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Estimation of kidney function is often part of daily clinical practice, mostly done by using the endogenous GFR-markers creatinine or cystatin C. A recommendation to use both markers in parallel in 2010 has resulted in new knowledge concerning the pathophysiology of kidney disorders by identification of a new set of kidney disorders, selective glomerular hypofiltration syndromes. These syndromes, connected to strong increases in mortality and morbidity, are characterised by a selective reduction in the glomerular filtration of 5-30 kDa molecules, such as cystatin C, compared to the filtration of small molecules < 1kDa dominating the glomerular filtrate e.g., water, urea, creatinine. At least two types of such disorders, shrunken or elongated pore syndrome, are possible according to the pore model for glomerular filtration. Selective glomerular hypofiltration syndromes are prevalent in investigated populations, and patients with these syndromes often display normal measured GFR or creatinine-based GFR-estimates. The syndromes are characterised by proteomic changes promoting the development of atherosclerosis, indicating antibodies and specific receptor-blocking substances as possible new treatment modalities. Presently, the KDIGO guidelines for diagnosing kidney disorders do not recommend cystatin C as a general marker of kidney function and will therefore not allow the identification of a considerable number of patients with selective glomerular hypofiltration syndromes. Furthermore, as cystatin C is uninfluenced by muscle mass, diet or variations in tubular secretion and cystatin C-based GFR-estimation equations do not require controversial race or sex terms, it is obvious that cystatin C should be a part of future KDIGO guidelines.

A pathophysiological classification of membrane dysfunction, which provides mechanistic links to functional characteristics, should be used when prescribing individualized dialysis or when planning modality transfer (e.g. to automated peritoneal dialysis (PD) or haemodialysis) in the context of shared and informed decision-making with the person on PD, taking individual circumstances and treatment goals into account. (). It is recommended that the PSTR is determined from a 4-h peritoneal equilibration test (PET), using either 2.5%/2.27% or 4.25%/3.86% dextrose/glucose concentration and creatinine as the index solute. () This should be done early in the course dialysis treatment (between 6 weeks and 12 weeks) () and subsequently when clinically indicated. (). A faster PSTR is associated with lower survival on PD. () This risk is in part due to the lower ultrafiltration (UF) and increased net fluid reabsorption that occurs when the PSTR is above the average value. The resulting lower net UF can be avoided by shortening glucose-based exchanges, using a polyglucose solution (icodextrin), and/or prescribing higher glucose concentrations. () Compared to glucose, use of icodextrin can translate into improved fluid status and fewer episodes of fluid overload. () Use of automated PD and icodextrin may mitigate the mortality risk associated with fast PSTR. (). UF This is easy to measure and a valuable screening test. Insufficient UF should be suspected when either (a) the net UF from a 4-h PET is <400 ml (3.86% glucose/4.25% dextrose) or <100 ml (2.27% glucose /2.5% dextrose), () and/or (b) the daily UF is insufficient to maintain adequate fluid status. () Besides membrane dysfunction, low UF capacity can also result from mechanical problems, leaks or increased fluid absorption across the peritoneal membrane not explained by fast PSTR. Diagnosing intrinsic membrane dysfunction (manifesting as low osmotic conductance to glucose) as a cause of UF insufficiency: When insufficien

Att lyckas behålla anställda har blivit en alltmer vanlig fråga för arbetsgivare i och med en förändrad arbetsmarknad med hög konkurrens, och en för hög omsättning av personal kan få stora konsekvenser för ett företag. En bransch som länge präglats av hög personalomsättning är revisionsbranschen, och trots att tidigare studier har gjorts för att hitta anledningar till detta är det fortfarande ett omtalat problem, och revisionsbyråerna arbetar ständigt med att få sina anställda att stanna kvar på företagen, inte minst Big Four företagen. Employer branding, och främst intern employer branding, har visat sig ha en påverkan på personalomsättning eftersom det kan leda till att anställda väljer att stanna kvar på företagen. Revisionsföretagen har fortfarande problem med hög personalomsättningen och ännu har inte intern employer branding undersökts i revisionsbranschen. Syftet med studien är att skapa förståelse för vad Big Four företagen kan förbättra i sitt arbete med intern employer branding för att minska personalomsättningen. Studien är en fenomenologisk flerfallstudie av kvalitativ karaktär där empirin har samlats in genom semistrukturerade intervjuer med nuvarande och tidigare anställda från de fyra största revisionsföretagen, Big Four. Den abduktiva ansatsen har möjliggjort en djupare förståelse av fenomenet då empirin och teorin under studiens gång har utvecklats och bearbetats för att nå fram till tydliga resultat. Studiens resultat redogör för vad som kan förbättras inom Big Four företagens interna employer branding arbete för att minska personalomsättningen. Dessa förbättringar är bland annat; skapa ett unik employer brand, ta hänsyn till individuell utveckling och att arbetsuppgifter ska vara intressanta över tid. Flera exempel på förbättringsmöjligheter är mer detaljerad feedback, att anställda ska bli mer bekanta med företagspolicys och att anställda ska få ökad förståelse för hur de bidrar till företagens organisatoriska mål., Success in retaining employees has become an increasingly common issue for employers as a result of a changing labor market with high competition, and too high a turnover of employees can have major consequences for a company. An industry that has long been characterized by high employee turnover is the audit industry, and although previous studies have been done to find reasons for this it is still a stated problem, and the accounting firms are constantly working to get their employees to stay at the companies, not least the Big Four companies. Employer branding, and in particular internal employer branding, has been shown to have an impact on employee turnover, as it can lead to employees choosing to stay with the companies. The audit firms still have problems with high employee turnover and internal employer branding has not yet been investigated in the audit industry. The study aims to create an understanding of what the Big Four companies can improve in their work with internal employer branding to reduce employee turnover. The study is a phenomenological multi-case study of a qualitative nature where the empirical data were collected through semi-structured interviews with employees and former employees of the four largest audit firms, the Big Four. The abductive approach has allowed a deeper understanding of the phenomenon as the theory and the empirical data has been developed and processed throughout the study to achieve clear results. The result of the study describe what can be improved within the Big Four companies' work with internal employer branding to reduce employee turnover. These improvements include; create a unique employer brand, take individual development into account and make work tasks interesting over time. Further examples of opportunities for improvement are more detailed feedback, that employees should become more familiar with company policies and that employees should gain a greater understanding of how they contribute to corporate or

INTRODUCTION: The osmotic conductance to glucose (OCG) is a crucial determinant of ultrafiltration (UF) in peritoneal dialysis (PD) patients and can be used to monitor membrane integrity in patients on long-term PD. It has been proposed that OCG can be assessed based on drained volumes in 2 consecutive 1-hour glucose dwells, usually 1.5% and 4.25% glucose, in a so-called double mini-peritoneal equilibration test (dm-PET). However, recent data indicated that the dm-PET provides a poor estimate of OCG unless the residual volume (RV) is taken into account. We introduce an easy, robust, and accurate method to measure OCG and compare it with conventional methods. METHODS: In a prospective cohort of 21 PD patients, a modified version of the dm-PET was performed, along with the determination of RV before, between, and after dwells. Based on computer simulations derived from the 3-pore model (TPM) for membrane permeability, we developed and validated a novel single-dwell method to estimate OCG. We next validated the equation in an independent cohort consisting of 32 PD patients. RESULTS: Single-dwell OCG correlated more closely with actual UF (r = 0.94 vs. r = 0.07 for conventional dm-PET), sodium sieving, and free water transport (FWT) compared with other methods. These findings were replicated in the validation cohort in which OCG calculated using the single-dwell method closely correlated with parameters of osmotic water transport, even when RV was not taken into account, using only drained volumes. CONCLUSION: We propose a novel, easy, and robust single-dwell method to determine OCG in individual patients and to monitor membrane integrity over time on PD.