Artificial Kidney Research Articles

Spectrum of Complications of Patients with Chronic Kidney Disease on Maintenance Continuous Ambulatory Peritoneal Dialysis: An Experience of Tertiary Nephrology Center in Najaf City-Iraq

BACKGROUND: Chronic kidney disease (CKD), also called chronic kidney failure, is described as gradual loss of kidney function. CKD can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or kidney transplant. Peritoneal dialysis (PD) has a widespread renal replacement therapy with great acceptance because of simplicity, flexibility, and independence. AIM: The aim of this study was to evaluate the complications of continuous ambulatory PD (CAPD) in patients with CKD. METHODS: A cross-sectional study, involved 140 patients, aged between 18 and 80 years old and suffered from CKD under maintenance CAPD in the dialysis unit of the renal center. All data regarding the sociodemographic profile of the patient, vitals, etiological diagnosis, frequency and duration of dialysis, and dialysis-related complications were taken. RESULTS: In the current study, there is a significant difference in the distribution of complications among gender where the female patients had a higher incidence of both infectious and non-infectious complications. The study also reported that there is much lower rate of complications among patients on laparoscope operation in compared with the open operation. In addition, patients with open abdomen PD developed the complications earlier than those with laparoscope maintenance CAPD. CONCLUSION: Peritoneal infection is the most prevalent complication among the other complications in the current study. There is much lower rate of complications among patients on PD in compared with hemodialysis and on laparoscope in compared with the open operation.

The future of the artificial kidney.

End-stage renal disease (ESRD) is increasing worldwide. In India, diabetes mellitus and hypertension are the leading causes of chronic kidney disease and ESRD. Hemodialysis is the most prevalent renal replacement therapy (RRT) in India. The ideal RRT must mimic the complex structure of the human kidney while maintaining the patient's quality of life. The quest for finding the ideal RRT, the “artificial kidney”– that can be replicated in the clinical setting and scaled-up across barriers– continues to this date. This review aims to outline the developments, the current status of the artificial kidney and explore its future potential.

In Vivo Motion Correction in Super-Resolution Imaging of Rat Kidneys.

Super-resolution (SR) imaging has the potential of visualizing the microvasculature down to the 10- [Formula: see text] level, but motion induced by breathing, heartbeats, and muscle contractions are often significantly above this level. This article, therefore, introduces a method for estimating tissue motion and compensating for this. The processing pipeline is described and validated using Field II simulations of an artificial kidney. In vivo measurements were conducted using a modified bk5000 research scanner (BK Medical, Herlev, Denmark) with a BK 9009 linear array probe employing a pulse amplitude modulation scheme. The left kidney of ten Sprague-Dawley rats was scanned during open laparotomy. A 1:10 diluted SonoVue contrast agent (Bracco, Milan, Italy) was injected through a jugular vein catheter at 100 [Formula: see text]/min. Motion was estimated using speckle tracking and decomposed into contributions from the heartbeats, breathing, and residual motion. The estimated peak motions and their precisions were: heart: axial- [Formula: see text] and lateral- [Formula: see text], breathing: axial- [Formula: see text] and lateral- [Formula: see text], and residual: axial-30 [Formula: see text] and lateral-90 [Formula: see text]. The motion corrected microbubble tracks yielded SR images of both bubble density and blood vector velocity. The estimation was, thus, sufficiently precise to correct shifts down to the 10- [Formula: see text] capillary level. Similar results were found in the other kidney measurements with a restoration of resolution for the small vessels demonstrating that motion correction in 2-D can enhance SR imaging quality.

Animal Trial of Sorbent Cartridge for Portable Artificial Kidney (PAK)

Animal Trial of Sorbent Cartridge for Portable Artificial Kidney (PAK)

Calcium Oxalate Crystallization: Influence of pH, Energy Input, and Supersaturation Ratio on the Synthesis of Artificial Kidney Stones.

The removal of kidney stones can lead to small residual fragments remaining in the human body. Residual stone fragments can act as seeds for kidney stone crystallization and may necessitate another intervention. Therefore, it is important to create a consistent model with a particle size comparable to the range of kidney stone fragments. Thus, the size-determining parameters such as supersaturation ratio, energy input, and pH value are examined. The batch crystallizations were performed with supersaturation ratios between 5.07 and 6.12. The compositions of the dried samples were analyzed with Raman spectroscopy, infrared spectroscopy, and X-ray diffraction (XRD). The samples were identified as calcium oxalate monohydrate with spectroscopic analysis, while calcium oxalate dihydrate being the most prominent crystalline species at all supersaturation ratios for the investigated conditions. The aggregate size, obtained with analytical centrifugation, varied between 2.9 and 4.3 μm, while the crystallite domain size, obtained from XRD, varied from 40 to 61 nm. Our results indicate that particle sizes increase with increasing supersaturation, energy input, and pH. All syntheses yield a high particle heterogeneity and represent an ideal basis for reference materials of small kidney stone fragments. These results will help better understand and control the crystallization of calcium oxalate and the aggregation of such pseudopolymorphs.

IR-Photometry Method for Measuring Glucose Concentration in Peritoneal Dialysis Fluid

Introduction. The transition of glucose into the blood during automated peritoneal dialysis with regeneration of the dialysis fluid leads to a decreased removal of excess fluid from the body and corresponding violations of the water-salt balance.Aim. To consider a system for automatically maintaining the concentration of glucose in the dialysate solution, which provides effective ultrafiltration, as well as to propose a non-contact photometric feedback sensor.Materials and methods. The sensor is an optical system of an IR laser diode with a power of 30 mW and a wavelength of 1600 nm, a photodiode and a quartz tube, through which the test solution circulates. The sensor measures the attenuation of the radiation passing through the solution in a pulsed mode and calculates the glucose concentration. The selected combination of digital filters provides compensation for the noise of the optical system. Experimental studies of the efficiency of the sensor were carried out on peritoneal dialysis solutions with various concentrations of urea, creatinine, uric acid and glucose. At the beginning of the experiments, the sensor was calibrated in a pure solution.Results. It was shown that the developed sensor makes it possible to measure the concentration of glucose in a solution for peritoneal dialysis in the range of 42…220 mmol / l with a relative error of about 15%. The time of one measurement is about 1 minute, which makes it possible to obtain up-to-date information on the current concentration of the solution.Conclusion. This combination of characteristics will allow the sensor to be used in artificial kidney wearable devices for assessing the glucose content in the solution, calculating the time to change the solution and as a feedback sensor in a system for maintaining the concentration of the osmotic agent.

Timing of renal-replacement therapy in intensive care unit-related acute kidney injury.

The optimal timing of renal-replacement therapy (RRT) initiation for the management of acute kidney injury (AKI) in the intensive care unit (ICU) is frequently controversial. An earlier-strategy has biological rationale, even in the absence of urgent indications; however, a delayed-strategy may prevent selected patients from receiving RRT and avoid complications related to RRT. Previous studies assessing the optimal timing of RRT initiation found conflicting results, contributing to variation in clinical practice. The recent multinational trial, standard vs. accelerated initiation of renal replacement therapy in acute kidney injury (STARRT-AKI) found no survival benefit and a higher risk of RRT dependence with an accelerated compared to a standard RRT initiation strategy in critically ill patients with severe AKI. Nearly 40% of patients allocated to the standard-strategy group did not receive RRT. The Artificial Kidney Initiation in Kidney Injury-2 (AKIKI-2) trial further assessed delayed compared to more-delayed strategies for RRT initiation. The more-delayed strategy did not confer an increase in RRT-free days and was associated with a higher risk of death. Early preemptive initiation of RRT in critically ill patients with AKI does not confer clear clinical benefits. However, protracted delays in RRT initiation may be harmful.

In Search of Effective UiO-66 Metal-Organic Frameworks for Artificial Kidney Application.

The removal of uremic toxins from patients with acute kidney injury is a key issue in improving the quality of life for people requiring peritoneal dialysis. The currently utilized method for the removal of uremic toxins from the human organism is hemodialysis, performed on semipermeable membranes where the uremic toxins, along with small molecules, are separated from proteins and blood cells. In this study, we describe a mixed-linker modulated synthesis of zirconium-based metal–organic frameworks for efficient removal of uremic toxins. We determined that the efficient adsorption of uremic toxins is achieved by optimizing the ratio between −amino functionalization of the UiO-66 structure with 75% of −NH2 groups within organic linker structure. The maximum adsorption of hippuric acid and 3-indoloacetic acid was achieved by UiO-66-NH2 (75%) and by UiO-66-NH2 (75%) 12.5% HCl prepared by modulated synthesis. Furthermore, UiO-66-NH2 (75%) almost completely adsorbs 3-indoloacetic acid bound to bovine serum albumin, which was used as a model protein to which uremic toxins bind in the human body. The high adsorption capacity was confirmed in recyclability test, which showed almost 80% removal of 3-indoloacetic acid after the third adsorption cycle. Furthermore, in vitro cytotoxicity tests as well as hemolytic activity assay have proven that the UiO-66-based materials can be considered as potentially safe for hemodialytic purposes in living organisms.

Efektivitas Pemberian Edukasi Kesehatan Terhadap Tingkat Kecemasan Pasien Gagal Ginjal Kronis yang dihemodialisa di RSKG Ny. Ra Habibie Bandung

Hemodialysis is a therapy for CRF patients to replace kidney function by using an artificial kidney in the form of a dialysis machine. Hemodialysis patients will experience lifelong dependence, this will lead to changes in imbalances in their life, these changes will cause physical and psychological problems, one of which is anxiety. Anxiety in CRF patients is a response to the threatening situation experienced by CRF patients and is a normal thing that occurs accompanied by developments, changes and new experiences in his life. Health education is a planned effort to influence others in doing what is expected. The aim of this reasearch is to determine the effect of providing health education on the level of anxiety in patients with chronic renal failure during hemodialysis at RSKG Ny. Ra Habibie Bandung. The methods of this research is a pre-experimental research design with one-group pre-post test design approach. The number of samples in this study were 60 respondents using purposive sampling technique. Using the Wilcoxon statistical test the results obtained p-value of 0.00 with a significance of p <? (0.05), p-value of 0.00 <0.05

The Use of Polymeric Materials in Modern Dentistry

The achievements and discoveries of chemical science have firmly established themselves in all branches of humanity. One of the most significant chemistry possibilities is the polymerization and polycondensation of compounds, which, in turn, are methods for producing polymers. Polymers are high molecular weight compounds consisting of many units (monomers) linked by chemical bonds. Unique polymer compounds are the basis of plastics, chemical fibers, rubber, paints, and varnishes, adhesives [8]. Polymers are used for the manufacture of removable prostheses, materials for fillings and inlays, orthodontic appliances, artificial teeth, dental implants, as well as in the creation of artificial heart valves, artificial kidney devices, artificial circulation, artificial heart [6].

Abstract 32 - Fabrication of artificial kidney stones of different physical properties for ex vivo experimentation

Abstract 32 - Fabrication of artificial kidney stones of different physical properties for ex vivo experimentation

Home hemodialysis

Heimhämodialyse (HHD) ist der Grundstein der Nierenersatztherapie in Deutschland. Sie ermöglichte ab 1969 das Überleben mit einer bis dahin tödlichen Diagnose. Mit dem Ausbau eines guten Netzes von Dialysezentren gingen das Wissen und die Erfahrung der HHD jedoch zunehmend verloren. In der Ausbildung kommt die HHD heute praktisch nicht mehr vor. Ungenügende Aufklärung und fehlendes Angebot der HHD sind die Folge. Aktuell werden in Deutschland weniger als 0,8 % der Patienten mit HHD behandelt. Die Industrie orientierte sich bei der Entwicklung von Dialysegeräten auf Standgeräte für die Zentren. Diese Form der Therapie behindert die Mobilität und schränkt die Aktivitäten von Patienten mit dialysepflichtiger Niereninsuffizienz ein. Ausgehend von der Advancing American Kidney Health Initiative hat sich eine erfreuliche Dynamik in der Entwicklung innovativer, tragbarer und implantierbarer künstlicher Nieren entwickelt. Damit kann die Lebensqualität verbessert und die Sterblichkeitsrate gesenkt werden. Auch in Deutschland und Europa sind erste Initiativen entstanden. Diese innovativen Geräte und der damit zusammenhängende Wandel in der Nierenersatztherapie werden viele Probleme der nephrologischen Community, wie Personalmangel oder den Mangel an Spenderorganen und Tod auf der Warteliste lösbar machen und den Patienten Unabhängigkeit und Mobilität schenken. Die Kostenbelastung der Gesundheitssysteme kann reduziert werden. Darüber hinaus werden der immense Wasser- und Stromverbrauch durch die regenerativen Techniken der neuen Geräte dramatisch verringert.

Safety of electrooxidation for urea removal in a wearable artificial kidney is compromised by formation of glucose degradation products

A major challenge for the development of a wearable artificial kidney (WAK) is the removal of urea from the spent dialysate, as urea is the waste solute with the highest daily molar production and is difficult to adsorb. Here we present results on glucose degradation products (GDPs) formed during electrooxidation (EO), a technique that applies a current to the dialysate to convert urea into nitrogen, carbon dioxide, and hydrogen gas. Uremic plasma and peritoneal effluent were dialyzed for 8 hours with a WAK with and without EO‐based dialysate regeneration. Samples were taken regularly during treatment. GDPs (glyoxal, methylglyoxal, and 3‐deoxyglucosone) were measured in EO‐ and non‐EO‐treated fluids. Glyoxal and methylglyoxal concentrations increased 26‐ and 11‐fold, respectively, in uremic plasma (at [glucose] 7 mmol/L) and 209‐ and 353‐fold, respectively, in peritoneal effluent (at [glucose] 100 mmol/L) during treatment with EO, whereas no change was observed in GDP concentrations during dialysate regeneration without EO. EO for dialysate regeneration in a WAK is currently not safe due to the generation of GDPs which are not biocompatible.

Artificial intelligence and kidney transplantation.

Artificial intelligence and its primary subfield, machine learning, have started to gain widespread use in medicine, including the field of kidney transplantation. We made a review of the literature that used artificial intelligence techniques in kidney transplantation. We located six main areas of kidney transplantation that artificial intelligence studies are focused on: Radiological evaluation of the allograft, pathological evaluation including molecular evaluation of the tissue, prediction of graft survival, optimizing the dose of immunosuppression, diagnosis of rejection, and prediction of early graft function. Machine learning techniques provide increased automation leading to faster evaluation and standardization, and show better performance compared to traditional statistical analysis. Artificial intelligence leads to improved computer-aided diagnostics and quantifiable personalized predictions that will improve personalized patient care.

A molecular investigation of urea and creatinine removal in the wearable dialysis device using Two-Dimensional materials

Urea and creatinine removal is considered challenging issues regarding the development of artificial kidneys. The present study was aimed at investigating the novel and tunable urea and creatinine adsorbents in the form of two-dimensional (2D) materials. To this end, various 2D materials were investigated. Moreover, the molecular dynamics (MD) and density functional theory (DFT) simulations were performed to assess urea and creatinine adsorption, interaction energies, and other adsorption properties of 2D materials. The validity of applied methods as well as results was confirmed by comparing them to relevant experimental studies. The results show 2D materials have high attraction energy for urea sorption. Twelve different types of 2D materials with high adsorption energies (up to −340.2 KJ/mol) can adsorb urea. These monolayers also can remove creatinine with stable adsorption (Gibbs free energies up to −17.23 KJ/mol). Accordingly, 2D materials can be suggested as promising adsorbents for artificial kidney applications. Besides, the COF, MXene, MoO3, and Bithmuthene monolayers exhibited greater urea and creatinine adsorption capacity, more enhanced adsorption energy, and excellent adsorption properties compared to other 2D materials. The functionalization of the surface with –COOH groups boasts the adsorption of urea and creatinine even further.

Fabrication and performance evaluation of polymeric membrane using blood compatible hydroxyapatite for artificial kidney application.

In the current study, a phase inversion scheme was employed to fabricate hydroxyapatite (HA)/polysulfone (PSF)-based asymmetric membranes using a film applicator with water as a solvent and nonsolvent exchanging medium. Fourier Transform Infrared (FTIR) and X-ray diffraction (XRD) spectroscopic studies were conducted to confirm the bonding chemistry and purity of filler. The inherent thick nature of PSF generated sponge-like shape while the instantaneous demixing process produced finger-like pore networks in HA/PSF-based asymmetric membranes as exhibited by scanning electron microscope (SEM) micrographs. The FTIR spectra confirmed noncovalent weak attractions toward the polymer surface. The leaching ratio was evaluated to observe the dispersion behavior of HA filler in membrane composition. Hydrophilicity, pore profile, pure water permeation (PWP) flux, and molecular weight cutoff (MWCO) values of all formulated membranes were also calculated. Antifouling results revealed that HA modified PSF membranes exhibited 43% less adhesion of bovine serum albumin (BSA) together with >86% recovery of flux. Membrane composition showed 74% total resistance, out of which 60% was reversible resistance. Biocompatibility evaluation revealed that the modified membranes exhibited prothrombin time (PT), and thrombin time (TT) comparable with typical blood plasma, whereas proliferation of living cells over membrane surface proved its nontoxic behavior toward biomedical application. The urea and creatinine showed effective adsorption aptitude toward HA loaded PSF membranes.

Audit of Blood Utilization in a Tertiary Care Hospital

Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of >2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.

“Dialysis and medical tourism. Investigating patients’ perceptions in Greece”

Purpose The purpose of this paper is to explore the possibilities and the growth prospects of medical tourism in Greece, while particularly focusing on the dialysis process. Patients with end-stage renal failure have the right to any treatment deemed necessary during their journey to another city or country away from the place where their treatment normally takes place. Design/methodology/approach The survey has been conducted among 193 kidney disease patients that underwent extra-renal dialysis in two public and three private artificial kidney units in Thessaloniki. The study population consists of patients with end-stage chronic renal failure (CRF) that undergo dialysis. For the purpose of this study, quantitative research was carried out via a structured and anonymous questionnaire. The design and structure of the study were based upon questionnaires from two relevant questionnaires. The questionnaires were modified appropriately to respond to the subject in question. Finally, for the analysis of the data, the SPSS software has been used. Findings One of the most obvious results is that patients on dialysis treatment have limited both the frequency and the duration of their vacation. The 8.3% of patients that did not use to travel increased to 37.8%, whereas only 22.3% continue to travel 2–4 times a year. Patients that keep on going on vacation frequently claim that a break from the daily routine improves their quality of life. Most of the participants (up to 36.3%) claim they feel healthier, while 34.2% stated they experience a normal life when they escape their everyday life and travel far from home. The 69.9% claim that Greece has the potentials to be a popular medical tourism destination. However, a well-structured and government-financed assistance programme is absent. The processing of data has revealed a positive correlation between age and tourism behaviour. Additionally, according to the research results, younger patients tend to be better informed regarding medical tourism in comparison with older ones. Social implications Considering the patients to be potential travellers facilitates the development, realization and promotion of medical tourism. Originality/value This study attempts to investigate, for the first time, the tourism behaviour of chronic kidney disease patients. The study highlights a sensitive issue, patients’ right to treatment without geographical or distance-related obstacles.

Dialysis/adsorption bifunctional thin-film nanofibrous composite membrane for creatinine clearance in portable artificial kidney

In this study, we proposed a facile strategy for the lightweight design for portable artificial kidney by using a novel dialysis/adsorption bifunctional thin-film nanofibrous composite (TFNC) membrane, which consisting of polyvinyl alcohol (PVA) hydrogel as a separation layer and polyacrylonitrile (PAN) nanofibrous membrane with UiO-66-(COOH)2 nanoparticles as a porous affinity substrate were developed to effectively remove creatinine and substantially reduce the volume of dialysate in dialysis process simultaneously. Here, as-synthesized UiO-66-(COOH)2 nanoparticles were strung through PAN nanofibers using colloid-electrospinning technique to prepare necklace-like nanofibrous affinity membrane for creatinine adsorption. The obtained PAN/UiO-66-(COOH)2 nanofibrous membrane (PAN-U) with optimum UiO-66-(COOH)2 loading (60 wt%) exhibited encouraging maximum adsorption capacities (54 mg/g) based on Langmuir isotherm models and pseudo-second-order kinetic models. In addition, the simulated dialysis results demonstrated that 62.8% of creatinine were eliminated and over 98% of bovine serum albumin (BSA) were rejected. Furthermore, the PVA/PAN-U TFNC membrane not only improved the clearance of creatinine in simulated blood, but also efficiently maintained the concentration of creatinine in simulated dialysate at a very low level compared to the pure PVA/PAN TFNC membrane. More importantly, the usage of dialysate in volume for PVA/PAN-U TFNC membranes in dialysis was only one tenth of that for PVA/PAN TFNC membranes but with very comparable dialysis performance. Therefore, the introduction of adsorption function in TFNC hemodialysis membrane may facilitate the development of the lightweight of portable artificial kidney.

Preliminary safety study of the Automated Wearable Artificial Kidney (AWAK) in Peritoneal Dialysis patients.

Regeneration of peritoneal dialysis (PD) fluid using sorbent technology can provide flexibility and improve quality of life. This study examined the safety and efficacy of the automated wearable artificial kidney (AWAK) device in PD patients. This pilot study included prevalent PD patients from a single center in Singapore between 2016 and 2018. Participants underwent up to nine AWAK therapies over 72 h and were followed up for 1 month. Primary outcomes were serious adverse events (SAEs) and completion of nine therapies without device deficiency. Secondary outcomes were weekly peritoneal Kt/Vurea, solutes clearance and adverse events (AEs). Twenty-one patients were screened and 15 were included in the study. Device alterations were required to overcome issues including flow occlusions initially, which resulted in three cohorts (n = 2, 2 and 11 respectively). No SAEs were observed during the study and at the follow-ups. Common AEs were abdominal pain/discomfort (60%) and bloatedness (47%). The median estimated peritoneal weekly Kt/Vurea was 3.0 (interquartile range: 2.2-4.8). There were significant reductions in pre- and post-study median serum urea (20.8 vs. 14.9 mmol/L; p = 0.001), creatinine (976.0 vs. 667.5 µmol/L; p = 0.001), phosphate (1.7 vs. 1.5 mmol/L; p = 0.03), and β2-microglobulin (29114.0 vs. 26339.0 µg/L; p = 0.048). Fluid reabsorption occurred among patients with residual kidney function. However, median body weights were not significantly different pre- and post-study (66.4 vs. 65.7 kg; p = 0.83). This preliminary study demonstrated that no SAEs were observed with the AWAK-PD device; however, 60% of participants developed abdominal pain/discomfort. Further device enhancements are needed to improve ultrafiltration and reduce AEs.