Hemodialysis Process Research Articles

Factors Regulating Fluid Restitution and Plasma Volume Reduction over the Course of Hemodialysis.

Over the course of hemodialysis, fluid and protein are restituted from the tissue compartment to the circulation compartment through the endothelia. Our previous model analysis on fluid and protein transport during hemodialysis is expanded to account for changes occurring in the tissue. The measured initial and end plasma protein concentration (PPC, Cp and Cp') for six hemodialysis studies are analyzed by this expanded model. The computation results indicate that the total driving pressure to restitute fluid from the tissue to the circulation ranges from 5.4 to 20.3 mmHg. The analysis identifies that the increase in plasma colloidal osmotic pressure (COP) contributes 78 ± 6% of the total driving pressure, the decrease in microvascular blood pressure 32 ± 4%, the increase in the COP of interstitial fluid -6 ± 3%, and the decrease in interstitial fluid pressure -5 ± 2%. Let this ratio (Cp' - Cp)/Cp' be termed the PPC increment. The six HDs can be divided into three groups which are to have these PPC increments 25.7%, 14.5 ± 2.6(SD)% and 8.3%. It is calculated that their correspondent filtration coefficients are 0.43, 1.29 ± 0.28 and 5.93 mL/min/mmHg and the relative reductions in plasma volume (RRPV) -22.1%, -13.1 ± 6% and -9.4%. The large variations in PPC increments and RRPV show the filtration coefficient is a key factor to regulate the hemodialysis process.

Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis

This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.

GANGGUAN HEMOSTASIS PADA PENYAKIT GINJAL KRONIK DERAJAT 5

Patients with chronic kidney disease (CKD) develop hemostatic disorders mainly in the form of bleeding diatheses. Platelet dysfunction is the main factor responsible for hemorrhagic tendencies in advanced kidney disease. Anemia, dialysis, the accumulation of medications due to poor clearance, and anticoagulation used during dialysis have some role in causing impaired hemostasis in CKD patients. Platelet dysfunction occurs both as a result of intrinsic platelet abnormalities and impaired platelet-vessel wall interaction. The normal platelet response to vessel wall injury with platelet activation, recruitment, adhesion, and aggregation is defective in advanced renal failure. Dialysis may partially correct these defects, but cannot totally eliminate them. The hemodialysis process itself may in fact contribute to bleeding. Hemodialysis is also associated with thrombosis as a result of chronic platelet activation due to contact with artificial surfaces during dialysis.

The use of a low-flux hemo-dialyzer is associated with impaired platelet aggregation in patients undergoing chronic hemodialysis.

In patients with chronic hemodialysis (HD), both abnormal thrombotic and bleeding events are commonly observed. Uremic platelet dysfunction is one of the important attributing factors. Moreover, HD may also result in aggregation dysfunction of platelets during the therapeutic procedure. However, how the HD process affects platelet and coagulation function is unknown and dialyzer membrane flux could have an impact on it. We aimed to compare the impacts of low-flux and high-flux HD on the platelet function of patients undergoing chronic HD. This was a cross-sectional study conducted in the HD unit of E-Da hospital in Taiwan. A total of 78 patients with maintenance HD three times per week for more than one year, including 40 with high- and 38 with low-flux hemodialysis, were recruited. Their platelet functions were evaluated using an in vitro platelet function analyzer (PFA-100) before and after the HD session. Of the 78 patients undergoing HD, 60 (76%) had prolonged pre-dialysis collagen/epinephrine (CEPI) and collagen/adenosine diphosphate closure times. Those receiving low-flux dialyzer had a significant increase in CEPI closure time (pre-dialysis 212.3 ± 62.1 seconds. post-dialysis 241.5 ± 64.3 seconds, P = .01), but not collagen/adenosine diphosphate closure time, after HD. After adjusting confounding factors, only the low-flux dialyzer demonstrated an independent association with the prolonged CEPI closure time after HD therapy (odds ratio = 23.31, 95% CI: 1.94-280.61, P = .01). We observed that impaired platelet aggregation is prevalent in patients undergoing chronic HD. Therefore, the use of low-flux dialyzers may further worsen platelet aggregation after dialysis. Patients with uremic bleeding diathesis should take precautions. We suggest that further studies using flow cytometry should be conducted to explore the mechanism of dialysis flux and platelet activity during HD.

The effects of Amlodipine and Propranolol on Haemodialysis Efficiency in End-Stage Renal Failure patients

Background: The high rate of death and sickness perceived in patients with end-stage renal disease is principally ascribed to the inadequacy of haemodialysis (HD), and this may relate to inadequate analysis of the factors affecting the HD process, including drugs taken by these patients. Aims and Objective: To explore the potential association of a dihydropyridine calcium channel blocker (amlodipine) and a beta-blocker prototype (propranolol) separately with the dialysis efficiency in HD patients. Methods: This is a retrospective study which include 275 (112 females and 163 males, 83% of whom also suffered from hypertension) patients with end-stage renal failure on haemodialysis. Patients were categorized into three groups: 125 patients taking amlodipine, 81 patients taking propranolol, and 69 patients not taking any of the above medications (controls). The HD efficiency, and the percentage reduction in creatinine, uric acid, and urea levels were compared between groups. Results: Compared with patients who were not receiving amlodipine or propranolol, a significant increase in the major HD adequacy marker which is the Kt/V ratio, as well as in the percentage reduction in creatinine, uric acid, and urea levels, was observed in patients taking amlodipine, but a significant decrease in these markers was detected in patients taking propranolol. Conclusions: Taken together, these findings indicate that the haemodialysis efficiency may be significantly improved (diminished) by supplementation with amlodipine (propranolol).

Experiences of Hemodialized Patients WHO Have Recovered From Covid-19 In Medan City

Hemodialysis is one of the appropriate treatments for patients with ESRD. The glomerular filtration rate in the kidneys decreased to &lt;60 mL/min and the creatinine and albumin values ​​in the patient's urine increased to &gt;30 mg/g, so that patients with chronic kidney failure had to undergo a treatment to balance and replace the work of the kidneys, namely the hemodialysis process. The research design used in this study is a descriptive phenomenological design. Phenomenology is a method that seeks to find the essence and meaning of phenomena as they are experienced, especially through in-depth interviews with people who have had relevant experiences. In this study, the characteristics of participants were obtained based on the demographic data obtained, where the average age of hemodialysis participants who were positively exposed to COVID-19 was more likely to be under 50 years old, with 7 participants, and 4 participants over 50 years old. . The gender of hemodialysis participants in this study was found to be 6 men and 5 women. Another characteristic that was obtained was that the ethnic groups that participated in this study were, the Batak tribe numbered 6 people, Karo 1 person, Malay 1 person, Padang 1 person and Javanese 1 person. The religion of the participants in this study, it was found that 2 Protestant Christians, 8 Muslims, and 1 Catholic Christian

GANGGUAN HEMOSTASIS PADA PENYAKIT GINJAL KRONIK DERAJAT 5

Patients with chronic kidney disease (CKD) develop hemostatic disorders mainly in the form of bleeding diatheses. Platelet dysfunction is the main factor responsible for hemorrhagic tendencies in advanced kidney disease. Anemia, dialysis, the accumulation of medications due to poor clearance, and anticoagulation used during dialysis have some role in causing impaired hemostasis in CKD patients. Platelet dysfunction occurs both as a result of intrinsic platelet abnormalities and impaired platelet-vessel wall interaction. The normal platelet response to vessel wall injury with platelet activation, recruitment, adhesion, and aggregation is defective in advanced renal failure. Dialysis may partially correct these defects, but cannot totally eliminate them. The hemodialysis process itself may in fact contribute to bleeding. Hemodialysis is also associated with thrombosis as a result of chronic platelet activation due to contact with artificial surfaces during dialysis.

Association of the efficiency of hemodialysis instruments in the removal of microbial and chemical pollutant.

Dialysis water is vital because of various harmful contaminants for patients. The aim of this study was to assess the efficiency of hemodialysis instruments in the removal of microbial and chemical pollutant in educational hospitals affiliated to Ahvaz Jundishapur University of medical sciences, Iran during 2018–2019. This cross-sectional descriptive research studied the microbial and chemical water quality of hemodialysis instruments in Razi, Sina, and Golestan hospitals in Ahwaz, Iran. 72 samples of microbial parameters and 24 samples of chemical parameters were collected from water used in hemodialysis instruments, including microbial characteristics (the total coliform, fecal coliform and heterotrophic bacteria counts) and chemical characteristics (pH, turbidity, PO4, Cl, Mg, So4, Ca, NO2, and EC) at Razi, Imam, and Golestan educational hospitals on all weekdays during 2018-2019. In this study, experiments were done according to the current standard methods, EPA from hemodialysis instruments. Finally, using SPSS18 software and descriptive statistics, the relationship between results at the removal of toxic, microbial, and chemical pollutants in different months and hospitals was investigated. this study showed that the average concentration of chemical characteristics during the warm season at Razi, Imam, and Golestan educational hospitals for pH, Turbidity, PO4, Cl, Mg, So4, Ca, NO2, and EC were (6.867, 6.4475, 6.53); (2.985, 3.035, 1.226); (0.075, 0.245, 0.195); (38.5, 21.965, 144.87); (1.552, 1.657, 39.445); (8.6, 4.5, 21.5), (2.09, 3.187, 78.975); (0.0082, 0.038, 0.155), and (125.25, 70.35, 78.35), respectively during 2018. Also, during 2019, results showed that the average levels of amounts for pH, Turbidity, PO4, Cl, Mg, So4, Ca, NO2, and EC in Razi, Imam, and Golestan educational hospitals were (7.077, 7.252, 6.435), (1.725, 0.595, 4.16), (0.0775, 0.0597, 0.0297), (52.33, 138.81, 20.92), (23.52, 18.227, 8.767), (35, 27.25, 4.05), (14.58, 28.152, 9.25), (0.0067, 0.0045, 0.0032), and (210.52, 121.62, 29.16), respectively. According to the results, hemodialysis instruments in Razi and Imam have a 90% efficiency in removing heterotrophic bacteria counts (HPC). Based on these findings, educational hospital hemodialysis equipment effluent in Ahvaz, Iran was mitted to Iran environmental standards for use in hemodialysis machines. The result showed that the removal percentage level of microbial and chemical pollutants by the hemodialysis process is comparatively suitable. It should be mentioned that in the proper operation and reconstruction, hemodialysis systems can have an increased rate of removal of microbial and chemical pollutants.

NURSE’S PRACTICE REGARDING USE OF INFECTION CONTROL SAFETY MEASURES IN HEMODIALYSIS UNITS- AT KHARTOUM STATE, SUDAN

Background: Nurses play an important role at the dialysis units, they are the key health caregivers responsible for applying the foremost skills and principles of infection control steps throughout the process of hemodialysis. This may reflect their attitude and knowledge of infection control principles. Aim: This study aims at Assess Nurse’s Practice Regarding Use of Infection Control Safety Measures Blood Born Diseases in Hemodialysis Units.Methods: This is a descriptive, cross-sectional hospital-based study, conducted at Khartoum main haemodialys). Itentres- Khartoum State, Sudan. Six main governmental hospitals were selected, plus the hospitals that provide haemodialysis. Seventy nurses providing haemodialysis nursing were enrolled in this study, data was collected using self-administered questionnaire with an observational check list for data collection, data analysis was carried out using the statistical package for social sciences (SPSS), and the results were presented in descriptive and numerical forms as well as cross tables.Result: This study, revealed that the level of practice and using of the standards of infection control percussions; 65 (92.9%) of participants used gloves among isolated and re-used it among non-isolated patients, around half of the participants 36 (51.4%) did not use hand washing, following patient or patient’s tools touching, where may have led to spread of blood borne diseases. There was no significant relationship between the practices and the study group, regarding the of level experience P-value &lt; 0.445. The level of practices was satisfied. So, the level of practice regarding the hazards of contamination is recommended to establish in- service regular staff training to encourage infection control management, standardize practices check list.

Investigating the Dialysis Treatment Using Hollow Fiber Membrane: A New Approach by CFD.

Due to the increase in the number of people affected by chronic renal failure, the demand for hemodialysis treatment has increased considerably over the years. In this sense, theoretical and experimental studies to improve the equipment (hemodialyzer) are extremely important, due to their potential impact on the patient’s life quality undergoing treatment. To contribute to this research line, this work aims to study the fluid behavior inside a hollow fiber dialyzer using computational fluid dynamics. In that new approach, the blood is considered as multiphase fluid and the membrane as an extra flow resistance in the porous region (momentum sink). The numerical study of the hemodialysis process was based on the development of a mathematical model that allowed analyzing the performance of the system using Ansys® Fluent software. The predicted results were compared with results reported in the literature and a good concordance was obtained. The simulation results showed that the proposed model can predict the fluid behavior inside the hollow fiber membrane adequately. In addition, it was found that the clearance decreases with increasing radial viscous resistance, with greater permeations in the vicinity of the lumen inlet region, as well as the emergence of the retrofiltration phenomenon, characteristic of this type of process. Herein, velocity, pressure, and volumetric fraction fields are presented and analyzed.

Level Fatigue of Chronic Kidney Disease Patients Undergoing Hemodialysis

Background: The hemodialysis process is beneficial for chronic kidney disease patients in maintaining their lives. This routine and the continuous process will cause complications in the body. Fatigue is the main complaint of patients undergoing long-term hemodialysis. Fatigue conditions in patients with chronic kidney disease appear to be caused by physiological and psychological factors. The fatigue condition in the client will affect the patient's daily activity level. Methods: This research is a descriptive study with a cross-sectional study design. The sample in this study was 78 patients undergoing hemodialysis who were taken using the purposive sampling technique—assessment of Fatigue using the PSF (Piper Fatigue Scale) questionnaire. Data analysis in this study used descriptive analysis to determine the variables' distribution, frequency, and percentage. Results: From the research results, some respondents do not work by 92.3%. Several reasons cause them not to work again since chronic kidney disease. One of the reasons is that they feel tired quickly, so their activity is limited, and some patients feel that they are limiting their activities because they have an av shunt attached. Based on the results of the study that most of the respondents had undergone the HD process for 2-4 years (78.8%). The highest Hb values were in the range of 9-10gr/dl (88.4%). Conclusion: Fatigue of patients undergoing hemodialysis increases. it is hoped that respondents can know and increase their level of self-efficacy after being vaccinated against covid-19

Oxidative stress in hemodialysis patients infected with HIV

Background: HIV-infected population presents the impaired renal function as a risk factor for death, and comorbid conditions are related in some traits to oxidative stress (OS). Objetive: To analyze the influence of OS in Human Immunodeficiency Virus Infection (HIV) and chronic kidney disease (CKD) by comparing the redox status between HIV patients with and without CKD and HIV hemodialysis patients. Methods: A comparative longitudinal study of the hemodialysis process was developed. The study included 96 individuals divided into four groups namely, supposedly healthy volunteers, patients with HIV infection without renal illnesses, patients with HIV infection and chronic renal disease, and HIV(-) with chronic renal disease. Indexes evaluating redox, hematological, hemochemical, immunologic, and virological aspects were determined. These indexes were also assessed before and after hemodialysis. Results: Viral load, uric acid, creatinine, and urea concentration were significantly (p&lt;0.05) lower after hemodialysis. The two HIV infected groups were significantly different (p&lt;0.05) regarding redox indexes of damage and antioxidant status compared to the group of supposedly healthy volunteers. Significantly increased values (p&lt;0.05) of malondialdehyde, advanced oxidation protein product (AOPP), and peroxidation potential (PP) and significantly lower values glutathione (GSH) (p&lt;0.05) were found after hemodialysis in both groups. In the case of HIV patients, increased values of superoxide dismutase were also found. HIV infected patients under HD tretament exhibited significantly (p&lt;0.05) higher values of AOPP and PP and lower values of GSH than HIV(-) hemodialysis patients after hemodialysis. Conclusion: Oxidative stress occurs in both HIV and CKD conditions, and it is also increased after hemodialysis intervention. Otherwise non-viral control could influence on oxidative status in HIV/CKD patients, that´s why ART affectivities should be monitoring using HIV progression markers. Redox indexes should be diagnosed in HIV hemodialysis patients for treatment and management adjustment.

Microvascular Dynamics and Hemodialysis Response of Patients With End-Stage Renal Disease.

In our previous analysis of three sets of hemodialysis studies, we found that patients possessing higher hematocrit have a higher filtration coefficient KSo and more fluid being restituted from the tissue. A new dynamic analysis is developed to reveal how the plasma protein concentration, restitution volume, and plasma volume are changing over the time course of 240 min hemodialysis. For patients with the filtration coefficient KSo as 0.43 or 5.88 ml/min/mmHg, we find that the restitution rate would reach 50% of the extraction rate in 5.3 or 57.4 min, respectively. By the end of hemodialysis, the restitution rate of both patients asymptotically approaches a value of 0.93 ml/min which is slightly higher than the extraction rate of 9.03 ml/min. The plasma volume drops by 10% of the total plasma volume in 11 min for patients with low KSo and drops by 2.1% and turns around to an increasing trend in 5.6 min for patients with high KSo. These results suggest that the filtration coefficient acts like a facilitator in restituting more fluid from the tissue to compensate for the loss of plasma volume due to extraction. The hematocrit data of three sets of hemodialysis also indicate that significant microvascular blood volume is shifted from small veins toward the venous side of macrocirculation. A better understanding of how the factors examined here cause hypovolemia can be the basis for one to modify the hemodialysis process such that the development of hypovolemia can be avoided over the course of hemodialysis.

MO922: Intradialytic Plantar Electrical Nerve Stimulation During Routine Hemodialysis Process Facilitate Physical Activities of Daily Life in Adults With Diabetes and End-Stage Renal Disease––A Randomized Double-Blinded Controlled Trial

Abstract BACKGROUND AND AIMS Reduced physical activity in daily life is a persistent problem in patients undergoing hemodialysis (HD). Although exercise could be beneficial, factors such as post-dialysis fatigue, time limitation and severe frailty may result in poor compliance. We are exploring an alternative therapy using intradialytic plantar electrical nerve stimulation (IPENS) provided during the routine hemodialysis process to address this gap. METHOD A total of 20 participants undergoing hemodialysis (age = 55 ± 2.7 years, BMI = 30.6 ± 1.3 kg/m2 female = 31%) were randomly assigned to the intervention group (IG), and 18 participants (age = 56 ± 2.2 years, BMI = 32.2 ± 1.2 kg/m2 female = 41%) were assigned to the control group (CG). The IG received 1-h IPENS during the routine hemodialysis process (three sessions/week) for 12 weeks. The CG received an identical but non-functional device for the same period. Participants and therapy-providers were blinded to the group allocation. Daily life physical activity was assessed remotely at baseline and every 12 week using a pendant wearable. To determine the effect of intervention, we estimated Cohen's effect size d. In addition, time effects, group and time × group effects were estimated using a general linear model. RESULTS We observed a significant increase in (Cohen's d = 0.97, P &amp;lt; 0.01) number of postural transitions, (d = 0.71, P = 0.04) daily step counts and (d = 0.73, P = 0.03) episodes of walking due to IPENS. All participants in the IG tolerated the IPENS and completed all therapy sessions, indicating the feasibility. CONCLUSION These are early results related to IPENS therapy's feasibility and effectiveness to improve mobility among individuals undergoing routine hemodialysis. We can recommend routine IPENS therapy as a practical alternative for those who may not engage in routine exercise programs if the results will be held in the larger sample.

Proactive Risk Assessment Through Failure Mode and Effect Analysis (FMEA) for Haemodialysis Facilities: A Pilot Project.

Haemodialysis (HD) is one of the methods for renal replacement therapy in the management of advanced chronic kidney disease through an osmosis process that allows purification of blood in the dialysis machine. The complexity of the dialytic procedure often requires the presence of a multi-specialist, multi-disciplinary team. The dialysis process is an important target for clinical risk management. Failure Mode and Effect Analysis (FMEA) is a proactive technique, considered a purposeful and dynamic tool for clinical risk management. FMEA is noted in five phases that allow a preliminary assessment of a definite process through identification and classification of risk priorities. This study represents the first of a two-phase project where FMEA is applied to HD in the setting of San Feliciano Hospital. The dialysis center performs ~12,000 dialysis sessions per year. The dialysis process is divided into different stages. A total of 31 failure modes were identified in the whole dialysis stages; more than 2/3 of the failure modes were related to the only connecting of the patient to the dialysis machine. The first phase of the study clearly remarked that the most critical step of the dialytic process is represented by the connection between the patient and the machine, as expected. Indeed, in order to have the dialysis set up, an arteriovenous fistula must be surgically created prior to the procedure and it is one of the most important issues in the HD process because of the necessity of a constant revision of it. FMEA application to HD is a useful tool, easy to be implemented and it is likely to nimbly reveal the practical and potential solutions to the critical steps of the procedure.

Online hemodiafiltration (HDF) versus high-flux hemodialysis (hf-HD): A review

Chronic kidney disease affects a vast part of the world population and as a consequence gradually declines renal function. Patients enter the end stage of kidney disease as the disease progresses, and the use of renal replacement therapy such as hemodialysis then becomes necessary. With the advance of technology, new modalities of dialyzers have been made available in the market with the objective of making the hemodialysis process more efficient and of increasing its biocompatibility. This review aims to discuss different hemodialysis techniques, focusing on online hemodiafiltration and high-flux hemodialysis, in terms of molecular clearance, biocompatibility, cardiovascular stability, survival, safety, and costs. In comparison to conventional hemodialysis (low-flux), online hemodiafiltration and high-flux hemodialysis present a greater capacity to filtrate medium molecular weight molecules, presenting greater biocompatibility and maintaining cardiovascular stability during dialysis sessions, and constituting factors which can justify better outcomes of patients submitted to these modalities. However, studies differ on the real superiority of online hemodiafiltration when compared to high-flux hemodialysis, which highlights the need for further discussion on the subject.

PROGRAM PELATIHAN DAN PENDAMPINGAN PASIEN HEMODIALISIS DALAM UPAYA AKSELERASI CAPAIAN ADEKUASI HEMODIALISIS

Hemodialysis adequacy is an important parameter that reflects the success of the hemodialysis process. The main problem related to the achievement of hemodialysis adequacy is the patient's non-adherence to hemodialysis management and prescribing. Therefore, it is necessary to design programs that train patients so that they have the ability to manage disease and increase adherence to therapy. The training and mentoring program is designed to improve patient compliance with therapy and to monitor changes in the patient's condition during the hemodialysis process. This program aims to accelerate the achievement of hemodialysis adequacy. The participants involved were patients who routinely underwent hemodialysis twice a week. Patients are given training and assistance regarding the management of kidney failure and hemodialysis. The results showed an increase in knowledge and patient compliance in disease management. The achievement of adequacy was found to increase after being given this program. Therefore, assistance for hemodialysis patients is very important and needs attention by health workers who work in the hemodialysis room.

Improving vascular access creation among hemodialysis patients: An agent-based modeling and simulation approach

Chronic kidney disease is a worldwide public health problem, and vascular access is known as hemodialysis patients' lifeline. Hemodialysis is the most common treatment for kidney replacement. The choice of vascular access should be “patient-centered.” However, the preferred or optimal type of vascular access that is generally recommended by clinical guidelines for hemodialysis patients is a native Arteriovenous Fistula (AVF). Despite the recommendations of the guidelines, unfortunately, many hemodialysis patients undergo dialysis through the catheter. Thus, this issue must be controlled by healthcare providers to reduce the adverse events of choosing this access for patients. As such, the prevalence of the concept of “first fistula, catheter last,” identification of barriers to catheterization and effective factors in the use of native venous arterial fistula, as well as evaluating its impact on improving health and quality of life should be considered. To this aim, we have developed an agent-based simulation to investigate the effects of different agents on this process, as well as plan to achieve the desired status for improving and optimizing vascular access creation and maintenance. The decisions and behaviors of the stakeholders (agents) play a critical role in hemodialysis processes, so we have simulated their behaviors and decisions that are the most essential factor in establishing the system's status. To understand and evaluate the current situation, several experts, including nephrologists, surgeons, and dialysis nurses have been recruited to detect the factors influencing this process plus the relevant stakeholders, and their roles and effects. Our study has shown that agent-based modeling has a great potential in developing a simulation model to improve vascular access creation among hemodialysis patients.

Chitosan-starch cross-linked citric acid as adsorptive hemodialysis membrane

The development and application of membrane methods in the medical field are essential to separate and eliminate toxins and impurities in the bloodstream through the process of hemodialysis. To be able to eliminate all toxic substances in the body fluid, the hemodialysis membrane must have the dual ability of adsorption properties and diffusion through the pore membrane. The chitosan-starch hemodialysis membrane un-crosslinked and cross-linked has been made to separate creatinine compounds with those with the dual ability to combine diffusion and adsorption from the membrane. Chitosan-binding starch membranes are made using citric acid as a cross-linking agent. Chitosan starch membrane uncross-linked has a clean water flux of 96 Lh−1 m−2, whereas chitosan-starch membrane cross-linked has 90 L h−1 m−2 clean water flux. Chitosan-starch membrane uncross-linked can remove creatinine of 11.89 mg/gram where the amount removed by adsorption reaches 8.66 mg/gram membrane. The chitosan-starch cross-linked membrane can remove creatinine 9.86 mg/gram membrane with the amount removed by adsorption reaching 5.14 mg/gram membrane. Chitosan-starch membranes have hemodialysis characteristics that are integrated with adsorption, where blood toxins are released in one step.

The Possibilities of Chronic Renal Failure Patients Contracting Occult Hepatitis B Virus Infection, Sudan

Introduction: Chronic kidney disease (CKD) is a major cause of death in sub-Saharan Africa. The effects of the CKD on the host and the continuous therapeutic measures increase the hypothesis of blood-borne diseases transmission. Objective: This study aimed to find the frequency of occult hepatitis B virus (OBI) in patients of chronic renal failure (CRF) and to study the possibilities of infection acquisition. Methods: During 2017 and 2019, two hundred CRF patients under regular haemodialysis and attending Gezira Hospital for Renal Diseases and Surgery were recruited. Plasma specimens were collected and used for detection of hepatitis B surface antigens (HbsAg), total hepatitis B core antibodies (anti-HBc) and hepatitis B virus DNA isolation. Nested PCR reaction was followed to identify HBV. Socio-clinical data for each participant was obtained. Results: Male patients represented 64% (128/200), most frequent age group was from 41 to 60 years with percentage of 56.5% (113/200), 86% (172/200) of CRF patients were received blood while 42% (84/200) get HBV vaccination. Hepatitis B core antibodies were found in 54% (108/200) of studied cases, and 22% (42/188) of tested DNA were positively amplified for target gene. Detection of Hepatitis B core antibodies was significantly associated with marital status while absence of vaccination significantly associated with the detection of both hepatitis B core antibodies and HBV DNA. Conclusion: This study found high frequency of OBI in CRF patients, to reduce the transmission of the disease, possible hypotheses should be studied, including blood transfusion, haemodialysis process and HBV vaccination status.