Vascular calcification and mineral bone disorder in chronic kidney disease

Chronic Kidney Disease (CKD), osteoporosis and mild hyponatremia are all prevalent chronic conditions that may coexist and are often under-recognized. Mineral-Bone Disorder begins early in the natural history of CKD and results in complex abnormalities of bone which ultimately confers a well-established increased risk of fragility fractures in End Stage Kidney Disease. Hyponatremia is a novel, usually renal mediated metabolic perturbation, that most commonly occurs independently of the stage of renal dysfunction but which may also predispose to increased fracture risk. The extent -if any- to which either early stages of renal dysfunction or the presence of hyponatremia contribute to fracture occurrence in the general population, independently of osteoporosis, is unclear. Renal transplantation is the treatment of choice for ESKD and although it restores endogenous renal function it typically fails to normalize either the long term cardiovascular or fracture risk. One potential mechanism contributing to these elevated long-term risks and to diminished Health Related Quality of Life is persistent, post-transplant hyperparathyroidism. In this study we retrospectively examine the association of renal function and serum sodium with Bone Mineral Density and fracture occurrence in a retrospective cohort of 1930 female members of the general population who underwent routine DXA scan. We then prospectively recruited a cohort of 90 renal transplant recipients in order to examine the association of post transplant parathyroid hormone (PTH) level with measures of CKD Mineral Bone Disorder, including, DXA Bone Mineral Density, Vascular Calcification (assessed using both abdominal radiography and CT techniques, as well as indirectly by carotid-femoral Pulse Wave Velocity) and Quality of Life (using the Short Form-12 and a PTH specific symptom score). In the retrospective DXA cohort, moderate CKD (eGFR 30-59ml/min/1.73m2) and hyponatremia (<135mmol/L) were associated with fracture occurrence, independently of BMD, with an adjusted Odds Ratio (95% Confidence Interval), of 1.37 (1.0, 1.89) and 2.25 (1.24, 4.09) respectively. In the renal transplant study, PTH was independently associated with the presence of osteoporosis, adjusted Odds Ratio (95% Confidence Interval), 1.15 (per 10ng/ml increment), (1.04, 1.26). The presence of osteoporosis but not PTH was independently associated with measures of vascular calcification, adjusted ß (95% Confidence Interval), 12.45, (1.16, 23.75). Of the eight quality-of-life domains examined, post-transplant PTH (per 10ng/ml increment), was only significantly and independently associated with reduced Physical Functioning, (95% Confidence Interval), 1.12 (1.01, 1.23). CKD and hyponatremia are both common health problems that may contribute to fracture occurrence in the general population, a major on-going public health concern. PTH and decreased Bone Mineral Density may signal sub-optimal long-term outcomes post renal transplantation, influencing bone and vascular health and to a limited extent long term Health Related Quality of Life

College adjustment, depressive symptoms and peer support among undergraduate university students

Background: College adjustment is a developmental milestone that can be stressful and may lead to mental health problems such as depression. Support during this adjustment period is seen as essential, however it is unknown if informal peer support from fellow students has any impact on either college adjustment or depressive symptoms. Aim: To identify levels of social and personal college adjustment, depressive symptoms and peer support among students, and to examine the relationship between the variables. Design: A quantitative correlational design was used Instruments: Data were collected using two subscales of the Student Adaptation to College Questionnaire; the Centre for Epidemiology Depressive Symptoms Scale and a subscale of the Peer Support Evaluation Inventory. Sample: The sample consisted of 417, first (n=188), second (n=134) and fourth (n=94) year nursing and midwifery students from one University in Ireland. Findings: The findings indicated that 20% of participants were poorly personally adjusted and 9% poorly socially adjusted. Furthermore, 34% of participants experienced significant depressive symptoms. Most students had good levels of peer support. Statistically significant relationships were found between all key variables, the strongest of which were between personal adjustment and depressive symptoms and social adjustment and depressive symptoms. Differences in adjustment and depressive symptom scores were found based on year of study, with second year students experiencing more depressive symptoms and having poorer personal adjustment scores. Participants who had poor relationships with their father’s experienced greater depressive symptoms and had more difficulties personally and socially adjusting to college. The alcohol consumption of participants had a statistically significant correlation with college adjustment, depressive symptoms and peer support, with higher consumption having a positive impact on the variables.