Dialysis Process Research Articles

Effects of Mineral and Almond Oil Administration on Transepidermal Water Loss and Skin Acidity in Chronic Renal Failure Patients Undergoing Hemodialysis

Introduction: Patients undergoing hemodialysis experience decreased moisture content in the dermis due to fluid transfer during the dialysis process, causing xerosis, pruritus, and damage to the skin barrier. Almond oil and mineral oil are well-known moisturizers used in skin care products. Objectives: To compare the effect of almond oil with mineral oil on transepidermal water loss (TEWL) and skin acidity in hemodialyzed chronic renal failure (CRF) patients. Methods: An experimental study was conducted on patients with chronic renal failure (CRF) undergoing hemodialysis at Dr. Moewardi Hospital in Indonesia. The study involved applying mineral and almond oils twice daily on the right and left forearms for four weeks. We measured TEWL and pH levels before and after the treatment. Results: There is a significant difference in TEWL between before and after mineral oil application (p=0.036), but not in the almond oil arm (p=0.394). Subsequently, the change of TEWL value significantly differed between mineral oil and almond oil (p=0.043). However, the effects of mineral oil and almond oil on pH were insignificant (p=0.574 and 0.268, respectively). Conclusion: After undergoing hemodialysis, CRF patients experienced a statistically significant reduction in transepidermal water loss (TEWL) when using mineral oil compared to both baseline and almond oil.

Synthesis of dumbbell-like heteronanostructures encapsulated in ferritin protein: Towards multifunctional protein based opto-magnetic nanomaterials for biomedical theranostic

Dumbbell-like hetero nanostructures based on gold and iron oxides is a promising material for biomedical applications, useful as versatile theranostic agents due the synergistic effect of their optical and magnetic properties. However, achieving precise control on their morphology, size dispersion, colloidal stability, biocompatibility and cell targeting remains as a current challenge. In this study, we address this challenge by employing biomimetic routes, using ferritin protein nanocages as template for these nanoparticles’ synthesis. We present the development of an opto-magnetic nanostructures using the ferritin protein, wherein gold and iron oxide nanostructures were produced within its cavity. Initially, we investigated the synthesis of gold nanostructures within the protein, generating clusters and plasmonic nanoparticles. Subsequently, we optimized the conditions for the superparamagnetic nanoparticles synthesis through controlled iron oxidation, thereby enhancing the magnetic properties of the resulting system. Finally, we produce magnetic nanoparticles in the protein with gold clusters, achieving the coexistence of both nanostructures within a single protein molecule, a novel material unprecedented to date. We observed that factors such as temperature, metal/protein ratios, pH, dialysis, and purification processes all have an impact on protein recovery, loading efficiency, morphology, and nanoparticle size. Our findings highlight the development of ferritin-based nanomaterials as versatile platforms for potential biomedical use as multifunctional theranostic agents.

Selenium Dioxide Catalyzed Polymerization of N‐doped Poly(benzodifurandione) (n‐PBDF) and Its Derivatives

The recent discovery of highly conductive, solution‐processable, n‐doped poly(benzodifurandione) (n‐PBDF) marks a milestone in the development of conducting polymers. Currently, n‐PBDF is prepared by either duroquinone‐mediated or copper‐catalyzed polymerizations, where scalability and cost‐effectiveness may present challenges. Here, we report a general, scalable, and cost‐effective method for n‐PBDF and its derivatives, namely selenium dioxide (SeO2) catalyzed polymerization. We discovered that a catalytic amount of selenium dioxide leads to high monomer conversions (>99% by NMR). The obtained n‐PBDF exhibits a consistently narrow hydrodynamic diameter distribution and its thin films show high conductivities. Furthermore, we revealed that this polymerization involves a mechanism distinct from the previously reported radical pathway. It involves successive Riley oxidation and aldol polycondensation processes. It was also found that the reduced selenium precipitates from dimethyl sulfoxide (DMSO) when the catalytic cycle is terminated, allowing for a straightforward purification process through centrifugation and filtration. This method thus eliminates the need for the costly and slow dialysis process. Finally, we demonstrated that SeO2 catalyzed polymerization is applicable to n‐PBDF derivatives, proving the generality of this method.

Selenium Dioxide Catalyzed Polymerization of N-doped Poly(benzodifurandione) (n-PBDF) and Its Derivatives.

The recent discovery of highly conductive, solution-processable, n-doped poly(benzodifurandione) (n-PBDF) marks a milestone in the development ofconducting polymers. Currently, n-PBDF is prepared by either duroquinone-mediated or copper-catalyzed polymerizations, where scalability and cost-effectiveness may present challenges. Here, we report a general, scalable, and cost-effective method for n-PBDF and its derivatives, namely selenium dioxide (SeO2) catalyzed polymerization. We discovered that a catalytic amount of selenium dioxide leads to high monomer conversions (>99% by NMR). The obtained n-PBDF exhibits a consistently narrow hydrodynamic diameter distribution and its thin films show high conductivities. Furthermore, we revealed that this polymerization involves a mechanism distinct from the previously reported radical pathway. It involves successive Riley oxidation and aldol polycondensation processes. It was also found that the reduced selenium precipitates from dimethyl sulfoxide (DMSO) when the catalytic cycle is terminated, allowing for a straightforward purification process through centrifugation and filtration. This method thus eliminates the need for the costly and slow dialysis process. Finally, we demonstrated that SeO2 catalyzed polymerization is applicable to n-PBDF derivatives, proving the generality of this method.

Purification Processes for Generating Cationic Lignin-Acrylamide Polymers.

Purification is an essential step in many polymerization processes for fabricating highly pure polymers. This study considered various purification methods for purifying the product of lignin, acrylamide (AM), and diallyl dimethylammonium chloride (DADMAC) copolymerization reactions at a laboratory scale. The charge density, yield, molecular weight, and solubility analyses confirmed that ethanol extraction and membrane filtration were the most effective processes for producing lignin-p(AM)-p(DADMAC). The 1H NMR analysis revealed that the membrane dialysis effectively removed unreacted AM and DADMAC monomers from the reaction medium. The produced samples of the ethanol-extraction and dialysis processes had higher solubility and yield compared to the product of the acidification process. Thermogravimetric studies confirmed that the ethanol-extracted and dialyzed samples had a degradation temperature (220 °C) higher than that of the acidified samples (160 °C). The rheological studies confirmed that the viscosities of the polymer solutions were influenced more by the solubility than by the molecular weight of the generated polymers within the molecular weight range examined in this study. The flocculation studies confirmed that the ethanol-extracted and dialyzed polymers were more effective flocculants than the acidified samples for the particles of a kaolinite suspension. Based on the above results, membrane filtration with a larger pore size could be an environmentally friendly method for effectively purifying lignin-p(AM)-p(DADMAC).

7378 Glargine Induced Neuroglycopenia in Patients with End-Stage Renal Disease: Importance of Insulin Regimen Optimization in Haemodialysis Patients

Abstract Disclosure: M. Shrivastava: None. L. Kaur: None. B. Armendariz: None. R. Kaur: None. A. Shetty: None. In patients with end stage renal disease (ESRD), hypoglycemia accounts for up to 3.6% of all the admissions with mortality rates of up to 30%. A combination of impaired insulin clearance, changes in glucose metabolism and dialysis process makes the patients with end stage renal disease vulnerable to neuroglycopenia.Case description:53 year old female with past medical history of insulin dependent type 2 diabetes mellitus, ESRD secondary to diabetes, on hemodialysis(HD) thrice weekly since two years, presented to the emergency with altered mental status, respiratory distress, tachycardia. Lab work revealed blood glucose(BG) of 23 mg/dl, HbA1c of 8.4%, eGFR of 6, and arterial blood gas showed hypercapnic respiratory acidosis. Patient received dextrose, with no improvement of symptoms. Eventually she developed acute hypercapnic respiratory failure requiring endotracheal intubation with mechanical ventilation, and was transferred to the ICU. As per family, a night prior to presentation, last recorded BG after dinner was 253 mg/dl, she took her night time glargine, which was recently increased by her primary care for poorly controlled HbA1c levels. Brain MRI and long term EEG monitoring findings were consistent with underlying extensive brain injury secondary to prolonged hypoglycemia. Unfortunately, the patient's condition did not improve despite HD and BG correction, eventually she underwent compassionate extubation. Case Discussion:The insulin requirements in ESRD patients are reduced by approximately 50%, regardless of residual insulin secretion. Malnutrition and acidosis reduce hepatic glycogen stores and availability of gluconeogenic precursor, expected compensatory renal gluconeogenesis is compromised by decreased renal function causing hypoglycemia, which is further worsened by inappropriately high plasma insulin levels caused by reduced renal insulin breakdown. Diabetes mellitus patients with ESRD are frequently managed with basal-bolus insulin regimen, and HD up to thrice weekly, leaving them without HD for up to 3 days especially over the weekend. This can result in accumulation of insulin metabolites causing delayed insulin clearance as seen in our patient. In such cases even long acting insulin, such as glargine, can have compounding effects, which could possibly cause fatal complications such as neuroglycopenia. In such patients continuous glucose monitor use with tapering dose glargine regimen may help eliminate this compounding effect. Conclusion: Neuroglycopenia is a rare manifestation of diabetes mellitus with ESRD. Compromised renal gluconeogenesis and impaired insulin clearance can cause inappropriately high plasma levels of insulin. In such patients continuous glucose monitoring along with tapering dose of long acting insulin should be utilized for proper glycemic control to limit compounded effect of insulin metabolite accumulation. Presentation: 6/3/2024

Keratin Gel From Chicken Feathers Waste Obtained by Mercaptoethanol Extraction

ABSTRACTProtein gels prepared by keratin extracted from chicken feathers show potential applications as engineered materials. Feathers are an abundant waste material, whose principal component is keratin, which may have gelling properties not yet sufficiently studied so far which are strongly dependent on the extraction method adopted. The aim of the study is to explore the properties of gels obtained through mercaptoethanol extraction and dialysis process and to evaluate their structural characteristics. The keratin hydrogels were characterized with Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy through which it was possible to identify the secondary structure of the protein on hydrated and dry gel. Moreover, the morphological analysis by scanning electron microscopy (SEM) combined with the rheological analysis showed how the consistency of the gels is maintained on a wide range of loads and frequencies. Furthermore, the biocompatibility of the gels was investigated for the release of subcutaneous drugs using curcumin, an antioxidant polyphenol compound. The fastest release was obtained at pH 7.4, corresponding to physiological conditions.

Enhancing infection control in dialysis at a resource limited public healthcare institute: A cross-sectional study on microbiological quality assessment of dialysis water and dialysate

PurposeTo evaluate the microbiological quality of dialysis water and dialysate samples from hemodialysis units at a tertiary care government hospital and to assess the use of culture, endotoxin and periodicity of testing these assays to guide the actions of monitoring the quality of hemodialysis fluids, implement preventive and corrective actions, and improve the safety and outcomes of the dialysis process. MethodsA cross-sectional study was conducted at a 250-bedded super-specialty government hospital with a 24/7 hemodialysis unit equipped with 40 dialysis machines. Dialysis water and dialysate samples were collected monthly and analysed for microbial contamination and endotoxin levels as per AAMI guidelines. Bacterial cultures were done using Reasoner's Agar plates, and endotoxin analysis was performed using gel clot assay. Interpretation of results was based on predefined thresholds. ResultsAmong the 740 samples processed for microbial culture 19.6 % and 80.4% were unacceptable and acceptable respectively.Among the acceptable samples 10.5 % were at action level. At the end of 2 days of incubation, 15.2%dialysis water samples and 5.1%dialysate samples had unacceptable levels of bacterial colonies and at 5days additional 10.6 % dialysis water samples and 7.7%dialysate samples were unacceptable. 21.5 % of the samples tested for endotoxin had unacceptable levels. ConclusionsRegular monitoring of water quality in government healthcare hemodialysis units is crucial for quality of care, timely preventive and corrective actions for mitigating adverse outcomes. Processing cultures for 5–7 days is essential for detecting all contaminated specimens. While there might be a link between endotoxin levels and bacterial contamination, both endotoxin testing and bacterial culture independently are vital for evaluating water quality in dialysis settings. A comprehensive approach integrating various testing methods is necessary to uphold patient safety and enable necessary improvements.

High Luminescent Carbon Dots Derived from Fermented Beverages for Sensitive Sensing of Tartrazine in Foods.

Highly luminescent carbon dots (CDs) derived from fermented beverages-kvass (K-CDs) were synthesized through a one-step hydrothermal method with ethylenediamine (EDA) as a surface passivation reagent. Purified K-CDs with a fluorescent quantum yield of 35.1% were obtained after a dialysis process. The K-CDs were characterized by TEM, FT-IR, XPS, fluorescence and UV-vis spectroscopy. The results indicated that K-CDs possess typical excitation wavelength-dependent blue fluorescence emission, and the strongest excitation and emission wavelengths are 350nm and 440nm, respectively. The great spectral overlap between the emission peak (440nm) of K-CDs and the absorption peak (430nm) of tartrazine (TAR) leads to an effective fluorescence quenching phenomenon by TAR through inner filter effect (IFE) and the calculated (lg(I0/I)) showed a linear response to TAR concentration in the range of 0.1-70 µM. The detection limit of the developed method is 23 nM for TAR, and the relative standard deviation (RSD) is 3.9% (c = 10 µM, n = 7). The fluorescent sensor for TAR based on K-CDs through the IFE mechanism possesses the characteristics of rapid, sensitive, and high selectivity. It has been successfully applied to detect of trace TAR in foods.

Mechanism underlying anion-sieving in poly(ionic liquid)-based membrane: Effective acid recovery from engineering waste

Anion exchange membranes (AEMs) are promising for recovering acid from different engineering effluent due to their lower energy consumption, positive environmental impact, and potential for providing clean water resources. Utilizing the diffusion dialysis (DD) process, AEMs effectively retain metal ions while selectively allowing fast proton permeation. Achieving high hydrophilicity, proton conductivity, and ion exchange capacity through exact control of polymeric structure and chemical composition is crucial for enhancing the efficiency of the acid recovery process. This study presents the findings on the impact of novel Poly(ionic liquid) on cellulose acetate-based AEMs for acid recovery through DD application. In this study, interconnected nanochannel AEMs with high acid permeability are engineered using a straightforward blending technique. Poly(3-butyl-1-vinylimidazolium bromide-co-methyl methacrylate-co-styrene) (poly([BVIM]-[Br]–co–MMA-co-Styrene, PIL) is blended with cellulose acetate to achieve ionic crosslinking, resulting in a mechanically stable membrane. The dosage of PIL within the membrane matrix plays a vital role in determining the prepared membranes' physicochemical properties and ion exchange capabilities, which exhibit excellent thermal stability. Remarkably, the optimal AEM (7.5 % PILM) exhibits a high acid dialysis coefficient (UH+) of 1.05 m/h and a separation factor (S) of 802, outperforming previously reported state-of-the-art AEMs and commercial membranes. These findings indicate that the prepared AEMs are highly effective for acid recovery through DD. Notably, our work stands out by introducing new AEMs with superior acid dialysis performance and selectivity.

High-density, reversible of hydrogen-bonding and Fe3+ ion bridging enable the fabrication of multifunctional PVA-based composites

The development of continuously degradable and recyclable polymeric composites with superb mechanical properties, which can extend the service life of materials and reduce the environmental impact, will make a significant contribution to global sustainability. In this study, poly(vinyl alcohol) (PVA)-based composites (D-PVA-Fe-TA) with degradability, recyclability and excellent mechanical properties are prepared by complexation of 3,4-dihydroxybenzaldehyde-grafted PVA (D-PVA), tannin (TA) and Fe3+ ions in dimethyl sulfoxide (DMSO), and then dialysis in deionized water and glycerol (Gly). The two-step dialysis process, playing a crucial role in reducing the free water of D-PVA-Fe-TA composites, enhances the formation of reversible of hydrogen-bonding and the reinforcement of self-assembled Fe3+-chelation between TA and D-PVA, and facilitates the fabrication of PVA-based composites with a breaking strength of ≈ 18.7 MPa, an elongation at break of ∼ 812 % and a toughness of ≈ 86.81 MJ/m3; Meanwhile, the resulting homogeneous and dense structure of D-PVA-Fe-TA composites hinders the penetration of Gly solution, thereby enhancing the bonding strength and environmental adaptability of D-PVA-TA-Fe composites within the temperature range of −20℃ to 60℃. Furthermore, the as-prepared D-PVA-TA-Fe composites exhibit recyclability for multiple cycles. When placed under soil culture medium, the resulting composites can be degraded without the need for manual interference. This study presents a novel strategy for the fabrication of materials possessing excellent mechanical strength, environmental adaptability, recyclability and degradation, which have great potential for taking the place of conversional composites in specific conditions.

Efficient Production and Purification of Bioactive E50-52-ClassIIa Peptidic Bacteriocin Is Achieved through Fusion with the Catalytic Domain of Lysostaphin-Class III Bacteriocin.

E50-52, a class IIa-peptidic bacteriocin produced by a strain of Enterococcus faecium, has broad-spectrum antimicrobial activity against various foodborne pathogens. However, effective utilization of the E50-52 has been limited by low production yields and challenges associated with separation and purification of this 39-amino acid antimicrobial peptide. In this study, we have successfully produced a biologically active recombinant form of E50-52 by fusing it with the 16-kDa catalytic domain of lysostaphin-classIII bacteriocin (LssCAT), which resulted in high-yield production. Initially, the LssCAT-E50-52 chimeric protein was insoluble upon over-expression in Escherichia coli, but it became soluble using phosphate buffer (pH7.4) supplemented with 8M urea. Purification using immobilized-Ni2+ affinity chromatography under urea denaturing conditions resulted in consistent production a homogenous products (LssCAT-E50-52) with >95% purity. The purified protein was refolded using an optimized stepwise dialysis process. The resulting refolded LssCAT-E50-52 protein exhibited dose-dependent inhibitory activity against Helicobacter pylori, a Gram-negative, flagellated, helical bacterium that is associated with gastric cancer. Overall, the optimized protocol described in this study effectively produced large quantities of high-purity recombinant LssCAT-E50-52 protein, yielding approximately 100mg per liter of culture. To thebest of our knowledge, this is the first report on the impact of LssCAT-E50-52 on H.pylori. This finding could pave the way for further research into bactericidal mechanism and potential applications of this bacteriocin in biomedical industry.

Dialysis rolled scaffold bioreactor allows extended production of monoclonal antibody with reduced media use.

Rapidly expanding biopharmaceutical market demands more cost-effective platforms to produce protein therapeutics. To this end, novel approaches, such as perfusion culture or concentrated fed-batch, have been explored for higher yields and lower manufacturing costs. Although these new approaches produced promising results, but their wide-spread use in the industry is still limited. In this study, a dialysis rolled scaffold bioreactor was presented for long-term production of monoclonal antibodies with reduced media consumption. Media dialysis can selectively remove cellular bio-wastes without losing cells or produced recombinant proteins. The dialysis process was streamlined to significantly improve its efficiency. Then, extended culture of recombinant CHO cells for 41 days was successfully demonstrated with consistent production rate and minimal media consumption. The unique configuration of the developed bioreactor allows efficient dialysis for media management, as well as rapid media exchange to harvest produced recombinant proteins before they degrade. Taken together, it was envisioned that the developed bioreactor will enable cost-effective and long-term large-scale culture of various cells for biopharmaceutical production.

Improving the solubilization, stability, dialysis performance and antioxidant properties of quercetin in surfactant-free microemulsion

The flavonol compound quercetin with poor water solubility, was solubilized in a novel green solvent constructed in this work. The solvent is composed of tributyl citrate, ethanol and water, recognized as surfactant-free microemulsion (SFME). The solubilization behavior and mechanism of quercetin were investigated, the light, thermal, storage stability and antioxidant properties were examined, as well as the dialysis properties and release kinetics. The results reveal that there are interactions existing between quercetin and tributyl citrate. Ethanol and tributyl citrate in SFME also have a synergistic solubilization effect on quercetin. Therefore, the content of quercetin increases with tributyl citrate, and the solubility of quercetin in oil in water SFME (RE/W = 7:3, ƒO = 0.1) is 9.88 mg/ml, much higher than that in water or ethanol. The light, heat, storage stability and antioxidant properties of quercetin are greatly improved by SFME. In the dialysis process, the release of quercetin in SFME follows a non-Fickian diffusion mechanism with a slow-release action. The SFME established has green and non-toxic advantages in the application of the solubilization field, and it is expected to provide important guidance for the extraction and separation of natural foods.

Green preparations of nanolignin from acid-saccharification-treated sugarcane trash

Characterization of isolated lignin and utilization of nanotechnology to produce nanolignin as a functional material are paramount. Lignin was extracted from acid-saccharification sugarcane trash (SCT-ASac) to produce acid-saccharification lignin (ASac-lignin). Then, lignin was further processed to nanolignin by a self-assembly dialysis process using THF:ethanol (1:1) as the solvent. The chemical, physical, and thermal properties of the lignin were evaluated, and the nanolignin size was confirmed via morphological analysis and PSA. SCT-ASac treatment prior to lignin isolation affects the structure of SCT and enhances the accessibility of lignin. Furthermore, this pretreatment can reduce residual carbohydrates, increasing the purity value. ASac-lignin has a nonconjugated phenolic group structure with a high number of β-O-4 bonds, a syringyl content, aromatic groups with low thermal stability, and a molecular weight with good phenolic hydroxyl content and total phenolic compounds. The obtained nanolignin is a spherical and more uniform particle with sizes less than 100 nm. ASac-nanolignin has the potential to be an environmentally friendly material in derivative lignin synthesis.

Green Dialysis From the Indian Perspective: A Systematic Review.

Global warming and climate change represent the most significant threats to humanity in the 21st century, both of which are manmade catastrophes. Addressing climate change requires corrective action across all aspects of modern human life and work, including the medical field. Among healthcare sectors, dialysis units stand out as major contributors to plastic waste and excessive water consumption. It is imperative for hemodialysis units to lead by example in the judicious use of natural resources. This systemic review is aimed to establish a bare minimum of recommendations for environmental sustainability across Indian dialysis units, and to guide future initiatives to reduce the environmental impact of dialysis process. A literature search was conducted on PubMed, and Google to retrieve articles or studies related to green dialysis. The predefined keyword search yielded a total of 291 studies. A total of 54 studies and articles which were relevant to study question, and fulfilled inclusion criteria, were retrieved and analyzed to form opinions on the implementation of green dialysis initiatives from an Indian perspective. Green dialysis initiatives are much-needed reforms to be adopted by the Indian dialysis community. Through careful planning and minimal efforts, substantial amounts of water used in hemodialysis can be conserved and repurposed for other hospital activities. Similarly, the vast majority of discarded plastic waste can be recycled or reused. Despite controversy, reconsidering the risk-benefit aspects of dialyzer reuse is essential, particularly in the context of resource-limited developing nations like India.

Characterization of New Experimental Materials for Hemodialysis Membranes and Simulation of Urea Dialysis Process with Their Use

Characterization of New Experimental Materials for Hemodialysis Membranes and Simulation of Urea Dialysis Process with Their Use

#704 Albumin, inflammation and nutrition in hemodialisis patients in Colombia: a cohort study

Abstract Background and Aims Hypoalbuminemia is a well-identified risk factor for mortality in chronic hemodialysis patients. As a negative acute phase reactant, albumin levels could be associated with several factors that affect the patient on hemodialysis (HD), such as alterations in the rate of hepatic synthesis, an increase in the rate of catabolism, or an increase in losses due to the dialysis process. The objective of the present study is to analyze serum albumin values in repeated measurements over time in two cohorts, one with expanded HD (HDx) enabled by the medium cut-off membrane (MCO) Theranova and the other with high flux (HF) HD and estimate the relationship with other relevant variables. Method Cohort study, one with HDx enabled by Theranova® and the other with HF HD, adult prevalent HD patients (> 90 days) at Baxter Renal Care Services Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 48 months. Sociodemographic and clinical characteristics were summarized descriptively, and a mixed linear model with repeated measures was performed to evaluate the association between dialysis membrane and albumin levels, controlling for confounding variables. Results We evaluated 1092 patients (62% male): 533 in HF-HD vs. 559 in HDx (Table 1); the median age was 61 years, 42% had a history of diabetes, and 19% had cardiovascular disease. We found no differences in albumin levels over time when comparing Theranova versus HF HD patients, p-value = 0.789 (see Fig. 1). No association between serum albumin levels and the Theranova dialyzer was found with the linear mixed model with repeated measures when controlling for confounding variables, p-value= 0.198. On the other hand, we found that serum albumin was associated with inflammatory and nutritional variables such as C reactive protein, Ratio platelets/lymphocytes, and Protein Energy Wasting (PEW) (Table 2). Conclusion Variables including nutritional status and inflammation, age, and hospitalization events are associated with serum albumin levels varying over time. Variation in serum albumin levels over time are not associated with type of dialyzer (Theranova® vs HF).

Stretchable hydrogels of chitosan/hyaluronic acid induced by polyelectrolyte complexation around neutral pH

In this work, we propose the formation of stretchable hydrogels at neutral pH from the physical crosslinking of chitosan (CS) and hyaluronic acid (HA) by polyelectrolyte complexation. A mixture of CS (Mw ≈ 600 kg/mol, degree of acetylation ≈ 50 %) solution and HA (Mw ≈ 77 kg/mol) solution was prepared with an excess of salts screening the electrostatic interactions CS/HA. In a controlled manner, the polyelectrolyte complexation was induced through the progressive dialysis of the salted polymer mixture against a sodium acetate solution (AcONa, 0.01 M) for 7 days. Depending on [HA], various materials were obtained: viscous solutions at [HA] = 0.75 % (w/v); hydrogels at [HA] = 1.50–2.24 % (w/v) with Young modulus of 14 kPa and stretchable to 200 %. The small angle X-ray scattering characterization of the hydrogels revealed a multiscale organization related to the conformation of the polymers induced by the physical interactions. The dialysis process with AcONa was optimized by adding a dialysis step against a zinc acetate solution containing Zn2+. The combination of polyelectrolyte complexation between CS/HA and metal complexation between Zn2+ and the polymers led to an enhancement of the hydrogel stretchability up to 400 %.

Psychological Stressor Of End Stage Chronic Kidney Disease Patients On Dialysis. A Battle For Life

Introduction Patients with chronic kidney disease (CKD) may choose to undergo dialysis. Factors that may have led patients to prescribe psychological interventions related to dialysis are poorly understood in the literature. The purpose of this study was to explore multi-level factors surrounding dialysis modalities such as Diagnosed Mood Disorders, Existential crises, Triggering events, Social support, and Distrust towards the process of dialysis.ObjectivesThe study aims to investigate the psychological battle of the client while going through the process of dialysis. The study reveals multiple mood disorders and existential crises leading to depression among chronic kidney disease patients. Therefore the study was conducted with the aim of providing a therapeutic guide line in future once the factors are investigated in detail.MethodsSemi-structured qualitative interviews were conducted in a dialysis clinic in Karachi where 19 participants participated in this qualitative study. The age ranges from 40-76. Initiating with informed consent followed by surveys assessing demographic and clinical information were administered to participants following their interviews.ResultsQualitative findings suggested that patients were dealing with Clinical Mood Disorders without being provided treatment. Moreover, the cohesive family support enabled them to continue with daily living activities; however, the patients with low support triggering adverse events in life lost their lives in follow-up sessions. Furthermore, nephrology care doesn’t seem sufficient as they are dealing with existential crises of hopelessness, regret, condemnation, and elevated death anxiety. In CKD the misinterpretation of dialysis by cognitively substituting it as End of life increased the clinical symptoms of Mood disorders. Thus the risk factors increase disturbing the quality of life.ConclusionsFindings point to broader factors affecting dialysis modalities with Mood disorders. The low social support and adverse triggering events precipitate the risk factors of dialysis treatment. Furthermore, distrust towards dialysis and existential crisis are recommended for therapeutic interventionsDisclosure of InterestNone Declared