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Studies in Health Technology and... Jan 2024eHealth solutions such as digital patient engagement platforms (DPEPs) aim at enhancing communication and collaboration between patients and clinicians. From the...
eHealth solutions such as digital patient engagement platforms (DPEPs) aim at enhancing communication and collaboration between patients and clinicians. From the clinicians' viewpoint, concerns exist about new information systems (IS) leading to increased workload and interoperability problems. This article aims to support the development and implementation of DPEPs from the end-users' perspective. We studied clinicians' needs for a new DPEP developed to support home dialysis (HD) care. Eight clinicians participated in remote semi-structured interviews. Clinicians had positive expectations for the new DPEP as it could provide an overall picture of patients' status, support patients' self-care, and save time during patient visits. However, they had concerns about successful implementation, changes to workflows, and integration issues. To conclude, it is important to design and agree on changes in work practices, patient care, and complex IS environments when implementing new DPEP solutions in clinics.
Topics: Humans; Hemodialysis, Home; Patient Participation; Renal Dialysis; Home Care Services; Telemedicine
PubMed: 38269987
DOI: 10.3233/SHTI231137 -
Peritoneal Dialysis International :... Mar 2024Overhydration is highly prevalent in patients on peritoneal dialysis (PD), with inappropriately high sodium load supposedly playing a central role in the pathophysiology... (Review)
Review
Overhydration is highly prevalent in patients on peritoneal dialysis (PD), with inappropriately high sodium load supposedly playing a central role in the pathophysiology of the conditions. Recent studies have revealed the novel role of the interstitium as a buffer system for sodium ions, and it has been reported that patients on dialysis, including PD, present increased levels of sodium in the interstitium, such as in subcutaneous tissue and muscle. Hence, therapy for correction of overhydration should target the excess extracellular volume and the excess sodium storage in the interstitium. The ultrafiltrate obtained using the currently available PD solutions is hypo- to isonatric as compared to serum, which is disadvantageous for prompt and efficient sodium removal from the body in patients with overhydration. In contrast, use of low sodium PD solutions is characterised by iso- to hypernatric ultrafiltrate, which may beneficial for reducing sodium storage in the interstitium. Trials of low sodium PD solutions have reported possible clinical merits, for example, decreased blood pressure, reduced dryness of mouth and decreased body water content as assessed using bioimpedance methods. Given these observations and the high prevalence of overhydration in current PD populations, it makes medical sense that low sodium solutions be positioned as the new standard solution in the future. However, for medical safety, that is, to avoid hyponatremia and excessive decreases in blood pressure, further studies are needed to establish the appropriate compositions and applications of low sodium solutions.
Topics: Humans; Peritoneal Dialysis; Dialysis Solutions; Water Intoxication; Renal Dialysis; Sodium
PubMed: 38265014
DOI: 10.1177/08968608231222141 -
Clinical Journal of the American... Jun 2024
Topics: Humans; United States; Renal Dialysis; Ambulatory Care Facilities
PubMed: 38261327
DOI: 10.2215/CJN.0000000000000421 -
Scientific Reports Jan 2024Copper (Cu) is a cofactor in numerous key proteins and, thus, an essential element for life. In biological systems, Cu isotope abundances shift with metabolic and...
Copper (Cu) is a cofactor in numerous key proteins and, thus, an essential element for life. In biological systems, Cu isotope abundances shift with metabolic and homeostatic state. However, the mechanisms underpinning these isotopic shifts remain poorly understood, hampering use of Cu isotopes as biomarkers. Computational predictions suggest that isotope fractionation occurs when proteins bind Cu, with the magnitude of this effect dependent on the identity and arrangement of the coordinating amino acids. This study sought to constrain equilibrium isotope fractionation values for Cu bound by common amino acids at protein metal-binding sites. Free and bound metal ions were separated via Donnan dialysis using a cation-permeable membrane. Isotope ratios of pre- and post-dialysis solutions were measured by MC-ICP-MS following purification. Sulfur ligands (cysteine) preferentially bound the light isotope (Cu) relative to water (ΔCu = - 0.48 ± 0.18‰) while oxygen ligands favored the heavy isotope (Cu; + 0.26 ± 0.04‰ for glutamate and + 0.16 ± 0.10‰ for aspartate). Binding by nitrogen ligands (histidine) imparted no isotope effect (- 0.01 ± 0.04‰). This experimental work unequivocally demonstrates that amino acids differentially fractionate Cu isotopes and supports the hypothesis that metalloprotein biosynthesis affects the distribution of transition metal isotopes in biological systems.
Topics: Amino Acids; Copper; Metalloproteins; Renal Dialysis; Glutamic Acid; Isotopes; Antifibrinolytic Agents
PubMed: 38253574
DOI: 10.1038/s41598-024-52091-7 -
Membranes Dec 2023This study presents the possibility of using diffusion dialysis for the separation of inorganic acids (hydrochloric, nitric, and hydrofluoric) and their ferric salts...
This study presents the possibility of using diffusion dialysis for the separation of inorganic acids (hydrochloric, nitric, and hydrofluoric) and their ferric salts whose composition corresponds to that of real spent pickling solutions. At a steady state, the transport properties of three different anion-exchange membranes (Fumasep-FAD, Neosepta-AFN, and Neosepta-AHA) are compared using a continuous counter-current dialyzer. At a constant composition of the solutions (acid concentration 3 mol L and iron concentration 30-40 g L), the effects of volumetric liquid flow rates on the transport rate of H and Fe ions through the membrane are studied. The dialysis process is characterized by the recovery of acids and the rejection of salts. Furthermore, the values of the dialysis coefficients of acids, iron, and the acid/iron separation factors are calculated and compared. The volumetric flow rates of the inlet streams change in limits from 3 × 10 to 6 × 10 m s (from 3 to 6 L h m, relative to the membrane area). A comparison of the tested membranes shows slightly better results for acid recovery, iron rejection, and acid/iron separation factors for the Fumasep-FAD membrane than for the Neosepta-AFN membrane. However, the results obtained show that both of these anion-exchange membranes can be considered good separators for tested mixtures that simulate real spent pickling solutions, and there is a good precondition for using diffusion dialysis for processing these solutions in industrial practice. On the contrary, very low values of acid recovery and the overall dialysis coefficient of acid are found for the Neosepta-AHA membrane in the test range of the volumetric flow rate, and, thus, this membrane is insufficient for the adequate separation of these acids and iron salts.
PubMed: 38248696
DOI: 10.3390/membranes14010006 -
Nefrologia 2023The sodium gradient during hemodialysis sessions is one of the key factors in sodium balance in patients with dialysis-dependent chronic kidney disease; however, until...
INTRODUCTION
The sodium gradient during hemodialysis sessions is one of the key factors in sodium balance in patients with dialysis-dependent chronic kidney disease; however, until the appearance of the new monitors with sodium modules, the differences between prescribed and measured sodium have been understudied. The present study aimed to compare the impact on the measured conductivity and the initial and final plasma sodium after changing the 5008 Cordiax to the new 6008 Cordiax monitor.
MATERIAL AND METHODS
106 patients on hemodialysis were included. Each patient underwent 2 dialysis sessions in which only the monitor was varied. The variables collected were dialysate, sodium and bicarbonate prescribed, real conductivity, initial and final plasma sodium measured, and the calculated sodium gradient (ΔPNa).
RESULTS
The change of dialysis monitor showed small but statistically significant differences in the initial (138.14mmol/L with 5008 vs. 138.81mmol/L with 6008) and final plasma sodium (139.58mmol/L vs. 140.97mmol/L), as well as in the actual conductivity obtained (13.97 vs. 14.1mS/cm). The ΔPNa also increased significantly.
CONCLUSION
The change from 5008 to 6008 monitor is associated with increased conductivity, leading the patient to end the sessions with higher plasma sodium and ΔPNa. Knowing and confirming this change will allow us to individualize the sodium prescription and avoid possible undesirable effects. It could be the preliminary study to explore the new sodium biosensor incorporated into the new generation of monitors.
Topics: Humans; Renal Dialysis; Sodium; Dialysis Solutions
PubMed: 38242765
DOI: 10.1016/j.nefroe.2024.01.006 -
Journal of Artificial Organs : the... Jun 2024Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin... (Review)
Review
Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin losses considers albumin "leaking" into the dialysate and losses due to protein/membrane interactions (i.e. adsorption, "secondary membrane formation" and denaturation). The former are fairly easy to determine, usually varying at the level of ~ 2 g to ~ 7 g albumin loss per session. Such values, commonly accepted as representative of the total albumin losses, are often quoted as limits/standards of permissible albumin loss per session. On albumin mass lost due to adsorption/deposition, which is the result of complicated interactions and rather difficult to determine, scant in vivo data exist and there is great uncertainty and confusion regarding their magnitude; this is possibly responsible for neglecting their contribution to the total losses at present. Yet, many relevant in vitro studies suggest that losses of albumin due to protein/membrane interactions are likely comparable to (or even greater than) those due to leaking, particularly in the currently favoured high-convection HDF (haemodiafiltration) treatment. Therefore, it is emphasised that top research priority should be given to resolve these issues, primarily by developing appropriate/facile in vivo test-methods and related analytical techniques.
Topics: Humans; Dialysis Solutions; Hemodiafiltration; Hypoalbuminemia; Renal Dialysis; Serum Albumin
PubMed: 38238597
DOI: 10.1007/s10047-023-01430-y -
ClinicoEconomics and Outcomes Research... 2024Approximately 24% of hospitalized stage 2-3 acute kidney injury (AKI) patients will develop persistent severe AKI (PS-AKI), defined as KDIGO stage 3 AKI lasting ≥3...
BACKGROUND
Approximately 24% of hospitalized stage 2-3 acute kidney injury (AKI) patients will develop persistent severe AKI (PS-AKI), defined as KDIGO stage 3 AKI lasting ≥3 days or with death in ≤3 days or stage 2 or 3 AKI with dialysis in ≤3 days, leading to worse outcomes and higher costs. There is currently no consensus on an intervention that effectively reverts the course of AKI and prevents PS-AKI in the population with stage 2-3 AKI. This study explores the cost-utility of biomarkers predicting PS-AKI, under the assumption that such intervention exists by comparing C-C motif chemokine ligand 14 (CCL14) to hospital standard of care (SOC) alone.
METHODS
The analysis combined a 90-day decision tree using CCL14 operating characteristics to predict PS-AKI and clinical outcomes in 66-year-old patients, and a Markov cohort estimating lifetime costs and quality-adjusted life years (QALYs). Cost and QALYs from admission, 30-day readmission, intensive care, dialysis, and death were compared. Clinical and cost inputs were informed by a large retrospective cohort of US hospitals in the PINC AI Healthcare Database. Inputs and assumptions were challenged in deterministic and probabilistic sensitivity analyses. Two-way analyses were used to explore the efficacy and costs of an intervention preventing PS-AKI.
RESULTS
Depending on selected costs and early intervention efficacy, CCL14-directed care led to lower costs and more QALYs (dominating) or was cost-effective at the $50,000/QALY threshold. Assuming the intervention would avoid 10% of PS-AKI complications in AKI stage 2-3 patients identified as true positive resulted in 0.066 additional QALYs and $486 reduced costs. Results were robust to substantial parameter variation.
CONCLUSION
The analysis suggests that in the presence of an efficacious intervention preventing PS-AKI, identifying people at risk using CCL14 in addition to SOC is likely to represent a cost-effective use of resources.
PubMed: 38235419
DOI: 10.2147/CEOR.S434971 -
Saudi Journal of Kidney Diseases and... May 2023In recent years, adynamic bone disease (ABD) has become a common skeletal lesion in adult patients with chronic kidney disease. We aimed to compare the effects of low...
In recent years, adynamic bone disease (ABD) has become a common skeletal lesion in adult patients with chronic kidney disease. We aimed to compare the effects of low calcium dialysate (LCD) and standard calcium dialysate of our facility [high calcium dialysate (HCD)] on the evolution of bone and mineral parameter related to ABD in dialysis patients. Forty patients with predialysis intact parathyroid hormone (iPTH) <100 pg/mL and/or bone-specific alkaline phosphatase (BAP) <27 U/L were included in this study and were equally distributed over LCD (1.25 mmol/L) or HCD (1.75 mmol/L) treatment. The duration of the study was 6 months. There was no significant difference in baseline characters and biochemical parameters related to chronic kidney disease-mineral and bone disorder in both the groups. The groups did not differ in the mean tCa before dialysis, but this parameter was significantly lower in the LCD group versus HCD at the end of the study. The mean serum levels of iPTH, total alkaline phosphatase, and BAP in the LCD group were increased at 3 months and at the end of the study compared with the baseline levels. The bone markers in the HCD group did not change significantly. At the end of the study, all bone parameters in the LCD group were significantly higher than in the HCD group. Development of measures indicating increased bone turnover in patients receiving 1.25 mmol/L of dialysate calcium, most likely as a result of inhibiting a positive calcium balance and allowing for long-term PTH secretion stimulation. Hence, LCD might be considered a valuable therapeutic option for ABD patients.
Topics: Adult; Humans; Calcium; Dialysis Solutions; Alkaline Phosphatase; Parathyroid Hormone; Renal Dialysis; Bone Diseases; Hypercalcemia
PubMed: 38231717
DOI: 10.4103/1319-2442.393995 -
Clinical Journal of the American... Jan 2024
PubMed: 38214917
DOI: 10.2215/CJN.0000000000000433