ObjectiveTo compare the rate of progression of diabetic chronic kidney disease in different ethnic groups.DesignProspective longitudinal observational study.ParticipantsAll new patients attending a tertiary renal unit in east London with diabetic chronic kidney disease between 2000 and 2007 and followed up till 2009 were included. Patients presenting with acute end-stage kidney failure were excluded.Main outcome measuresThe primary outcome was annual decline in the estimated glomerular filtration rate (eGFR) in different ethnic groups. Secondary end points were the number of patients developing end-stage kidney failure and total mortality during the study period.Results329 patients (age 60±11.9 years, 208 men) were studied comprising 149 south Asian, 105 White and 75 Black patients. Mean follow-up was 6.0±2.3, 5.0±2.7 and 5.6±2.4 years for White, Black and south Asian patients, respectively. South Asian patients were younger and had a higher baseline eGFR, but both systolic and diastolic blood pressures were higher in Black patients (p<0.05). Baseline proteinuria was highest for the south Asian group followed by the White and Black groups. Adjusted linear regression analysis showed that an annual decline in eGFR was not significantly different between the three groups. The numbers of patients developing end-stage kidney failure and total mortality were also not significantly different between the three groups. ACE or angiotensin receptor blockers use, and glycated haemoglobin were similar at baseline and throughout the study period.ConclusionsWe conclude that ethnicity is not an independent factor in the rate of progression renal failure in patients with diabetic chronic kidney disease.

The Internet of Things (IoT) is an extensive network of heterogeneous devices that provides an array of innovative applications and services. IoT networks enable the integration of data and services to seamlessly interconnect the cyber and physical systems. However, the heterogeneity of devices, underlying technologies and lack of standardization pose critical challenges in this domain. On account of these challenges, this research article aims to provide a comprehensive overview of the enabling technologies and standards that build up the IoT technology stack. First, a layered architecture approach is presented where the state-of-the-art research and open challenges are discussed at every layer. Next, this research article focuses on the role of middleware platforms in IoT application development and integration. Furthermore, this article addresses the open challenges and provides comprehensive steps towards IoT stack optimization. Finally, the interfacing of Fog/Edge Networks to IoT technology stack is thoroughly investigated by discussing the current research and open challenges in this domain. The main scope of this study is to provide a comprehensive review into IoT technology (the horizontal fabric), the associated middleware and networks required to build future proof applications (the vertical markets).

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We would like to thank Hasan Ersel, our lead discussant, for his insightful comments as well as other participants at the Cairo workshop. We thank Kabbashi Suliman for a careful reading and valuable comments, including a title suggestion with which we agreed. Ibrahim Elbadawi would like to acknowledge the excellent research support by Ms. Dhuha Fadhel of the Dubai Economic Council. Omer Ali would like to thank George Stefanidis and Guillaume Sublet for useful comments and suggestions.