrations were independent predictors of elevated CRP in the multivariate analysis. Additionally, CRP levels were significantly associated with the presence of a catheter, when comparing the levels before and after catheter insertion (p=0.002) as well as before and after catheter removal (p=0.009). Our results indicate that the presence of a hemodialysis catheter is an independent determinant of an exaggerated inflammatory response in CHD patients representing a potentially modifiable risk factor. [ABSTRACT FROM AUTHOR]

The role of the dialysis unit Medical Director has evolved over time to an expanded set of roles from one that used to be strictly “medical” to one that is more “managerial.” Physicians providing these Medical Director services are facing increasing demands for a leadership role regarding clinical quality improvement and measurement of performance in core areas of care within the dialysis program. The dialysis Medical Director is asked to lead in group decision-making, in analyzing core process and patient outcomes and in stimulating a team approach to Continuous Quality Improvement (CQI) and patient safety. For the end-stage renal disease program, national quality expectations in dialysis care have stimulated the dialysis providers to measure, report and respond consistently in an effort to provide a higher level of cost-efficient care. Medical Directors are usually contractually linked to the dialysis programs for which they provide oversight and their contracts are explicit about the relationship they maintain and the role they are expected to play within dialysis companies (often called “provider organizations”). The evolution of the Medical Director role has led to a close relationship between the company that provides the dialysis services and the physician providing the medical oversight. [ABSTRACT FROM AUTHOR]

Suggests possible ways to enhance the partnership between the United States Centers for Disease Control and Prevention (CDC) and the dialysis community. Consolidation of dialysis-related recommendations of the CDC; Designation of representatives from dialysis providers to the infection control contact for the CDC.

Examines angiotensin-converting enzyme inhibitors in hemodialysis membranes. Acute reactions to cellulosic membranes; Pathogenesis of PAN-Associated anaphylactoid reaction; Clinical features of membrane-induced reactions associated ACE-I; Prevention and treatment of anaphylactoid reactions.

The authors discuss the reasons why they believe that increased research investments are an integral step in helping reduce the public health burden of kidney disease as of 2016, and it mentions how chronic kidney disease (CKD) is a growing public health problem in the U.S. According to the article, more than 20 million Americans have CKD which can lead to end-stage renal disease. U.S. federal expenditures for kidney disease treatment are examined, along with CKD treatment costs.

Presents a letter to the editor regarding a previously published article which discussed findings that hemodialysis care in private not-for-profit centers was associated with a lower risk of mortality. Number of studies the authors excluded in their report.

Use of intradialytic oral nutritional supplements (ONS) improve nutritional biomarkers but an association with hospitalization risk is unexplored. We evaluated hospitalization events from all causes (HOS), comparing patients with serum albumin ≤3.5 g/dL who received monitored ONS (at no patient cost) during chronic outpatient hemodialysis (HD) as part of a standardized national program in Fresenius Medical Care, North America facilities, with eligible patients who did not receive ONS (controls). Study enrolment covered Q4‐2009 and follow‐up was until 12/31/10. Patients who received ONS outside of the program or started during 2010 were excluded. Two protein bars and two liquid formulations of ONS options were offered – – which were available until albumin was ≥ 4.0 g/dL. Overall, HOS was lower in the ONS group (N= 7,264) at 2.5 vs. 2.7 episodes/pt‐year for controls (N= 13,853), p<0.001. The unadjusted time to 1st HOS hazard ratio for ONS was 0.92 (0.88, 0.95) and after adjustment for baseline case‐mix, HOS 30‐days prior to study entry, and 5 HD quality indicators was 0.93 (0.90, 0.96). Although limited by the observational design, these results indicate lower HOS associated with ONS use in malnourished chronic HD patients with albumin ≤3.5 g/dL. [ABSTRACT FROM AUTHOR]

Use of intradialytic oral nutritional supplements (ONS) improve nutritional biomarkers but an association with survival has not been proven. We evaluated mortality, comparing patients with serum albumin ≤3.5 g/dL who received monitored ONS (at no patient cost) during chronic outpatient hemodialysis (HD) as part of a standardized national program in Fresenius Medical Care, North America facilities, with eligible patients who did not receive ONS (controls). Participation was promoted but not mandatory. Study enrolment covered Q4‐2009 and follow‐up was until 12/31/10. Patients who received ONS outside of the program or started during 2010 were excluded. Two protein bars and two liquid formulations of ONS options were offered, which were available until albumin was ≥ 4.0 g/dL. Crude mortality in the ONS group (N= 7,264) was 29.4% vs. 36.6% for controls (N= 13,853), p<0.001. Compared to controls, the unadjusted mortality hazard ratio for ONS was 0.70 (0.67, 0.74) and after adjustment for baseline case‐mix and 5 quality indicators was 0.68 (0.64, 0.71). Although limited by the observational design, these results indicate favorable survival associated with ONS use in malnourished chronic HD patients with albumin ≤3.5 g/dL. [ABSTRACT FROM AUTHOR]

We hypothesized that glycosylated hemoglobin (HghA1c) that is averaged for a period of 1 year is relatively stable within hemodialysis (HD) patients and maintains a good correlation with the yearlong averaged random pre-dialysis blood glucose. HD patients in the database of a large dialysis organization with a diagnosis of diabetes and ≥3 HgbA1c results during 2002 who were present from Jan. 1, 2003 to Jan. 1, 2004 formed the study cohort. All available HgbA1c values and pre-dialysis blood glucose measurements were included in computing the averages. There were 18, 867 patients with mean age 63.9 ± 12 years, 52% female, 51% white and 39% black, 90% type 2 diabetes, with mean HgbA1c 6.8 ± 1.5% (median 6.5%) and mean glucose 169 ± 68 mg/dL (median 156 mg/dL). The distribution of the standard deviations (SD) of the HgbA1c in individual patients is shown below. Eighteen percent of patients had HghA1c SD > 1%. The association with random pre-dialysis blood glucose averaged over 1 year is R=0.68 (p < 0.001). The HgbA1c appears stable over the course of the year for most patients with median HgbA1c SD at 0.5%. The prognostic significance of high vs. low HgbA1c variability remains to be determined. [ABSTRACT FROM AUTHOR]

Reports that hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Examination of the potential effects of hemodialysis on energy metabolism; Increase in muscle protein proteolysis due to hemodialysis; Alteration in substrate oxidation during post-hemodialysis with diminished carbohydrate.