India’s commitment to Paris Climate Change Agreement through its Nationally Determined Contribution (NDC) will require the energy system to gradually move away from fossil fuels. The current energy ...system is witnessing a transformation to achieve these through renewable energy targets and enhanced energy efficiency (EE) actions in all sectors. More stringent global GHG mitigation targets of 2 °C and well below 2 °C regimes would impose further challenges and uncertainties for the Indian energy systems. This paper provides a quantitative assessment using bottom-up optimization model (AIM/Enduse) to assess these until 2050 for meeting carbon mitigation commitments while achieving the national sustainable development goals. Energy transformation trajectories under five scenarios synchronized with climate mitigation regimes are explored—Business As Usual scenario (BAU), NDC scenario, 2 °C scenarios (early and late actions), and well below 2 °C scenario. The key results from the study include (a) coal-based power plants older than 30 years under NDC and older than 20 years for deeper CO
2
mitigation will be stranded before their lifetime, (b) increase in renewables of up to 225–280 GW by 2050 will require battery storage with improved integrated smart grid infrastructure, (c) growth in nuclear to 27–32 GW by 2050 is dependent on nuclear supply availability, (d) gradual shift towards electrification in industry, building, and transport sectors, and (e) installation of CCS technologies in power and industry sectors. Cumulative investments of up to 6–8 trillion USD (approximately) will be required during 2015–2030 to implement the actions required to transform the current energy systems in India.
Summary Background End-stage kidney disease is a leading cause of morbidity and mortality worldwide. Prevalence of the disease and worldwide use of renal replacement therapy (RRT) are expected to ...rise sharply in the next decade. We aimed to quantify estimates of this burden. Methods We systematically searched Medline for observational studies and renal registries, and contacted national experts to obtain RRT prevalence data. We used Poisson regression to estimate the prevalence of RRT for countries without reported data. We estimated the gap between needed and actual RRT, and projected needs to 2030. Findings In 2010, 2·618 million people received RRT worldwide. We estimated the number of patients needing RRT to be between 4·902 million (95% CI 4·438–5·431 million) in our conservative model and 9·701 million (8·544–11·021 million) in our high-estimate model, suggesting that at least 2·284 million people might have died prematurely because RRT could not be accessed. We noted the largest treatment gaps in low-income countries, particularly Asia (1·907 million people needing but not receiving RRT; conservative model) and Africa (432 000 people; conservative model). Worldwide use of RRT is projected to more than double to 5·439 million (3·899–7·640 million) people by 2030, with the most growth in Asia (0·968 million to a projected 2·162 million 1·571–3·014 million). Interpretation The large number of people receiving RRT and the substantial number without access to it show the need to both develop low-cost treatments and implement effective population-based prevention strategies. Funding Australian National Health and Medical Research Council.
Global Trends in Rates of Peritoneal Dialysis JAIN, Arsh K; BLAKE, Peter; CORDY, Peter ...
Journal of the American Society of Nephrology,
03/2012, Letnik:
23, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the ...use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, health ministries, academic centers, national experts, and industry affiliates. In 2008, there were approximately 196,000 peritoneal dialysis patients worldwide, representing 11% of the dialysis population. In total, 59% were treated in developing countries and 41% in developed countries. Over 12 years, the number of peritoneal dialysis patients increased in developing countries by 24.9 patients per million population and in developed countries by 21.8 per million population. The proportion of all dialysis patients treated with peritoneal dialysis did not change in developing countries but significantly declined in developed countries by 5.3%. The use of automated peritoneal dialysis increased by 14.5% in developing countries and by 30.3% in developed countries. In summary, the number of patients treated with peritoneal dialysis rose worldwide from 1997 to 2008, with a 2.5-fold increase in the prevalence of peritoneal dialysis patients in developing countries. The proportion of all dialysis patients treated with this modality continues to decline in developed countries.
Identifying people at risk for progressive chronic kidney disease and connecting them with recommended care is crucial for providing timely and optimal treatment. The ASSIST-CKD (A programme to ...Spread eGFR estimated glomerular filtration rate graph Surveillance for the early identification, Support and Treatment of people with progressive CKD chronic kidney disease) trial evaluated the effect of graphical eGFR reporting to primary care physicians on late presentation to a nephrologist in the United Kingdom. Trial data were obtained from the UK Renal Registry. Although the results were neutral, the data generated from the ASSIST-CKD trial are informative and provide useful estimates of the intervention effect. The trial also provides valuable insights into the challenges of implementing complex interventions in busy health care environments, which can be used to guide the designs of future interventions.
Background Advantages of the arteriovenous fistula (AVF), including long patency and few complications, were ascertained more than 2 decades ago and may not apply to the contemporary dialysis ...population. Study Design Systematic review and meta-analysis. Estimates were pooled using a random-effects model and sources of heterogeneity were explored using metaregression. Setting & Population Patients treated with long-term hemodialysis using an AVF. Selection Criteria for Studies English-language studies indexed in MEDLINE between 2000 and 2012 using prospectively collected data on 100 or more AVFs. Predictor Age, AVF location, and study location. Outcomes Outcomes of interest were primary AVF failure and primary and secondary patency at 1 and 2 years. Results 7,011 citations were screened and 46 articles met eligibility criteria (62 unique cohorts; n = 12,383). The rate of primary failure was 23% (95% CI, 18%-28%; 37 cohorts; 7,393 AVFs). When primary failures were included, the primary patency rate was 60% (95% CI, 56%-64%; 13 studies; 21 cohorts; 4,111 AVFs) at 1 year and 51% (95% CI, 44%-58%; 7 studies; 12 cohorts; 2,694 AVFs) at 2 years. The secondary patency rate was 71% (95% CI, 64%-78%; 10 studies; 11 cohorts; 3,558 AVFs) at 1 year and 64% (95% CI, 56%-73%; 6 studies; 11 cohorts; 1,939 AVFs) at 2 years. In metaregression, there was a significant decrease in primary patency rate in studies that started recruitment in more recent years. Limitations Low quality of studies, variable clinical settings, and variable definitions of primary AVF failure. Conclusions In recent years, AVFs had a high rate of primary failure and low to moderate primary and secondary patency rates. Consideration of these outcomes is required when choosing a patient's preferred access type.
The best treatment option for many patients with kidney failure is a kidney transplant from a living donor. Countries that successfully increase their rate of living kidney donation will decrease ...their reliance on dialysis, the most expensive and high-risk form of kidney replacement therapy. Outlined here are some barriers that prevent some patients from pursuing living kidney donation and current knowledge on some potential solutions to these barriers. Also described are strategies to promote living kidney donation in a defensible system of practice. Safely increasing the rate of living kidney donation will require better programs and policies to improve the experiences of living donors and their recipients, to safeguard the practice for years to come.
•Local cooling effects of 262 urban green spaces (UGS) are analysed for Bengaluru.•Cooling is estimated using a novel ring-based method with multiple robustness checks.•UGS were 2.23 °C cooler and ...provided cooling till 347 m beyond their boundaries.•Cooling reduced with distance and was impacted by the size, shape, greenness of UGS.•Innovative approaches need to be considered to enhance urban greening in India.
Rapid unplanned urbanization has led to a deterioration in green cover in Indian cities and an increase in urban temperatures due to the urban heat island (UHI) effect. With India’s urban population set to double from 400 million in 2011 to 800 million by 2050, it becomes critical to understand the role of urban green spaces (UGS) in mitigating the UHI. In this study, we have used high-resolution Landsat and Google Earth data and integrated it with spatial statistical analysis to quantify the cooling effects provided by UGS beyond their boundaries. We analyzed cooling effects at the level of individual UGS for 262 UGS in the megacity of Bengaluru, India. Our results showed that the average UGS provided local cooling effects till points 347 m (95% CI: 318 m to 376 m) beyond its boundary. The average UGS was 2.23 °C (95% CI: 2.13 °C to 2.33 °C) cooler than the point where it ceased to provide cooling effects. Cooling effects reduced with distance from the UGS, and were impacted by the greenness, size, and shape of the UGS. The findings of this study are important in the context of India’s Smart Cities Mission that has been criticized for an inadequate focus on urban greening. Our study addresses a concern that most previous studies have used a small sample of UGS for their analysis. To the best of our knowledge, this is the first study to quantify the role of UGS in localized surface temperature reduction for a large Indian city.
The true prevalence of hidradenitis suppurativa (HS) is unknown.
To establish standardized overall and group-specific prevalence estimates for HS in the United States.
This retrospective analysis ...included a demographically heterogeneous population-based sample of more than 48 million unique patients across all US census regions. As of October 27, 2016, a total of 47 690 patients with HS were identified using electronic health record data.
Standardized overall point prevalence for HS and sex-, age-, and race-specific prevalence estimates of HS in the general US population.
Of the 47 690 patients with HS (26.2% men and 73.8% women), the overall HS prevalence in the US population sample was 0.10%, or 98 per 100 000 persons (95% CI, 97-99 per 100 000 persons). The adjusted prevalence in women was 137 per 100 000 (95% CI, 136-139 per 100 000), more than twice that of men (58 per 100 000; 95% CI, 57-59 per 100 000; P < .001). The prevalence of HS was highest among patients aged 30 to 39 years (172 per 100 000; 95% CI, 169-275 per 100 000) compared with all other age groups (range, 15-150 per 100 000; P < .001). Adjusted HS prevalences among African American (296 per 100 000; 95% CI, 291-300 per 100 000) and biracial (218 per 100 000; 95% CI, 202-235 per 100 000) patients were more than 3-fold and 2-fold greater, respectively, than that among white patients (95 per 100 000; 95% CI, 94-96 per 100 000; P < .001).
Hidradenitis suppurativa is an uncommon, but not rare, disease in the United States that disproportionately affects female patients, young adults, and African American and biracial patients.
Although peritoneal dialysis (PD) costs less to the health care system compared to in-center hemodialysis (HD), it is an underused therapy. Neither modality has been consistently shown to confer a ...clear benefit to patient survival. A key limitation of prior research is that study patients were not restricted to those eligible for both therapies.
Retrospective cohort study.
All adult patients developing end-stage renal disease from January 2004 to December 2013 at any of 7 regional dialysis centers in Ontario, Canada, who had received at least 1 outpatient dialysis treatment and had completed a multidisciplinary modality assessment.
HD or PD.
Mortality from any cause.
Among all incident patients with end-stage renal disease (1,579 HD and 453 PD), PD was associated with lower risk for death among patients younger than 65 years. However, after excluding approximately one-third of all incident patients deemed to be ineligible for PD, the modalities were associated with similar survival regardless of age. This finding was also observed in analyses that were restricted to patients initiating dialysis therapy electively as outpatients. The impact of modality on survival did not vary over time.
The determination of PD eligibility was based on the judgment of the multidisciplinary team at each dialysis center.
HD and PD are associated with similar mortality among incident dialysis patients who are eligible for both modalities. The effect of modality on survival does not appear to change over time. Future comparisons of dialysis modality should be restricted to individuals who are deemed eligible for both modalities to reflect the outcomes of patients who have the opportunity to choose between HD and PD in clinical practice.
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