scholarly journals Molecular insight into optimizing the N- and P-doped fullerenes for urea removal in wearable artificial kidneys

2021 ◽  
Vol 32 (5) ◽  
Author(s):  
Ahmad Miri Jahromi ◽  
Pegah Zandi ◽  
Mohammad Khedri ◽  
Ebrahim Ghasemy ◽  
Reza Maleki ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Chemical Properties ◽  
Md Simulations ◽  
The Body ◽  
Radius Of Gyration ◽  
Doped Fullerenes ◽  
Artificial Kidneys ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractUrea is the result of the breakdown of proteins in the liver, the excess of which circulates in the blood and is adsorbed by the kidneys. However, in the case of kidney diseases, some products, specifically urea, cannot be removed from the blood by the kidneys and causes serious health problems. The end-stage renal disease (ESRD) patients are not able to purify their blood, which endangers their life. ESRD patients require dialysis, a costly and difficult method of urea removal from the blood. Wearable artificial kidneys (WAKs) are consequently designed to remove the waste from blood. Regarding the great amount of daily urea production in the body, WAKs should contain strong and selective urea adsorbents. Fullerenes—which possess fascinating chemical properties—have been considered herein to develop novel urea removal adsorbents. Molecular dynamics (MD) has enabled researchers to study the interaction of different materials and can pave the way toward facilitating the development of wearable devices. In this study, urea adsorption by N-doped fullerenes and P-doped fullerenes were assessed through MD simulations. The urea adsorption was simulated by five samples of fullerenes, with phosphorous and different nitrogen dopant contents. For comparing the urea adsorption capacity in the performed simulations, detailed characteristics—including the energy analysis, radius of gyration, radial distribution function (RDF), root-mean-square fluctuation (RMSD), and H-bond analyses were investigated. It had been determined that the fullerene containing 8% nitrogen—with the highest reduction in the radius of gyration, the maximum RDF, a high adsorption energy, and a high number of hydrogen bonds—adsorbs urea more efficiently.

Geometric Enhancements of an Arteriovenous Graft

2009 ◽  
Author(s):  
Stephen P. Broderick ◽  
Gráinne Carroll ◽  
Micheal Walsh
Keyword(s):  
United States ◽  
The Elderly ◽  
The United States ◽  
Cost Of Care ◽  
The Body ◽  
Venous Anastomosis ◽  
And Migration ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End Stage Renal Disease (ESRD) is the degeneration of kidney function to remove uremic toxins from the blood. Currently there are over 484,000 sufferers of ESRD in the United States, with this figure predicted to rise to over 800,000 by 2020 [1]. The total cost of care for patients with ESRD was estimated to exceed 1 billion dollars in the United States [2]. A kidney transplant is the ideal solution for ESRD patients; however with the increasing number of ESRD patients the odds of receiving a donor kidney are poor. The alternative is hemodialysis. This process is involves the extraction of blood from the patient to an extracorporal machine. Blood is pumped at a rate of 350 mL/min to ensure effective dialysis. The blood is then returned to the body cleaned. The gold standard for hemodialysis access is the native arteriovenous fistula [3] with the most common type being the Brescia-Cimino fistula at the wrist [4]. In some subgroups the fistula performs poorly. In diabetics and the elderly, specifically over 70s [2] or can’t be constructed because of unsuitable blood vessels [5]. In this case an alternative is the synthetic AV graft. Made of polytetrafluoroethelyne, it has lower patency rates against the fistula [6] [7] mediated by the susceptibility to thrombosis induced by stenosis development and infection [7].The majority of stenosis development is within the venous anastomosis (kanterman1995). The formation of intimal hyperplasia (IH) leading to stenosis formation is caused by smooth cell proliferation and migration as a result of endothelial cells reacting to shear stress receptors. The development of IH has been linked to local hemodynamics and turbulence in the flow, which in turn are heavily influenced by the geometry of the graft.

scholarly journals The future of dialysis treatment: wearable artificial kidneys (WAKs)

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Rameez Imtiaz ◽  
Tharshika Thangarasa
Keyword(s):  
End Stage Renal Disease ◽  
Prise En Charge ◽  
Artificial Kidney ◽  
Medical Community ◽  
Dialysis Treatment ◽  
Artificial Kidneys ◽  
Wearable Artificial Kidney ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Present day limitations in conventional dialysis therapies have prompted the medical community to explore alternative options in the management of end-stage renal disease (ESRD). The wearable artificial kidney (WAK) is a portable dialysis device, worn around an individual’s waist, which aims to provide ESRD patients with sustained hemodialysis. In this paper we will explore the mechanisms by which the WAK operates, as well as the evidence for its efficacy and feasibility in clinical practice. RÉSUMÉ Les limites actuelles des thérapies de dialyse conventionnelles ont incité la communauté médicale à explorer des options alterna- tives pour la prise en charge de l’insuffisance rénale chronique. Le rein artificiel portable (WAK, de l’anglais) est un appareil de dialyse portatif, porté autour de la taille d’un individu, qui vise à fournir une hémodialyse continue aux patients atteints d’insuffisance rénale terminale. Dans cet article, nous explorerons les mécanismes de fonctionnement du WAK, ainsi que les preuves de son efficacité et de sa faisabilité en pratique clinique. 

scholarly journals Chronic Kidney Disease in Community

2020 ◽  
pp. 75-78
Author(s):  
Dimitra Paikopoulou
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
The United States ◽  
World Health ◽  
Chronic Kidney Diseases ◽  
Real Increase ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World ◽  
Esrd Patients

The world's disease profile is changing, and chronic diseases now account for the majority of global morbidity and mortality. The causes of chronic kidney diseases (CKD) reflect this change. The increase in prevalence of CKD is partly due to a real increase in its frequency (due to the increase in the average age of people surviving), better detection of CKD, but also to the increasing incidence of diabetes and hypertension among people today, not only within the developed world, but also increasingly within the emerging world. Furthermore, hypertension, smoking, hypercholesterolemia, and obesity, currently among the World Health Organization’s (WHO’s) top 10 global health risks, are strongly associated with CKD. The factors, together with increasing diabetes prevalence and an aging population, will result in significant global increases in chronic kidney diseases (CKD) end stage renal disease (ESRD) patients. There are approximately 275000 patients with ESRD in the United States and it is estimated that an additional 8 million US adults have kidney disease (defined as a glomerular filtration rate [GFR] of 60 mL/min per 1.73 m2). Because kidney disease often progresses to ESRD and its attendant complications, the identification of precursors of kidney disease is important, with the belief that interventions will prevent or delay the progression to ESRD.

Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters

2020 ◽  
Vol 15 (3) ◽  
pp. 249-263
Author(s):  
Maria Aktsiali ◽  
Theodora Papachrysanthou ◽  
Ioannis Griveas ◽  
Christos Andriopoulos ◽  
Panagiotis Sitaras ◽  
...  
Keyword(s):  
Bone Mineral ◽  
Mineral Metabolism ◽  
Treatment Options ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Protective Agent ◽  
Positive Correlation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Due to the premium rate of Chronic Kidney Disease, we have increased our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End- Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and Parathormone levels, improving the quality of life. The aim of the present study was to investigate the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia parameters such as hematocrit and hemoglobin. Materials and Methods: retrospective observational study was conducted in a Chronic Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of 30-120 mg. Results: Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet. Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested. Conclusions: Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved for use in ESRD patients to assist SHPT. A novel information was obtained from this study, regarding the improvement of the control of anemia.

Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Glen H Stanbaugh ◽  
A. W, Holmes Diane Gillit ◽  
George W. Reichel ◽  
Mark Stranz
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Overload ◽  
End Stage Renal Disease ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Peritoneal Dialysate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.

scholarly journals Prediction of All-Cause Mortality Using an Echocardiography-Based Risk Score in Hemodialysis Patients

2020 ◽  
pp. 1-11
Author(s):  
Jing Zhu ◽  
Chao Tang ◽  
Han Ouyang ◽  
Huaying Shen ◽  
Tao You ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Model ◽  
Prognostic Score ◽  
Basic Model ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Cardiac Valve Regurgitation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

<b><i>Aim:</i></b> To derive an echocardiography-based prognostic score for a 3-year risk of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). <b><i>Methods:</i></b> 173 ESRD patients hospitalized in the second affiliated hospital of Soochow University from January 1, 2010, to July 31, 2016, were enrolled and followed up for 3 years. All subjects began to receive HD from recruitment. Baseline clinical and echocardiographic parameters were collected and screened for risk factors using univariate and multivariate analysis. The prognostic value of echocardiographic indexes was determined by concordance indexes and reclassification assay. Restricted cubic spline models (RCS) and forest plots were employed to visualize the association between risk factors and all-cause mortality. A multivariate nomogram including the identified factors was developed to estimate the prognosis. <b><i>Results:</i></b> After multivariate adjustment for advanced age, hypertension, diabetes, and decreased hemoglobin (Hb), echocardiographic indexes including left atrial diameter index (LADI), cardiac valvular calcification, and moderate to severe cardiac valve regurgitation were independently associated with the risk of 3-year mortality in HD patients. RCS showed that age, Hb, and LADI were positively associated with the risk of mortality. Adding multiple echocardiographic indexes to a basic model containing age, hypertension, diabetes, and Hb increased the concordance index and improved reclassification. A multivariate Cox model-derived nomogram showed the association between each factor and mortality by the end of follow-up. <b><i>Conclusions:</i></b> Echocardiographic indexes showed independent predictive power for mortality in ESRD patients and may constitute a promising prognostic tool in this population.

Adipokines and Gut Hormones in End-Stage Renal Disease

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 298-302
Author(s):  
Robert H. Mak ◽  
Wai Cheung
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Peptide Yy ◽  
Gut Hormones ◽  
Poor Quality ◽  
Mortality And Morbidity ◽  
Novel Therapeutic Strategies ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Cachexia is common in end-stage renal disease (ESRD) patients, and it is an important risk factor for poor quality of life and increased mortality and morbidity. Chronic inflammation is an important cause of cachexia in ESRD patients. In the present review, we examine recent evidence suggesting that adipokines or adipocytokines such as leptin, adiponectin, resistin, tumor necrosis factor α, interleukin-6, and interleukin-1β may play important roles in uremic cachexia. We also review the physiology and the potential roles of gut hormones, including ghrelin, peptide YY, and cholecystokinin in ESRD. Understanding the molecular pathophysiology of these novel hormones in ESRD may lead to novel therapeutic strategies.

scholarly journals Hemodialysis exacerbates proteolytic imbalance and pro-fibrotic platelet dysfunction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aaron J. Velasquez-Mao ◽  
Mark A. Velasquez ◽  
Zhengxiong Hui ◽  
Denise Armas-Ayon ◽  
Jingshen Wang ◽  
...  
Keyword(s):  
Blood Flow Rate ◽  
Mode Switching ◽  
Platelet Dysfunction ◽  
Compensatory Mechanisms ◽  
Before And After ◽  
Basal Plasma ◽  
Stage Renal Disease ◽  
End Stage ◽  
Plasma Factors ◽  
Esrd Patients

AbstractMulti-organ fibrosis among end stage renal disease (ESRD) patients cannot be explained by uremia alone. Despite mitigation of thrombosis during hemodialysis (HD), subsequent platelet dysfunction and tissue dysregulation are less understood. We comprehensively profiled plasma and platelets from ESRD patients before and after HD to examine HD-modulation of platelets beyond thrombotic activation. Basal plasma levels of proteolytic regulators and fibrotic factors were elevated in ESRD patients compared to healthy controls, with isoform-specific changes during HD. Platelet lysate (PL) RNA transcripts for growth and coagulative factors were elevated post-HD, with upregulation correlated to HD vintage. Platelet secretome correlations to plasma factors reveal acutely induced pro-fibrotic platelet phenotypes in ESRD patients during HD characterized by preferentially enhanced proteolytic enzyme translation and secretion, platelet contribution to inflammatory response, and increasing platelet dysfunction with blood flow rate (BFR) and Vintage. Compensatory mechanisms of increased platelet growth factor synthesis with acute plasma matrix metalloproteinase (MMP) and tissue inhibitor of MMPs (TIMP) increases show short-term mode-switching between dialysis sessions leading to long-term pro-fibrotic bias. Chronic pro-fibrotic adaptation of platelet synthesis were observed through changes in differential secretory kinetics of heterogenous granule subtypes. We conclude that chronic and acute platelet responses to HD contribute to a pro-fibrotic milieu in ESRD.

scholarly journals Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (7) ◽  
pp. 3471
Author(s):  
Hyeon-Ju Lee ◽  
Youn-Jung Son
Keyword(s):  
Systematic Review ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Associated Factors ◽  
Meta Analysis ◽  
Screening Tools ◽  
Cochrane Library ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Hemodialysis is the most common type of treatment for end-stage renal disease (ESRD). Frailty is associated with poor outcomes such as higher mortality. ESRD patients have a higher prevalence of frailty. This systematic review and meta-analysis aimed to identify the prevalence and associated factors of frailty and examine whether it is a predictor of mortality among ESRD patients undergoing hemodialysis. Five electronic databases including PubMed, Embase, CINAHL, Web of Science, and Cochrane Library were searched for relevant studies up to 30 November 2020. A total of 752 articles were found, and seven studies with 2604 participants in total were included in the final analysis. The pooled prevalence of frailty in patients with ESRD undergoing hemodialysis was 46% (95% Confidence interval (CI) 34.2−58.3%). Advanced age, female sex, and the presence of diabetes mellitus increased the risk of frailty in ESRD patients undergoing hemodialysis. Our main finding showed that patients with frailty had a greater risk of all-cause mortality compared with those without (hazard ratio (HR): 2.02, 95% CI: 1.65−2.48). To improve ESRD patient outcomes, healthcare professionals need to assess the frailty of older ESRD patients, particularly by considering gender and comorbidities. Comprehensive frailty screening tools for ESRD patients on hemodialysis need to be developed.

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