EDTA

EDTA application on agricultural soils affects microelement uptake of plants.[Pubmed:28327292]

Sci Total Environ. 2017 Jan 15;577:166-173.

Chelates such as ethylenediaminetetraacetic acid (EDTA) enter soils via various sources but their effect on agricultural crops is mostly unknown. Sources of EDTA include industry, households, sewage water and agricultural practices. In a field experiment EDTA was applied in its free form at different rates (0, 150, 550, 1050kgha(-1)) to study its translocation in the soil profile and to evaluate its effect on yield and mineral composition of the cultivated crop, both in the year of application (oilseed rape) and in the following year (winter wheat). The results indicate that EDTA was translocated from the soil surface to deeper soil layers in the time-frame of the experiment. EDTA was still detectable in the rooting zone 19months after application, indicating its persistence in the soil. Only the highest EDTA rate (1050kgha(-1)) reduced vegetative growth of oilseed rape until stem elongation, but seed yield was not affected by EDTA application. EDTA application changed the mineral composition of plants. Higher phosphorus (P), sulphur (S), iron (Fe) and manganese (Mn) and lower cadmium (Cd) concentrations were determined in the seeds of oilseed rape. No yield effects of residual EDTA were observed for the following crop, winter wheat, but the Cd content in seeds was still lower in plots where EDTA had been applied in the previous year. Data show that EDTA application affects the mineral uptake of cultivated crops under field conditions.

Interactions between the Tetrasodium Salts of EDTA and 1-Hydroxyethane 1,1-Diphosphonic Acid with Sodium Hypochlorite Irrigants.[Pubmed:28342478]

J Endod. 2017 Apr;43(4):657-661.

INTRODUCTION: A clinically useful all-in-one endodontic irrigant with combined proteolytic and decalcifying properties is still elusive. In this study, the chemical effects of dissolving the tetrasodium salts of 1-hydroxyethane 1,1-diphosphonic acid (Na4HEDP) or Na4EDTA directly in sodium hypochlorite (NaOCl) irrigants in polypropylene syringes were assessed during the course of 1 hour. METHODS: The solubility of the salts in water was determined. Their compatibility with 1% and 5% NaOCl was measured by iodometric titration and in a calcium complexation experiment by using a Ca(2+)-selective electrode. RESULTS: The salts dissolved within 1 minute. The dissolution maximum of Na4HEDP in water (wt/total wt) was 44.6% +/- 1.6%. The corresponding dissolution maximum of Na4EDTA was 38.2% +/- 0.8%. Na4HEDP at 18% in 5% NaOCl caused a mere loss of 16% of the initially available chlorine during 1 hour. In contrast, a corresponding mixture between NaOCl and the Na4EDTA salt caused 95% reduction in available chlorine after 1 minute. Mixtures of 3% Na4EDTA with 1% NaOCl were more stable, but only for 30 minutes. Na4HEDP lost 24% of its calcium complexation capacity after 60 minutes. The corresponding loss for Na4EDTA was 34%. CONCLUSIONS: The compatibility and solubility of particulate Na4HEDP with/in NaOCl solutions are such that these components can be mixed and used for up to 1 hour. In contrast, short-term compatibility of the Na4EDTA salt with NaOCl solutions was considerably lower, decreasing at higher concentrations of either compound. Especially for Na4HEDP but also for Na4EDTA, the NaOCl had little effect on calcium complexation.

Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).[Pubmed:28340239]

Nephrol Dial Transplant. 2017 Apr 1;32(4):620-640.

In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis.[Pubmed:28336050]

Lancet. 2017 May 27;389(10084):2128-2137.

BACKGROUND: We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. METHODS: In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. FINDINGS: Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15.8 deaths per 1000 patient-years (IQR 6.4-16.4). France had a mortality rate (9.2) of more than 3 SDs better, and Russia (35.2), Poland (39.9), Romania (47.4), and Bulgaria (68.6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0.69, 95% CI 0.52-0.91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1.31 [95% CI 1.13-1.53], p=0.0005, to 1.21 [0.97-1.51], p=0.10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. INTERPRETATION: Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities. FUNDING: ERA-EDTA and ESPN.