Artificial Kidney Research Articles

Coordination of thin-film nanofibrous composite dialysis membrane and reduced graphene oxide aerogel adsorbents for elimination of indoxyl sulfate

• A novel combination of PVA/PAN TNFC dialysis membrane with rGO aerogel was proposed. • The rGO aerogel exhibited good adsorption performance for indoxyl sulfate. • The coordination of TFNC membrane and rGO lightened conventional hemodialysis. The protein-bound uremic toxins, represented by indoxyl sulfate (IS), have been associated with the progression of chronic kidney disease and the development of cardiovascular disease in the presence of impaired renal function. Herein, we proposed a novel strategy of thin-film nanofibrous composite (TNFC) dialysis membrane combined with reduced graphene oxide (rGO) aerogel adsorbents for clinical removal of IS as well as high retention of proteins. The TFNC membrane was prepared by electrospinning in conjunction with coating-reaction method and proved to have good selectivity and permeability. To further improve the removal rate of toxins, we used a medium hydrothermal method following by freeze-drying treatment to obtain the rGO aerogel adsorbents. It exhibited excellent adsorption for IS with a maximum adsorption capacity of 69.40 mg∙g −1 through π−π interaction and hydrogen bonding interaction based on Langmuir isotherm models. Time-dependent absorption experiments showed that it reached adsorption equilibrium within 4 h, which was matched with the hemodialysis time. The coordination was significantly exhibited by introducing rGO aerogel blocks into the dialysate for absorbing the diffused free IS during hemodialysis. Taking the advantages of the TFNC dialysis membrane and the rGO aerogel, the volume of dialysate for hemodialysis was only one-tenth of that without adsorbent blocks but with very comparable dialysis performance (the clearance of IS at 51.8% and the retention of HSA over 98%), which could lighten conventional hemodialysis effectively and be benefit to realize the miniaturization of the hemodialysis equipment. Therefore, the coordination of the TFNC dialysis membrane and rGO aerogel adsorbents would open a new path for the development of portable artificial kidney.

Normothermic liver machine perfusion as a dynamic platform for regenerative purposes: What does the future have in store for us?

Liver transplantation has become an immense success; nevertheless, far more recipients are registered on waiting lists than there are available donor livers for transplantation. High-risk, extended criteria donor livers are increasingly used to reduce the discrepancy between organ demand and supply. Especially for high-risk livers, dynamic preservation using machine perfusion can decrease post-transplantation complications and may increase donor liver utilisation by improving graft quality and enabling viability testing before transplantation. To further increase the availability of donor livers suitable for transplantation, new strategies are required that make it possible to use organs that are initially too damaged to be transplanted. With the current progress in experimental liver transplantation research, (long-term) normothermic machine perfusion may be used in the future as a dynamic platform for regenerative medicine approaches, enabling repair and regeneration of injured donor livers. Currently explored therapeutics such as defatting cocktails, RNA interference, senolytics, and stem cell therapy may assist in the repair and/or regeneration of injured livers before transplantation. This review will provide a forecast of the future utility of normothermic machine perfusion in decreasing the imbalance between donor liver demand and supply by enabling the repair and regeneration of damaged donor livers.

Multilayer Perceptron-Based Real-Time Intradialytic Hypotension Prediction Using Patient Baseline Information and Heart-Rate Variation.

Intradialytic hypotension (IDH) is a common side effect that occurs during hemodialysis and poses a great risk for dialysis patients. Many studies have been conducted so far to predict IDH, but most of these could not be applied in real-time because they used only underlying patient information or static patient disease information. In this study, we propose a multilayer perceptron (MP)-based IDH prediction model using heart rate (HR) information corresponding to time-series information and static data of patients. This study aimed to validate whether HR differences and HR slope information affect real-time IDH prediction in patients undergoing hemodialysis. Clinical data were collected from 80 hemodialysis patients from 9 September to 17 October 2020, in the artificial kidney room at Yeungnam University Medical Center (YUMC), Daegu, South Korea. The patients typically underwent hemodialysis 12 times during this period, 1 to 2 h per session. Therefore, the HR difference and HR slope information within up to 1 h before IDH occurrence were used as time-series input data for the MP model. Among the MP models using the number and data length of different hidden layers, the model using 60 min of data before the occurrence of two layers and IDH showed maximum performance, with an accuracy of 81.5%, a true positive rate of 73.8%, and positive predictive value of 87.3%. This study aimed to predict IDH in real-time by continuously supplying HR information to MP models along with static data such as age, diabetes, hypertension, and ultrafiltration. The current MP model was implemented using relatively limited parameters; however, its performance may be further improved by adding additional parameters in the future, further enabling real-time IDH prediction to play a supporting role for medical staff.

Development of a Patient Preference Survey for Wearable Kidney Replacement Therapy Devices.

Recent innovations have the potential to disrupt the current paradigm for kidney failure treatment. The US Food and Drug Administration is committed to incorporating valid scientific evidence about how patients weigh the benefits and risks of new devices into their decision making, but to date, premarket submission of patient preference information (PPI) has been limited for kidney devices. With input from stakeholders, we developed a survey intended to yield valid PPI, capturing how patients trade off the potential benefits and risks of wearable dialysis devices and in-center hemodialysis. We conducted concept elicitation interviews with individuals receiving dialysis to inform instrument content. After instrument drafting, we conducted two rounds of pretest interviews to evaluate survey face validity, comprehensibility, and perceived relevance. We pilot tested the survey with in-center hemodialysis patients to assess comprehensibility and usability further. Throughout, we used participant input to guide survey refinements. Thirty-six individuals receiving in-center or home dialysis participated in concept elicitation (N=20) and pretest (N=16) interviews. Participants identified reduced fatigue, lower treatment burden, and enhanced freedom as important benefits of a wearable device, and many expressed concerns about risks related to device disconnection-specifically bleeding and infection. We drafted a survey that included descriptions of the risks of serious bleeding and serious infection and an assessment of respondent willingness to wait for a safer device. Input from pretest interviewees led to various instrument modifications, including treatment descriptions, item wording, and risk-level explanations. Pilot testing of the updated survey among 24 in-center hemodialysis patients demonstrated acceptable survey comprehensibility and usability, although 50% of patients required some assistance. The final survey is a 54-item web-based instrument that will yield estimates of the maximal acceptable risk for the described wearable device and willingness to wait for wearable devices with lower risk.

The Application of Hollow Fiber Cartridge in Biomedicine.

The hollow fiber cartridge has the advantages of good semi-permeability, high surface area to volume ratio, convenient operation, and so on. Its application in chemical analysis, drug in vitro experiment, hemodialysis, and other fields has been deeply studied. This paper introduces the basic structure of hollow fiber cartridge, compares the advantages and disadvantages of a hollow fiber infection model constructed by a hollow fiber cartridge with traditional static model and animal infection model and introduces its application in drug effects, mechanism of drug resistance, and evaluation of combined drug regimen. The principle and application of hollow fiber bioreactors for cell culture and hollow fiber dialyzer for dialysis and filtration were discussed. The hollow fiber cartridge, whether used in drug experiments, artificial liver, artificial kidney, etc., has achieved controllable experimental operation and efficient and accurate experimental results, and will provide more convenience and support for drug development and clinical research in the future.

A literature review of benson relaxation technique for reducing anxiety in patients with chronic kidney disease

Hemodialysis is cleaning blood through an artificial kidney or dialyzer assisted by a machine. Kidney failure patients undergoing therapy experience anxiety due to various stressors. One way to overcome fear is to use relaxation therapy, including Benson relaxation. Benson relaxation is a breathing relaxation technique with the addition of an element of belief in the form of words that express the anxiety that the patient is experiencing. This literature aims to determine the effectiveness of Benson's relaxation on reducing stress in chronic kidney failure patients undergoing hemodialysis. A literature review comparing some literature through the journal databases used is Pubmed, Google Scholar, ScienceDirect, Garuda Portal, and Jane Semantic. The keywords are "Benson relaxation, anxiety, chronic renal failure and hemodialysis," "Benson relaxation technique on the anxiety of patient hemodialysis," "Benson relaxation for anxiety disorders," or "Benson relaxation for patients undergoing hemodialysis" or "non-pharmacological therapy for reduce anxiety from 2016-2021 full text. There are seven journals reviewed and used in this literature review. The results show that Benson relaxation is proven effective in reducing anxiety in chronic kidney failure patients undergoing hemodialysis.
 Keywords: Kidney disease; nursing care; relaxation technique; anxiety; psychological outcomes

Immobilization of Urease onto Nanochitosan Enhanced the Enzyme Efficiency: Biophysical Studies and in Vitro Clinical Application on Nephropathy Diabetic Iraqi Patients

Immobilization of enzymes is an effective method for improving the properties and applications of modern enzymes. There are several supports for enzyme immobilization. Because of its unique features, such as inertness and high surface area, chitosan was widely used to immobilize enzymes. Immobilization of urease onto chitosan is a promising approach to treating high urea levels in the blood, however, the immobilization conditions for the best kinetics and enzyme efficiency are still challenging. Herein, we tried to immobilize urease onto nanochitosan (chitosan NPs) through a cross-linker and study the kinetics (km and v max values) and thermodynamics (Ea, ∆H, ∆S, and ∆G) parameters of the enzyme reaction before and after immobilization at different substrate concentration (50, 100, 150, 200, and 250 mg/dl) and incubation temperature (15, 20, 25, 30, 35, and 40°C) under selected optimum conditions. The immobilized urease chitosan NPs was characterized in our previous work using Fourier transform infrared infrared (FTIR), Atomic force force microscopy (AFM), and and imaged here by scanning electron microscopy microscopy (SEM). Results revealed that the highest efficiency % of immobilization (70.38%) was observed at 750 mg/ml chitosan NPs and phosphate buffer pH 7 at 40°C. With an increase of Km value for the immobilized enzyme, however, the efficiency of the enzyme was significantly higher than the free enzyme, p < 0.001 . In addition, the activation energy of the reaction catalyzed by the immobilized enzyme was lower than that of the free enzyme, which suggests that the active site geometry of the immobilized enzyme was more favorable to accommodate the substrate and thus required less energy than that of the free enzyme. The reaction was endothermic by means of positive ∆H. The immobilized urease enzyme was in vitro applied to blood samples of Iraq nephropathy diabetic patients (n = 35) to investigate the effect on serum urease activity and urea level compared to healthy volunteers. Interestingly, the activity of serum urease significantly increased after adding the immobilized enzyme and the level of urea significantly decreased ( p < 0.0001 ) by ∼1.5 folds. Thus, applying an immobilized urease urease to remove urea from blood could be effective in the blood detoxification or dialysis regeneration system of artificial kidney machines.

P13: Hemodynamic Study of an Implantable Artificial Kidney Device Using a Computational Model

Study: Gradual loss of kidney function is experienced by patients diagnosed with chronic kidney disease (CKD) and may escalate to a severe condition of end-stage kidney disease. A treatment approach alternative to hemodialysis could be the implantation of an artificial kidney that filters blood using the natural pressure drop in the systemic circulation. This study aims to investigate the hemodynamic performance of several variations of two previously reported implantable artificial kidney device (IAKD) designs using a computational hemodynamic model. Methods: An in-house custom hemodynamic lumped parameter model was developed to analyze the implantation of an IAKD on the combined patient-device hemodynamics. The time-varying hemodynamic model (HM) consisted of all four cardiac chambers, systemic and venous circulations and included the implantation of an IAKD in parallel with the systemic circulation (Figure 1a). Two major IAKD configurations were analyzed: (i) a serpentine configuration (series flow path through the device) and (ii) a parallel configuration (parallel flow path through the device). For each configuration, several variations of the internal device resistance were analyzed to investigate the resulting pressure drop across and flow through the device, in order to investigate the customization of IAKD designs depending on a perceived patient-specific need. Results: We tested 8 variations of the serpentine IAKD and 6 variations of the parallel IAKD. For each case, the virtual patient characteristics were maintained constant (i.e. all cardiac, systemic and pulmonary circulatory parameters) and only the device resistance was varied. Preliminary data indicated that for the serpentine configuration, the flow through the IAKD reduced by over 50% as the resistance was increased, also causing an increase in the pressure drop across the IAKD for each variation (Figure 1b). This behavior was similar for the variations in the parallel configuration (Figure 1c), with an increase in flow up to 35% through the IAKD due to the overall reduced flow resistance of the parallel design in comparison to the serpentine design. Interestingly, as the device resistance was decreased, the patient MAP was reduced by more than 11% due to the shunting of more flow through the IAKD, and thereby less flow available to pass through the systemic circulation – this behavior was seen for both configurations. Conclusions: The HM developed in this study is capable of investigating several clinically-relevant scenarios to tailor an IAKD for patients with renal failure. Our analysis suggests that there is a complex interplay between the patient’s systemic circulatory network and the IAKD, necessitating detailed hemodynamic analysis such as that performed in this study. Depending on the patient’s needs, it is possible to tailor an IAKD, potentially with variable resistance configurations, that can best serve to maintain hemodynamic stability and hemodialysis efficiency.

Application of Self-Care Behaviour Scale for Arterio Venous Fistula Among Hemodialysis Patients

Objectives: To evaluate self-care behavior for Arterio Venous Fistula among Hemodialysis Patients Methods: Descriptive research was carried out using a scale to assess the self-care habits of dialysis patients with CKD. The study was conducted on (5) teaching hospitals in Baghdad City from the Artificial Kidney Centers divided into three Health Directorate: Results: Result show that the highest evaluation rate for Item(No.3) I do compression of puncture sites with the fingers (hemostasis). in the rate of RS%(70.72)rated fair self-care behaviors" While the lowest evaluation rate for item No. 25 (I shave the hairs on the fistula arm( in the rate of RS% (31.44)rated Poor self-care behavior. Majority of patients in this study experienced with a fair level of knowledge regarding self-care behaviors of AV fistula 425 (85.0%). Conclusions: Majority of patients in this study experienced with a fair level of knowledge regarding self-care behaviors of AV fistula. Keyword: Self-Care, Behavior Scale, Arteriovenous Fistula

Construction of high-performance polymer hydrogel composite materials for artificial bionic organs

Hydrogel, with excellent hydrophilicity biocompatibility and stimuli responsive, has been widely used in biomedical and artificial organs fields. However, synthetic hydrogel usually displays poor gel strength, poor toughness and slow speed of absorbing water. Therefore, extensive exploratory research is still required to develop new composite materials for the application of bionic viscera. In this work, we constructed a new kind of composite hydrogel by a facile wet chemistry method to cross-link three kinds of polymer resin, polyvinyl alcohol, carboxymethyl cellulose, and carboxymethyl starch. The conductivity, moisture content and elastic modulus of hydrogel can be controlled by the dosage of potassium salt, sodium salt, water and glycerol. After molding and testing, the electrical conductivity, elastic modulus, and moisture content of the artificial liver and kidney organs were similar to those of the corresponding pig viscera, which is superior to most of the current research on hydrogels. This work provides a facile approach to synthesize highly efficient hydrogel, which accelerates the application of hydrogel in bionic organs.

Zirconium cyclosilicate: An oral sorbent for potassium, four decades in the making.

HemoCleanse collaborated with Dr. John Sherman and Union Carbide in the 1980s to develop a cation exchanger with high selectivity for potassium and ammonium, for use in a wearable artificial kidney. Synthetic zeolites had unexpected solubility in this application but by 2000, UOP (a sister company of Union Carbide) had developed zirconium cyclosilicate (SZC). HemoCleanse performed early animal studies of SZC as an oral sorbent. These showed remarkable binding characteristics. HemoCleanse then obtained the license for SZC for medical applications, helped to form ZS Pharma, and collaborated in further animal studies and clinical trials. AstraZeneca purchased ZS Pharma in 2015, and SZC (Lokelma®) has now become an effective treatment for hyperkalemia in patients with kidney failure and cardiac conditions.

Integration Of Bioinspired Artificial Channels For The Concept Design Of An Artificial Kidney Device

Integration Of Bioinspired Artificial Channels For The Concept Design Of An Artificial Kidney Device

Integration Of Bioinspired Artificial Channels For The Concept Design Of An Artificial Kidney Device

Integration Of Bioinspired Artificial Channels For The Concept Design Of An Artificial Kidney Device

Breaking the Barriers to Innovation in Kidney Care: The Time is Now.

Breaking the Barriers to Innovation in Kidney Care: The Time is Now.

Conducting hemodialysis in case of cellophane film breakthrough in the "Artificial kidney" device

There were 7 cases of cellophane film breakthrough per 100 hemodialysis performed at the Kazan Kidney Center.

Artificial Kidney Capsule Packed with Mesenchymal Stem Cell-Laden Hydrogel for the Treatment of Rhabdomyolysis-Induced Acute Kidney Injury.

Acute kidney injury (AKI) has emerged as a major public health problem affecting millions of people worldwide without specific and satisfactory therapies due to the lack of an effective delivery approach. In the past few decades, hydrogels present infinite potential in localized drug delivery, while their poor adhesion to moist tissue and isotropic diffusion character always restrict the therapeutic efficiency and may lead to unwanted side effects. Herein, we proposed a novel therapeutic strategy for AKI via a customizable artificial kidney capsule (AKC) together with a mesenchymal stem cell (MSC)-laden hydrogel. Specifically, an elastic capsule owning an inner chamber with the same size and shape as the kidney is designed and fabricated through three-dimensional (3D) modeling and printing, serving as an outer wrap for kidney and cell-laden hydrogels. According to the in vitro experiment, the excellent biocompatibility of gelatin-based hydrogel ensures viability and proliferation of MSCs. In vivo mice experiments proved that this concept of AKC-assisted kidney drug delivery could efficiently reduce epithelial cell apoptosis and minimize the damage of the renal tubular structure for mice suffering AKI. Such a strategy not only provides a promising alternative in the treatment of AKI but also offers a feasible and versatile approach for the repair and recovery of other organs.

Incidence of Hepatitis B Infection among People with Renal Failure in Babylon Province

Introduction: This study was performed in the Marjan Medical City/ hemodialysis Center of Babylon province, Iraq from 1 February 2020 to 1 February 2021. It aimed to investigate the incidence of the hepatitis B virus in people with renal failure. The study included some factors such as virus type, seasons, gender, age group, and blood groups. Methods: The reporting of all suspected HBV cases with renal failure in Marjan Medical City/ Haemodialysis Center in the Directorate General of Health (DGoH) of Babylon province/ Iraq from 1 February 2020 to 1 February 2021 were used in the current study.Results: The results of this study showed that the total infection incidence in renal failure samples reached (16.67%) of 48 diseased cases that were monitored by the artificial Kidney centre (hemodialysis) for people infected with the hepatitis B virus. The prevalence of this pattern was observed during the seasons of the year, where the infection incidence was higher in June and September, amounting to 61.11% and 36.39%, respectively, while males 17.42% recorded a higher incidence of infection than it is in females 15.45%. It was found that the infection rates varied. Among the different age groups (13-68 years), the highest infection rate was within the youth age group (11-20), (21-30), and (41-50) years old, which was 66.67%, 26.67%, and 25%, respectively. Conclusion: Subjects with HBV demonstrated that O+ and unidentified blood groups had confirmed instances of HBV contrast to other blood groups with 39.58 per cent and 29 per cent, respectively.

Toward Urease-free wearable artificial kidney: Widened interlayer spacing MoS2 nanosheets with highly effective adsorption for uremic toxins

The high incidence of kidney disease caused by various factors (such as COVID-19) has triggered an extreme desire for wearable artificial kidney (WAK). Nevertheless, the dialysate regeneration system in WAK presents a very low adsorption capacity of urea, and must rely on the help of urease and zirconium compounds, which make the device too complex and costly, thus limiting their application. In this study, we employ the adsorption activity of defect-rich MoS2 nanosheets with widened interlayer spacing (WDR-MoS2) for the elimination of three crucial uremic toxins (urea, creatinine, and uric acid). The high adsorption performances of WDR-MoS2 are owing to the presence of abundant S atoms between the two MoS2 sheets that can efficiently adsorb uremic toxins through the unique S–N bond. Furthermore, widening the layer spacing of MoS2 is similar to adjusting the aperture of a filter, which can not only speed up the transport of uremic toxins but also prevent the passage of large molecules (such as proteins). Thus, the WDR-MoS2 can neither affect cell viability nor produce hemolysis and coagulation in the blood. Finally, a home-made WDR-MoS2 fixed-bed system without urease and zirconium compounds is used to efficiently remove uremic toxins in the dialysate. WDR-MoS2 is expected to fundamentally solve the materials science challenges in WAK and provide a new design idea for the development of high-performance 2D material-based adsorbents.

Home hemodialysis

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

Factors Associated with Sarcopenia among Hemodialysis Patients

Purpose : This descriptive survey aims to identify the prevalence of factors associated with sarcopenia among hemodialysis patients.Methods : The study subjects were 137 patients with chronic kidney failure undergoing hemodialysis in three artificial kidney centers in B and Y cities. Data were collected from August 1 to September 30, 2020, using the SARC-F (Strength, Assistant walking, Rising from a chair, Climbing stairs, Falls) questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF), International Physical Activity Questionnaire (IPAQ-SF), Bioelectrical Impedance Analysis (BIA), and a grip dynamometer. The collected data were analyzed using t-tests, crossover analysis, and logistic regression using the IBM SPSS 23 program.Results : The prevalence of sarcopenia among hemodialysis patients, determined using the SARC-F questionnaire, was 16.1%. The associated factors of sarcopenia among hemodialysis patients were found to be gender (OR=6.44, <i>p</i> =.002), age (OR=1.07, <i>p</i> =.015), nutritional status (OR=10.37, <i>p</i> =.027), and albumin level (OR=0.10, <i>p</i> =.014). These findings are supported by an explanatory power of 46.3% (<i>p</i> =.597).Conclusion : The identified risk factors for sarcopenia in hemodialysis patients were; sex, age, nutritional status, and albumin level. The findings of this study can serve as clinical evidence for the development of an intervention program for preventing and managing sarcopenia in patients undergoing hemodialysis.