By R. Malir. Kennesaw State University. 2018.
Both the glom erular filtration rate (GFR) and effective renal plas- ↑ Renin m a flow (ERPF) increase by 50% minomycin 100mg low cost. ERPF probably increases to a greater extent generic minomycin 100mg mastercard, and thus discount 100mg minomycin mastercard, the filtration fraction is decreased during early and m id pregnancy. M icropuncture studies perform ed in ani- m als suggest the basis for the increase in GFR is prim arily the increase in glom erular plasm a flow. The average creatinine level and urea nitrogen concentration are slightly lower than in pregnant Renal vasodilation ↑ Aldosterone wom en than in those who are not pregnant (0. The increased filtered load also results in ↑ Renal blood flow ↑ W ater reabsorption increased urinary protein excretion, glucosuria, and am inoaciduria. H ypercalciuria is a result of increased GFR and of increases in circulating 1,25-dihydroxy-vitam in D3 in pregnancy (absorptive hypercalciuria). The renin-angiotensin system is stim u- lated during gestation, and cum ulative retention of approxim ately 950 m Eq of sodium occurs. This sodium retention results from a com plex interplay between natriuretic and antinatriuretic stim uli present during gestation. A, During norm al gestation, serum ↓ Serum sodium and ↓ Posm unchanged compared with + osmolality decreases by 10 mosm/L and serum sodium (Na ) decreases with ↓ Osmotic Threshold women who are not pregnant by 5 m Eq/L. A resetting of the osm oreceptor system occurs, with for the argenine vasopressin release and thirst decreased osm otic thresholds for both thirst and vasopressin release. B, Serum chloride (Cl-) levels essentially are unchanged during pregnancy. C, Despite significant increases in aldosterone levels + - during pregnancy, in most women serum potassium (K+) levels are Na Cl 136 mEq/L 104 mEq/L either norm al or, on average, 0. K HCO3 D, Arterial pH is slightly increased in pregnancy owing to m ild respiratory alkalosis. The hyperventilation is believed to be an effect of progesterone. Plasma bicarbonate (HCO- ) concentrations 3 C M ild hypokalemia may be D M ild respiratory alkalosis is decrease by about 4 m Eq/L. N orm al pregnancy is associated with profound alterations in B, Despite the decrease in blood pressure, plasm a renin activity cardiovascular and renal physiology. These alterations are (PRA) increases during the first few weeks of pregnancy; on accom panied by striking adjustm ents of the renin-angiotensin- average, close to a fourfold increase in PRA occurs by the end of aldosterone system. A, Blood pressure and peripheral vascular the first trim ester, with additional increases until at least 20 resistance decrease during norm al gestation. The source of the increased renin is thought to be the blood pressure is apparent by the end of the first trim ester of m aternal renal release of renin. Although a correlation exists aldosterone, which m ay reflect an increased production of the between the increase in renin and that of aldosterone, the latter 3-oxo conjugate m easured in urine. D, Despite the m arked increas- increases to a greater degree in late pregnancy. This observation es in aldosterone during pregnancy, 24-hour urinary sodium and suggests that other factors may regulate secretion to a greater degree potassium excretion rem ain in the norm al range. Urinary aldosterone (From W ilson and coworkers; with perm ission. W e determ ine whether changes in the RAS in pregnancy are prim ary, and the cause of the increase in plasm a vol- 80 20 um e, or whether these changes are secondary to the vasodilation and changes in blood pressure. To do so, we adm inistered a single 75 15 * dose of captopril to norm otensive pregnant wom en in their first P <. W e then m easured m ean arterial pressure (M AP) P < 0. This observation suggests that the A B RAS plays a greater role in supporting blood pressure in pregnan- cy. B, Baseline PRA was higher in pregnant wom en com pared with those who were not pregnant, and pregnant wom en had a greater increase in renin after captopril com pared with those who were not pregnant. Som e wom en PREGNANCY AND RENAL DISEASE with intrinsic renal disease, particularly those with baseline azotemia and hypertension, suffer m ore rapid deterioration in renal function after gestation. In general, as kidney disease progresses and function Impact of pregnancy on renal disease Impact of renal disease on pregnancy deteriorates, the ability to sustain a healthy pregnancy decreases. The Hemodynamic changes → hyperfiltration Increased risk of preeclampsia presence of hypertension greatly increases the likelihood of renal deterioration. Although hyperfiltration (increased glom erular Increased proteinuria Increased incidence of prematurity, intrauterine growth retardation filtration rate) is a feature of norm al pregnancy, increased intra- Intercurrent pregnancy-related illness, eg, preeclampsia glom erular pressure is not a m ajor concern because the filtration Possibility of permanent loss fraction decreases. Possible factors related to the pregnancy-related of renal function deterioration in renal function include the gestational increase in proteinuria and intercurrent pregnancy-related illnesses, such as preeclam psia, that m ight cause irreversible loss of renal function. W om en with renal disease are at greater risk for com plications related to pregnancy such as preeclam psia, prem ature delivery, and intrauterine growth retardation. Diabetes M ellitus and Pregnancy FIGURE 10-7 RENAL DISEASE CAUSED Diabetes mellitus is a common disorder in pregnant women. Patients with overt nephropathy BY SYSTEM IC ILLNESS are likely to develop increased proteinuria and m ild but usually reversible deteriorations in renal function during pregnancy. H ypertension is com m on, and preeclam psia occurs in 35% of wom en. Pregnancies in women with evidence Pregnancy and SLE* Antiphospholipid antibody syndrome in pregnancy of nephritis are potentially hazardous, partic- ularly if active disease is present at the time Poor outcome is associated with the following: Increased fetal loss of conception or if the disease first develops Active disease at conception Arterial and venous thromboses during pregnancy. W hen hypertension and Disease first appearing during pregnancy Renal vasculitis, thrombotic microangiopathy azotemia are present at the time of concep- Hypertension, azotemia in the first trimester Preeclampsia tion the risk of complications increases, as it High titers of antiphospholipid antibodies or Treatment: heparin and aspirin? The lupus anticoagulant presence of high titers of antiphospholipid antibodies also is associated with poor preg- *Systemic lupus erythematosus (SLE) is unpredictable during pregnancy. The presence of anti- phospholipid antibodies or the lupus anti- coagulant is associated with increased fetal loss, particularly in the second trim ester; increased risk of arterial and venous throm - bosis; m anifestations of vasculitis such as throm botic m icroangiopathy; and an increased risk of preeclam psia.
It complicates the hospital stays of 20% of the people over the age of 65 years cheap minomycin 100 mg fast delivery, and is found in up to 87% of older patients in intensive care wards (Pisani et al buy minomycin 100mg free shipping, 2003) purchase minomycin 100mg without a prescription. Disturbance of attention (reduced ability to focus, sustain, or shift attention). Develops over a short time (hours or a few days) – a change from baseline attention and awareness, fluctuates in severity in the course of a day. An additional disturbance in cognition (such as memory deficit, disorientation, language disturbance). Sub-types of delirium Three clinical subtypes of delirium, based on arousal and psychomotor behaviour are described (Trezepacz et al, 1999) 1. Hyperactive (hyperaroused, hyperalert, or agitated) 2. Hypoactive (hypoaroused, hypoalert, or lethargic) 3. Mixed (alternating features of hyperactive and hypoactive types) Pridmore S. Last modified: January, 2018 2 Hyperactive symptoms Hypoactive symptoms Hypervigilance Unawareness Restlessness Decreased alertness Fast or loud speech Lethargy Irritability Slowed movements Combativeness Staring Impatience Apathy Swearing Singing Laughing Uncooperativeness Euphoria Anger Wandering Easy startling Fast motor responses Distractibility Tangentiality Nightmares Persistent thoughts While the “classic” presentation of delirium is considered to be the wildly agitated patient, the hyperactive type represents only about 25% of cases. Over half all delirious patients have the hypoactive “quite” type. These people attract less attention and may pass undiagnosed - this (hypoactive) type has the poorer prognosis. Another “classic” feature is widely believed to be “sundowning”, by which is meant, the mental status deteriorates in the evening. Recent work, however, demonstrated that more symptoms were demonstrated in the morning (47%) than in the afternoon, evening and night (37%). Confusion Assessment Method (CAM) CAM (Inouye et al, 1990) is a remarkable instrument – it is a brief structured assessment - with a sensitivity of 94%, a specificity of 89%, and moderate-to-high inter-rater reliability. The diagnosis of delirium by CAM requires the presence of features 1 and 2 and either 3 or 4. Does the (abnormal) behaviour fluctuate during the day, that is, does it tend to come and go or increase or decrease in severity? Inattention This feature is shown by a positive response to the following question: Does the patient have difficulty focusing attention such as are they easily distracted or do they have difficulty keeping track of what is being said? I the conversation rambling or incoherent, unclear with an illogical flow of ideas or unpredictable switching from one subject to another? Rudolph & Marcantonio (2003) make the point that this test requires more calculation skill than attention. Accordingly, they recommend the following: • Days of the week backwards • Months of the year backwards • Digit span (forwards and backwards) • Spell “world” backwards • Trailmaking test A Predisposing and precipitating factors Delirium is a difficult topic, both theoretically and clinically. A list of predisposing and precipitating factors is valuable. Placement under these headings is somewhat arbitrary, and there is overlap. The large number of factors sets the scene for the next section which points out that multiple factors are involved in most cases. In the predisposing factors listed below, we learn that age is a risk factor – in ICU patients, the probability of developing delirium increases by 2% per year after the age of 65 years. We also not that any cognitive loss or dementia are potent risk factors. Any reduction of fitness makes the organism vulnerable. Last modified: January, 2018 4 Predisposing factors • Advanced age • Dementia • Functional impairment in activities of daily living • Medical comorbidity • History of alcohol abuse • Male gender • Sensory impairment (blindness, deafness) Precipitating factors • Acute myocardial events • Acute pulmonary events • Bed rest • Fluid and electrolyte disturbance (including dehydration) • Drug withdrawal (sedatives, alcohol) • Infection (especially respiratory, urinary) • Medications (wide range, esp. The systems of the body interact – a difficulty in one system soon embarrasses another, which then contributes to the dysfunction and clinical picture. One study found 16% of a sample had a single etiologic factor, 27% had two, and 90% had up to four etiologic factors (Camus et al, 2000). Where multiple factors are identified, they may have arisen independently or as consequence. Nevertheless, in more than half the cases, the aetiology remains unknown (Stiefel et al, 1992). Maldonado (2017) describes a System Integration Failure Hypothesis of delirium. This is an amazingly complex account of how the various human physiological systems interact – illustrating the mechanisms by which delirium may be provoked delirium, and each other. He thereby unites 1) Neuroinflammatory hypothesis, 2) Oxidative stress hypothesis, 3) Neuroendocrine hypothesis, 4) Melatonin dysregulation hypothesis, 5) Neurotransmission hypothesis, and 6) Network disconnectivity hypothesis. Last modified: January, 2018 5 Under-pinning findings include (Maldonado, 2013): 1. Recent evidence suggests the blood-brain barrier becomes leaky or disrupted as the brain ages, allowing exposure to drugs and toxins. It is seen in overdose of anticholinergic drugs, such as atropine. It may also be seen with the use of drugs not primarily classified as anticholinergics, but with clear cholinergic action: antihistamines, some opioids and antidepressants. However, significant anticholinergic activity has been found in the serum of patients who are not taking drugs with anticholinergic properties - this suggests an endogenous anticholinergic activity may predispose certain patients to delirium. Production depends on transport of tryptophan across the blood-brain barrier. Tryptophan competes with the amino acid phenylalanine for transport across the blood-brain barrier. Disturbance of the tryptophan: phenalanine ratio may increase or decrease the level of serotonin resulting in delirium.
Quantitative trait loci mine in alcoholism: human and basic science studies minomycin 50mg overnight delivery. Alcohol analysis of human event-related brain potentials: P3 voltage order 100mg minomycin otc. FISCHMAN Although the prevailing view for many decades was that severity ranging from occasional drug use to a dangerous drug dependent patients simply suffered from character but moderately severe state called 'abuse' in the American weakness cheap minomycin 50 mg on line, the persuasive data emerging from modern brain Psychiatric Association Diagnostic and Statistical Manual imaging techniques and the application of molecular biol- (DSM), to a severe compulsive state known as 'depen- ogy methods to animal models of compulsive drug use indi- dence' or 'addiction. The integration the usefulness of the term 'addiction' to denote this severe of a number of new technologies has allowed investigators state that occurs only in the minority of users who lose to combine behavioral and neurobiological approaches to control and become compulsive drug users with a chronic more completely evaluate multiple aspects of this difficult relapsing clinical course. The other point of view is that the term 'dependence' during the 1990s, the decade of the brain. The section con- creates confusion because it is already used to designate the centrates on advances most relevant to neuropsychopharma- state marked by drug-specific withdrawal symptoms that cology, integrating neurobiology, behavioral biology, and normally occur when regular drug use is abruptly termi- pharmacology. Knowledge of the pathophysiology of drug nated ('physical' dependence). Dependence also has a long- use disorders has greatly increased with the identification standing use as a personality disorder descriptor completely and cloning of receptors for the major drugs of abuse. Most important, patients with is also a much greater understanding of the brain circuits chronic pain receiving opiates often show signs of tolerance involved, including those common to different classes of and withdrawal symptoms without any behavior that could drugs. The efficacy of treatment has also increased through be categorized as abuse. Physicians who are confused by the availability of effective medications for alcohol, heroin, 'dependence' defined as a normal response and 'depen- and nicotine, as well as behavioral approaches used with dence' as a disorder have been known to mistakenly with- cocaine abusers. Also, there is greater acceptance of the hold pain medication to 'prevent addiction. There is general agreement that there are degrees of over proper terminology. For example, in the United States, over 4% of the general population is alcohol dependent and another 5 to The first step in the pharmacologic treatment of alcoholism 10 million people drink hazardously at least several times is to help patients safely detoxify from alcohol. The economic and medical costs of alcohol- historically, alcohol detoxification has occurred in inpatient ism and alcohol abuse continue to escalate. Most recent setting, increasingly alcohol detoxification is being con- figures put the economic costs of alcohol-related expenses ducted in ambulatory settings. Except in the case of medical at $176 billion annually in the United States (2). This in- or psychiatric emergencies, outcome studies generally show cludes the economic costs of increased health care expenses, that successful detoxification can safely and effectively be lost productivity at work, and legal expenses. Similarly, al- carried out in ambulatory setting using medications such though there have been some reductions in the number of as benzodiazepines (5,6). In addition, the use of anticonvul motor vehicle deaths attributed to excessive alcohol drink- sants has received recent interest. Benzodiazepines Current psychosocial approaches to alcohol addiction are moderately effective, with perhaps as many as half the pa- Benzodiazepines are �-aminobutyric acid (GABA) agonists tients receiving treatment becoming abstinent or signifi- that metaanalysis of placebo-controlled double-blind studies cantly reducing episodes of binge drinking (4). In the past have consistently shown to be safe and effective (7). Benzo two decades significant progress has been made in under- diazepines differ widely in their pharmacologic half-life, and standing the pharmacology of alcohol and why some people this has been a factor in the choice of which benzodiazepines become dependent. This has led to the development of sev- to use for detoxification. For example, one popular ap eral medications that have been shown in research studies proach is to use a benzodiazepine with a long half-life such to improve treatment outcomes. This chapter reviews some as chlordiazepoxide as a loading dose and let the benzodiaze of the possible neurobiological mechanisms involved in al- pine self-taper (8). We introduce precludes problems with patience noncompliance. A second future directions for research such as the use of combina- approach is to use shorter acting benzodiazepines and titrate tions of medications that may have additive or synergistic the dose depending on symptoms. In a recent study, oxaze effects on improving treatment, and discuss the role of psy- pam was used as needed depending on the severity of with chosocial support to facilitate the effectiveness of pharmaco- drawal symptoms as assessed by the Clinical Institute With- therapy. As needed oxazepam resulted in effective alcohol withdrawal management with a lower total amount of oxazepam over a shorter duration compared to routine dosing (9). Volpicelli: Department of Psychiatry, University of Pennsylva- Anticonvulsants nia, Veterans Affairs Medical Center, Philadelphia, Pennsylvania. Anticonvulsants have the 1446 Neuropsychopharmacology: The Fifth Generation of Progress advantage of no abuse potential and a theoretical advantage drinking (17–33). These studies have consistently demon of reducing kindling, a sensitization of withdrawal symp strated that alcohol enhances the release of endogenous toms that occurs after multiepisodes of alcohol withdrawal. For example, Gia of less hostility in the phenobarbital group (10). Carbamaze noulakis and colleagues (34) have found that in humans pine has also been used as an alternative to benzodiazepines peripheral levels of �-endorphin increase in family his to attenuate alcohol withdrawal symptoms (11). Although tory–positive subjects following a moderate dose of alcohol, its mechanism of action remains unknown, research gener whereas there is no increase in �-endorphin for social drink ally shows that carbamazepine is as effective as benzodiaze ers without a family history of alcoholism. Disadvantages of carbamazepine include a rather nar lich and colleagues (36) have also demonstrated that alco row therapeutic window, the need to monitor serum levels, hol-induced �-endorphin responses both prior to and and hepatotoxic effects. For patients with a history of alco following alcohol administration are significantly heritable.
The notion of rized that disruption in social zeitgebers (i buy minomycin 50mg with mastercard. Malkoff-Schwartz In the ECA buy minomycin 50 mg cheap, bipolar disorder was much less frequent and colleagues (46) found than severe social rhythm disrup- among married people discount minomycin 100 mg mastercard, as contrasted with divorced or tions (e. Bipolar disorder was more prevalent ing a job) were associated with onsets of mania, but not among those with multiple divorces (42). DISCUSSION Genetic and Familial Factors Beliefs and hypotheses about risk factors for depression In a review of the eight family studies of bipolar I disorder (such as undue interpersonal dependency) emerged from that included a control group, a metaanalysis (43) showed clinicians treating individual patients and from studies done that bipolar I disorder was seven times more likely among in psychiatric settings. Both suffer from sampling bias: those relatives of bipolar I probands than of controls. These stud- presenting for treatment are evaluated, but many factors in ies also demonstrate an increased risk of MD in relatives of addition to the illness itself affect treatment seeking (e. Jones (43) calculated an estimate of proband-wise concor- For MD there is strong evidence that women have two- dance of 50%, although the authors believe this to be an fold the prevalence of men, an age of onset between 25 and underestimate. There are signifi- Craddock and Jones conclude that there is a substantial cant differences in lifetime rates around the world. Personality factors are non- determining the actual genes involved in bipolar illness. Early life trauma, particularly sexual abuse, is asso- tempts to demonstrate linkage to the X-chromosome, to ciated with early-onset depression in women. Increased rates color blindness, to chromosomes 4, 11, 18, and others have of depression are found in several general medical illnesses. The most likely explanation for The association between depression and cardiovascular ill- lack of success is that these strategies assume a single genetic ness is strong, with depression predicting increased rates of mode of inheritance for a complex multiple-gene interaction morbidity and mortality among cardiovascular patients. Analytic studies (such as twin studies) have suggested some interaction among genetic and environmental factors. The incidence of depression was increased when several life Environmental Factors events (such as death of a close relative) occurred in the Although biological and genetic factors have long been prior month in individuals with high genetic liability. The known to play a major role in the etiology of bipolar disor- ongoing NIMH sib-pair study of early-onset depression will der, psychosocial factors are gaining attention. In particular, shed light on the possible genetic etiology of early-onset many studies have identified the association between stress- recurrent MD. There is little variation in chronicity and recurrence. J Affective Disord 1993;29(2–3): lifetime rates around the world (about 1%), and nearly equal 85–96. Bipolar spectrum is much rates of major depressive disorder among relatives of patients with more frequent, in the range of 3% to 6%. Age, period range of studies strongly support a genetic predisposition and cohort effects on the risk of major depression: results from to bipolar disorder, but specific replicable genetic factors five United States communities. The prevalence action with environmental factors is most likely, a situation and distribution of major depression in a national community that is challenging to research and to isolate. Life events, sample: the National Comorbidity Survey. Am J Psychiatry 1994; especially disruptions in social zeitgebers, increase the likeli- 151(7):979–986. Demographic and clinical risk factors for first onset. An intriguing new area of interest is emerging in risk 8. A family study of schizo- factors for depression—that of differences in consumption affective, bipolar I, bipolar II, unipolar, and normal control pro- of fish oils around the world. Psychiatric disor- ders in the relatives of probands with affective disorders. The Yale of MD and the annual apparent fish consumption per per- University—National Institute of Mental Health Collaborative son in nine countries worldwide. Recurrent and nonrecurrent fatty acids in diets in different cultures (48). Arch Gen Psychiatry 1986;43(11): An experimental epidemiologic study is under way that 1085–1089. Family history in recur- will test genetic risk factors for bipolar disorder. Onset with a mood stabilizer in a longitudinal double-blind pla- of major depression in early adulthood. Longitudinal study of diagnoses in children of women with unipolar and bipolar affec- tive disorder. Grandparents, par- ents, and grandchildren at high risk for depression: a three-gener- The authors would like to especially thank Lana A. J Am AcadChildAdolesc Psychiatry 1999;38(3): 289–296. Hirschfeld has received research support from Ab- 54(10):932–940. He has served as a consultant or on an advisory parental depression and childhood psychopathology. The lifetime history Wellcome, Forest Laboratories, Eli Lilly & Company, of major depression in women. Reliability of diagnosis and herit- Pfizer, SmithKline Beecham, Organon, Pharmacia & Up- ability. Laboratories, Bristol-Myers Squibb, Forest Laboratories, Eli 19. A population-based twin study of life- Lilly & Company, Organon, SmithKline Beecham, and time major depression in men and women. Cross-national twin study of major depression in women.
Elisabet Jacobsen (Research Assistant) reviewed the evidence on the cost-effectiveness of the bioimpedance devices and contributed to the economic evaluation under the supervision of Graham Scotland (Senior Health Economist) order minomycin 100mg amex. David Cooper (Research Fellow) double-checked the data extracted from the included randomised studies and conducted all statistical analyses buy 50mg minomycin overnight delivery. Cynthia Fraser (Senior Information Specialist) developed and ran the literature searches and provided information support generic minomycin 50mg online. Michal Shimonovich (Research Assistant) contributed to the data extraction process and to the assessment of the risk of bias of included studies with assistance from Moira Cruickshank (Research Fellow) and from Miriam Brazzelli (Senior Research Fellow). Angharad Marks (Clinician Scientist & Honorary Consultant Nephrologist) provided expert advice on the clinical aspects of this assessment. Miriam Brazzelli (Senior Research Fellow) oversaw and co-ordinated all aspects of this assessment. All authors contributed to the writing of this report and approved its final version. Data sharing statement Most technical data are included as appendices to this report. Additional data may be obtained by contacting the corresponding author. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 73 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. The BCM – Body Composition Monitor for Managing Fluid in People Having Dialysis. Chronic Kidney Disease in Adults: Assessment and Management. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ley, Liu JJ, Wong DSM, Tan SHC, Tavintharan S, Sum CF, et al. Association of circulating irisin with renal function and body composition in type 2 diabetes mellitus. Current status and future perspectives for CKD testing. Testing for chronic kidney disease: a position statement from the National Kidney Foundation. Longitudinal studies on the rate of decline in renal function with age. Moderate chronic kidney disease and cognitive function in adults 20 to 59 years of age: Third National Health and Nutrition Examination Survey (NHANES III). James MT, Hemmelgarn BR, Wiebe N, Pannu N, Manns BJ, Klarenbach SW, et al. Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. James MT, Quan H, Tonelli M, Manns BJ, Faris P, Laupland KB, et al. CKD and risk of hospitalization and death with pneumonia. Frailty and chronic kidney disease: the Third National Health and Nutrition Evaluation Survey. Chronic Kidney Disease (Stage 5): Peritoneal Dialysis. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 75 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. Guidance on Home Compared with Hospital Haemodialysis for Patients with End-Stage Renal Failure. Assessment of dry weight in hemodialysis: an overview. UK Renal Registry 18th Annual Report: Chapter 2 UK Renal Replacement Therapy Prevalence in 2014: national and centre-specific analyses. Hamilton AJ, Braddon F, Casula A, Inward C, Lewis M, Mallett T, et al. UK Renal Registry 18th Annual Report: Chapter 4 Demography of Patients Receiving Renal Replacement Therapy in Paediatric Centres in the UK in 2014. Lash JP, Ricardo AC, Roy J, Deo R, Fischer M, Flack J, et al. Race/ethnicity and cardiovascular outcomes in adults with CKD: findings from the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC studies. Milani GP, Groothoff JW, Vianello FA, Fossali EF, Paglialonga F, Edefonti A, et al. Bioimpedance and Fluid Status in Children and Adolescents Treated With Dialysis. Zaloszyc A, Fischbach M, Schaefer B, Uhlmann L, Salomon R, Krid S, Schmitt CP. Body composition monitoring-derived urea distribution volume in children on chronic hemodialysis. Hypervolemia is associated with increased mortality among hemodialysis patients.