Artificial Kidney Research Articles

Fatigue, quality of life, and social support in Greek health staff: Public versus private kidney units

Healthcare professionals often experience fatigue and a diminished quality of life due to demanding hours and challenges in balancing work and personal life. Social support plays a critical role in influencing these factors. This study focused on nurses and healthcare workers in the artificial kidney unit, a specialized area requiring significant expertise to operate complex machinery for seriously ill patients. We assessed levels of fatigue, social support, and quality of life among 159 doctors and nurses in public and private facilities across Greece using the Fatigue Assessment Scale, Multidimensional Scale of Perceived Social Support, and General Health Questionnaire-28. Participants reported moderate fatigue (mean = 2.63, standard deviation [SD] = 0.57 for doctors; mean = 2.42, SD = 0.49 for nurses) and moderate-to-high levels of social support (mean = 5.66, SD = 1.35). Factors negatively impacting quality of life, such as physical symptoms, anxiety, social dysfunction, and severe depression, yielded low scores. Notably, fatigue and quality of life differed significantly between public and private sectors (p < 0.05), with public sector professionals reporting higher fatigue levels and lower quality of life. These findings highlight the need for healthcare authorities to address the unique challenges faced by staff in artificial kidney units, particularly in public hospitals, to improve working conditions and overall well-being.

Loading Self-Assembly Siliceous Zeolites for Affordable Next-Generation Wearable Artificial Kidney Technology.

The global demand for dialysis among patients with end-stage kidney disease has surpassed the capacity of public healthcare, a trend that has intensified. While wearable artificial kidney (WAK) technology is seen as a crucial solution to address this demand, there is an urgent need for both efficient and renewable toxin-adsorbent materials to overcome the long-standing technological challenges in terms of cost, device size, and sustainability. In this study, we employed screening experiments for adsorbent materials, multimodal characterization, and Monte Carlo adsorption simulations to identify a synthetic self-assembly silicalite-1 zeolite that exhibits highly ordered crystal arrays along the [010] face (b-axis) direction, demonstrating exceptional adsorption capabilities for small molecular toxins such as creatinine and urea associated with uremia. Moreover, this metal-free, cost-effective, easily synthesized, and highly efficient toxin adsorbent could be regenerated through calcination without compromising the performance. The simulated toxin adsorption experiments and comprehensive biocompatibility verification position it as an auxiliary adsorbent to reduce dialysate dosages in WAK devices as well as a potential adsorbent for small-molecule toxins in dialysis. This work is poised to propel the development of next-generation WAK devices by providing siliceous adsorbent solutions for small-molecule toxins.

A peristaltic electromagnetic (EM) micropump with dome-shaped PDMS membranes for biomedical application

A peristaltic electromagnetic (EM) micropump driven by dome-shaped membranes was successfully fabricated and tested. The pump system comprises EM coil components, three magneto-mechanical actuators, and a microfluidic system. The pump system with three actuator membranes/chambers connected in series is intended to replace the conventional valve and pump rollers, enabling the delivery of fluids at a high flowrate. The actuator membrane is made of polydimethylsiloxane (PDMS), measuring 5 mm in diameter and approximately 100 µm thick, and fabricated using soft lithography techniques to form a normally deflected dome-shaped membrane structure. The microfluidic channel is made of PDMS and created using a sacrificial layer-pattern process, allowing straightforward soft-litography process without mold transfer. The fabricated device was tested by applying electrical DC currents ranging from 500 mA to 1000 mA at frequencies up to 10 Hz. This resulted in the depletion of the membrane by up to 2 mm, causing fluid flow through the microchannel at a flow rate of 8 mL per minute. The test results revealed that the peristaltic EM micropump can generate a significant fluid flow rate, making it suitable for pumping controlled fluids within a range of up to 10 mL/minute. This micropump has a wide range of potential applications, including the management of insulin medication for patients with acute diabetes mellitus and the delivery of drugs and dialysate fluid in artificial kidney applications.

Examining Ultrafiltration Variance across Two Peritoneal Dialysis Prescriptions of the Automated Wearable Artificial Kidney (AWAK) in a Porcine Model

Examining Ultrafiltration Variance across Two Peritoneal Dialysis Prescriptions of the Automated Wearable Artificial Kidney (AWAK) in a Porcine Model

Prepivotal Study Exploring Safety, Efficacy, and Usability of the Automated Wearable Artificial Kidney (AWAK) PD Device

Prepivotal Study Exploring Safety, Efficacy, and Usability of the Automated Wearable Artificial Kidney (AWAK) PD Device

Magnetic Kidney Stone Removal

Abstract Residual fragments can remain after kidney stone extraction which may necessitate another intervention. A new approach needs to be developedis needed to lower the risk of disease severe side effects caused by these fragments. Magnetic nanoparticles can be applied due to their properties of being able to bind to residual fragments and to be extracted by an external magnetic field. Fractals and magnetic nanoparticles have been synthesized and characterized thoroughly. The small nanoparticles bind covalently to the kidney stones and a magnetic extraction of calcium oxalate fractals with magnetic nanoparticles is possible. The aggregation of nanoscale iron oxide nanoparticles can be induced with the addition of salt which improves the extraction process. The separation is validated by simulation and experimentally in a porcine kidney as well as in artificial kidney models. This proof-of-concept study successfullyis the fundament for a new waydemonstrated of extracting kidney stones extraction and including their fractals and might pave the way for new procedures in urology.

Dr. Willem Kolff: The Father of the Artificial Kidney.

Dr. Willem J. Kolff(February 14, 1911-February 11, 2009) is widely considered the father of dialysis. In addition, his innovations also included the artificial heart and lung, which earned him the title "the Father of Artificial Organs". In due course, his artificial kidney evolved into modern dialysis, a procedure that filters and purifies blood using an extracorporeal circuit, now a life-sustaining treatment for patients with end-stage kidney failure. Furthermore, his membrane oxygenator, which provided a method to add oxygen to blood as it passed through a machine, is still used in heart-lung machines during open-heart surgery. He is also known for his work in developing the artificial heart (although it now carries the name of his student, Dr. Robert Jarvik), which was used in subsequent designs, as a bridge to heart transplantation.Thanks to his work on the artificial kidney, millions of patients worldwide have benefited from life-sustaining hemodialysis. It can also be argued that Dr. Kolff's introduction of dialysis in 1943 marks the dawn of modern nephrology.

Dialoxygenation: A Preclinical Trial for Transforming the Artificial Kidney Into an Oxygenator.

Critically ill patients sometimes require tandem application of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) which is easier and cheaper. We aimed to transform the kidney membrane into a lung membrane by adding hydrogen peroxide (H 2 O 2 ) to the dialysate as the oxygen source. A solution containing H 2 O 2 and a dialysate fluid mixture was used as the final dialysate. Starting with 100% H 2 O 2 solution and gradually reducing the volume of H 2 O 2 , respectively: 50%, 10%, 5%, 4%, 3%, 2%, and 1%. PRISMAFLEX system, Prismaflex M60 set and a bag of packed red blood cells (pRBCs) were the prototype. blood flow rate was about 40 ml/minute and the dialysis rate was about 200 ml/m 2 /minute/1.73 m 2 . blood sampling times were; at the beginning ( T0 ), at 15th ( T1 ), 30th ( T2 ), 60th ( T3 ) minutes. Amongst eight attempts H 2 O 2 concentration that increased the partial oxygen pressure (pO 2 ) level significantly in a reasonable period, without any bubbles, was 3%. Methemoglobinemia was not observed in any trial. After the test with 3%, H 2 O 2 in the dialysate fluid decreased progressively without any H 2 O 2 detection at post-membrane blood. Three percent H 2 O 2 solution is sufficient and safe for oxygenation in CRRT systems. With this new oxy-dialysate solution, both pulmonary and renal replacement can be possible viaa single membrane in a simpler manner.

Fabrication of acoustically and physically validated artificial stones to natural kidney stones under shock waves and laser lithotripsy

To present an efficient method for fabricating artificial kidney stones with acoustic and physical properties to assess their fragmentation efficiency under shock waves and laser lithotripsy for very hard stones. The mixture ratio of super-hard plaster and water was adjusted to produce artificial kidney stones for comparison with > 95% human genuine calcium oxalate monohydrate (COM) and uric acid (UA) stones. Acoustic and physical properties, such as wave speed, stone hardness, density, compressive strength, and stone-free rates under shock-wave and laser lithotripsy, were assessed. The longitudinal wave speed of artificial stones prepared at a plaster-to-water ratio of 15:3 closely matched that of COM stones. Similarly, the transverse wave speed of artificial stones prepared at a plaster-to-water ratio of 15:3 to 15:5 aligned with that of COM stones. Stone fragmentation using shock-wave of artificial stones with mixed ratios ranging from 15:3 to 15:5 resembled that of COM stones. The Vickers hardness was similar to that of artificial stones produced with a mixing ratio of 15:3, similar to that of COM stones, while that of artificial stones produced with a mixing ratio of 15:5 was similar to that of UA stones. Density-wise, artificial stones with mixing ratios of 15:4 and 15:5 resembled COM stones. Compressive strength test results did not confirm the similarity between natural and artificial stones. The stone fragmentation using laser showed that stones produced with higher moisture content at a mixing ratio of 15:6 were similar to COM stones. This novel method for fabricating artificial kidney stones could be used to provide reliable materials for lithotripsy research.

Catalytic urea electrooxidation on nickel‐metal hydroxide foams for use in a simplified dialysis device

AbstractElectrocatalytic urea removal is a promising technology for artificial kidney dialysis and wastewater treatment. Urea electrooxidation was studied on nickel electrocatalysts modified with Cr, Mo, Mn, and Fe. Mass transfer limits were observed for urea oxidation at physiological concentrations (10 mmol L). Urea oxidation kinetics were explored at higher concentrations (200 mmol L), showing improved performance, but with lower currents per active site. A simplified dialysis model was developed to examine the relationship of mass transfer coefficients and extent of reaction on flowrate, composition, and pH of the reacting stream. For a nickel hydroxide catalyst operating at 1.45 V, 37 , and pH 7.1, the model shows a minimum geometric electrode area of 1314 cm2 is needed to remove 3.75 g urea h with a flow rate of 200 mL min for continuous operation.

Design and simulation of a microfluidics-based artificial glomerular ultrafiltration unit to reduce cell-induced fouling.

The microfluidic-based Glomerulus-on-Chips (GoC) are mostly cell based, that is, 3D cell culture techniques are used to culture glomerular cells in order to mimic glomerular ultrafiltration. These chips require high maintenance to keep cell viability intact. There have been some approaches to build non-cell-based GoCs but many of these approaches have the drawback of membrane fouling. This article presents a structural design and simulation study of a dialysate free microfluidic channel for replicating the function of the human glomerular filtration barrier. The key advancement of the current work is addressing the fouling issue by combining a pre-filter to eliminate cellular components and performing filtration on the blood plasma. The Laminar Flow Mixture Model in COMSOL Multiphysics 5.6 has been utilized to simulate the behavior of blood flow in the microchannels. The geometrical effect of microchannels on the separation of the filtrate was investigated. The velocity at the inlet of the microchannel and pore size of the filtration membrane are varied to see the change in outflow and filtration fraction. The efficiency of the device is calculated in terms of the filtration fraction (FF%) formed. Simulation results show that the filtrate obtained is ~20% of the plasma flow rate in the channel, which resembles the glomerular filtration fraction. Given that it is not dependent on the functionality of grown cells, the proposed device is anticipated to have a longer lifespan due to its non-cell-based design. The device's cost can be reduced by avoiding cell cultivation inside of it. It can be integrated as a glomerular functional unit with other units of kidney model to build a fully developed artificial kidney.

Am I Ready to Use a Portable Artificial Kidney or a Wearable Artificial Kidney?

Am I Ready to Use a Portable Artificial Kidney or a Wearable Artificial Kidney?

A review: current urea sorbents for the development of a wearable artificial kidney

A review: current urea sorbents for the development of a wearable artificial kidney

Effect of Social Support, Fatigue, and Depression on the Quality of Life of Patients Undergoing Peritoneal Dialysis

Purpose: This study investigated the effects of social support, fatigue, and depression on the quality of life of patients undergoing peritoneal dialysis.Methods: This descriptive research included 130 patients undergoing peritoneal dialysis, who were treated in an artificial kidney room. Data were collected from June 2021 to August 2021, and a hierarchical multiple regression analysis was performed.Results: Social support, depression, and medical staff providing dialysis-related information were significant factors inflencing the quality of life of patients undergoing peritoneal dialysis, and the explanatory power of the model was found to be 41%. Among the factors, social support (β=.52) had the greatest impact on quality of life.Conclusion: The results of this study suggest the need to develop nursing interventions and educational programs that can improve the social support of patients with peritoneal dialysis and reduce depression, thereby improving their quality of life.

#2978 Formative usability test of a novel device for peritoneal dialysis (WEAKID)

Abstract Background and Aims Chronic kidney disease is a growing problem worldwide with a growing number of patients requiring kidney replacement therapy. In recent years we have developed a novel device for peritoneal dialysis (PD), the WEarable Artificial KIDney (WEAKID); composed of a wearable device connected to a dialysate reservoir. WEAKID uses both sorbent technology and continuous flow PD to improve dialysis efficacy. Formative usability testing aids to the identification of design issues that may interfere with a device's safe and effective use and thus may influence decisions made in the design process. Here, we present the results of an international, multicentre, formative usability study of WEAKID among nurses and patients. Method This study used a mixed-methods design and was conducted in hospitals in Italy (Modena University Hospital), Spain (La Paz University Hospital, Madrid), and the Netherlands (University Medical Center Utrecht) between November 2021 and December 2022. An individual, formative usability testing session was conducted with each participant (nurse or patient) under the conditions of simulated use. Participants were asked to perform basic operational procedures (i.e. turning the device on/off, input of dialysis settings, handling an alarm) with the device according to a usability task list. Their performance was observed and use errors (i.e., something that a participant does or fails to do that results in an unexpected or unintended outcome) were noted. Furthermore, participants were asked for feedback, both verbally and by means of completing the system usability scale (SUS), reflecting perceived usability on a scale from 0 (worst) to 100 (best). Results We included 14 participants (n = 6 nurses, n = 8 patients) in three participating centres. All nurses were female and had a median experience with PD of 20.5 years (range 0.5-32). Patients were generally highly educated (n = 5, 63%). In total, 22 use errors occurred, 10 in nurses and 12 in patients. These use errors included factors not related to the device, e.g. not taking appropriate hygiene measures. In particular, use errors occurred during the priming/connection of catheter and handling the alarm. Participants’ feedback mainly concerned the small screen (and thus font) size, user interface (e.g. lack of colour-coded soft buttons), and (short) length of the patient line. The mean SUS score was 70 (range 57.5–85) for nurses, and 71.9 (range 55–87.5) for patients. Conclusion Despite the slightly above-average perceived usability of the device's current design stage, participants made a lot of suggestions for improvements, and usability must be improved to make the device ready for market introduction.

#3022 Rationale and design of the CORDIAL first-in-human clinical trial: a system for sorbent-assisted continuous flow peritoneal dialysis

Abstract Background and Aims Peritoneal dialysis has important disadvantages, including low plasma clearance and a limited technique survival. A new device for sorbent-assisted continuous flow peritoneal dialysis has been designed (Wearable Artificial KIDney, WEAKID) that is based on continuous recirculation (rapid cycling) of peritoneal dialysate via a single-lumen peritoneal catheter with regeneration of dialysate using sorbents. Anticipated benefits are a better plasma clearance a higher mass transfer area coefficient with continuous flow of dialysate and enhanced diffusion due to a higher time-averaged plasma-dialysate concentration gradient with sorbent-based dialysate regeneration, and a prolonged technique survival thanks to lower peritonitis risk (less (dis)connections) and a lower glucose exposure. Method This is a first-in-human, prospective, open-label, non-randomized, single-arm, multicenter study, that will be performed at the University Medical Center Utrecht (Utrecht, The Netherlands), Università degli studi di Modena e Reggio Emilia (Italy), and Instituto de Investigación Hospital Universitario La Paz, Servicio Madrileño de Salud (Spain). We aim to include 12 stable, adult PD patients. In the first week, blood, urine, and dialysate samples will be collected over three separate days to assess the efficacy of the patient's standard PD schedule. The WEAKID system will then be tested in a clinical setting on 6 days over a period of 2 weeks (three consecutive days per week). During the first week, participants will be treated with WEAKID without sorbents for 4h (first day) or 8h (second and third day). The second week, treatment will consist of WEAKID with sorbents for 4h (first day) or 8h (second and third day). This way, exposure to new components of the system is incremental and the effectiveness of continuous recirculation of dialysate and that the added effect of sorbent-based dialysate regeneration can be analyzed separately. Outcomes The primary aim of this first-in-human clinical trial is to evaluate the (short term) clinical safety and performance of WEAKID treatment in a clinical setting. The primary safety objective will be assessed by describing and examining the incidence of: Key secondary objectives include an evaluation of efficacy in terms of plasma clearance, ultrafiltration, net base release, and patient tolerance. Planning Inclusion of the first patient is expected in January 2024, the final inclusion is expected to take place in November 2024.

#540 Investigation of vascular sound visualization system using electronic stethoscope

Abstract Background and Aims The routine evaluation of VA involves visual, palpatory, and auscultatory examinations, as well as monitoring of venous pressure and other parameters. Surveillance indices include Flow Volume (FV) and Resistance Index (RI) obtained by Doppler ultrasound (DU) and Access Blood Flow (Qa) obtained by the Ultrasound Dilution Method (UDM) are well known. On the other hand, the MSS-U11C electronic stethoscope (Fig. 1) and dedicated application (Fig. 2) developed by Pioneer Inc. converts vascular sound into digital data and calculates the INDEX value obtained from the sound intensity (dB) analyzed by the vascular sound visualization system. In this study, we examined the correlation between INDEX values and conventional surveillance indices. Method 1. Eighty-three cases in which INDEX, FV, RI, and Qa were simultaneously measured in hemodialysis patients with AVF at the Artificial Kidney Department of Osaka Metropolitan University Hospital were included. 2. The measurement site for INDEX was just above the anastomosis of the AVF. 3. FV and RI were measured using a KONICA MINOLTA SONIMAGE HS2 diagnostic ultrasound system with the brachial artery as the measurement site. 4. Measurements were expressed in Median [IQR], and for statistical examination, Pearson's correlation coefficient was used for the correlation of each measurement, transformed to the natural logarithm to satisfy the assumption of normality of the residuals. The significance level for all hypothesis tests was 5%. For statistical analysis, R version 4.2.1 (https://www.r-project.org/foundation/) with the “rms” and “RcmdrPlugin.EZR ” packages were used. 5. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent. Results INDEX showed a significant positive correlation with Qa and FV (R = 0.449, P = 0.002 / R = 0.484, P < 0.001, respectively), INDEX showed a significant negative correlation with RI (R = −0.336, P = 0.002). Conclusion INDEX measurement using an electronic stethoscope is a monitoring index and showed a positive correlation with FV and Qa, which are established surveillance indices, and a weak negative correlation with RI. In Japan, FV and RI are commonly used as surveillance indices, but it has been reported that these indices can be underestimated or overestimated depending on the skill of the examiner, and that Qa requires specialized equipment and cannot be measured depending on the puncture site. We believe that monitoring by stethoscope is influenced by subjective factors of staff members, which may lead to differences in evaluation, but INDEX could become a more quantitative and standardized indicator. In addition, the electronic stethoscope could be used without any difference compared to the stethoscope currently in clinical use.

Pulsating magnetohydrodynamic hybrid nanofluid flow with thermal radiation, viscous dissipation, and entropy generation: Application to bio-nanomedicine

The aim of this investigation is to explore the flow phenomena in two distinct hybrid nanofluids (with micropolar fluid as the base fluid) undergoing hydromagnetic pulsation between two vertical walls, accompanied by entropy generation. This study also explores the unique heat transfer characteristics of F e 3 O 4 − Ti O 2 and A l 2 O 3 − MgO hybrid nanofluids, with the effects of Ohmic heating, thermal radiation, and viscous dissipation. The goal of using hybrid nanofluids is to improve the performance of biological systems such as nano-drug delivery in arteries, magnetic bio-separation, artificial kidneys, pressure surges, magnetofection agents, biomedical engineering, cancer treatments, and brain tumor treatment. The governing partial differential equations are transformed into a system of ordinary differential equations, which are then solved numerically by a shooting technique with a fourth-order Runge-Kutta method using a bvp4c MATLAB solver. Graphical explanations are provided for the flow variables such as the velocity, the microrotation, the temperature, the entropy generation, and the Bejan number. The heat transfer rate is an increasing function of the thermal radiation parameter; when the thermal radiation parameter increases from 1 to 3 the increases in the heat transfer rates in micropolar fluid (the base fluid), first hybrid nanofluid ( F e 3 O 4 − Ti O 2 ), and second hybrid nanofluid ( A l 2 O 3 − MgO ) are respectively 55%, 51%, and 43.86%. However, while the heat transfer rate (the Nusselt number) is a diminishing function of the Hartmann number. Further, the outcomes reveal that the hybrid nanofluids with emerging physical effects are helpful to treat cancer patients, recovering the damaged tissues and cells in arteries, and various medical-related procedures.

Effect of nephrostomy sheath size on renal pelvic pressure during endoscopic combined intrarenal surgery: artificial kidney model study

BackgroundThis study aimed to evaluate the intrarenal pelvic pressure in endoscopic combined intrarenal surgery using an artificial kidney model.MethodsAn artificial kidney model was created using the Urovac evacuator™. Four sizes of nephrostomy sheaths (MIP-L: 25/26 Fr, MIP-M: 16.5/17.5 Fr, MIP-S: 11/12 Fr, MIP-XS: 8.5/9.5 Fr) and two sizes of ureteral access sheaths (12/14 Fr and 10/12 Fr) were installed into the model. For each combination of nephrostomy and ureteral access sheath, renal pelvic pressure was measured with and without insertion of the retrograde flexible ureteroscope. Irrigation from the nephroscope was adjusted to 40–160 mmHg using an automatic irrigation device, and the irrigation of the ureteroscope was by spontaneous dripping at 80 cmH2O. Conditions were measured six times, and the renal pelvic pressure was compared in different conditions.ResultsWithout ureteroscope insertion through the ureteral access sheath, the renal pelvic pressure never exceeded 30 mmHg. Meanwhile, when the ureteroscope was inserted, the renal pelvic pressure increased as the nephrostomy sheath and ureteral access sheath became narrower and as the irrigation pressure increased. Intrarenal pelvic pressure exceeded 30 mmHg when the irrigation pressure was increased in 12/14 Fr ureteral access sheath when MIP-XS was used, and in 10/12 Fr ureteral access sheath when MIP-XS and MIP-S were used.ConclusionsThe use of a thin nephrostomy sheath in endoscopic combined intrarenal surgery can lead to increased intrarenal pelvic pressure. Although our results are from an artificial kidney model, special care is suggested to be required when using a retrograde flexible ureteroscope simultaneously in treatment of patients.

Artificial kidney: Challenges and opportunities.

This review aims to present the developments occurring in the field of artificial organs and particularly focuses on the presentation of developments in artificial kidneys. The challenges for biomedical engineering involved in overcoming the potential difficulties are showcased, as well as the importance of interdisciplinary collaboration in this marriage of medicine and technology. In this review, modern artificial kidneys and the research efforts trying to provide and promise artificial kidneys are presented. But what are the problems faced by each technology and to what extent is the effort enough to date?