Journal: Nephrology Dialysis Transplantation

Abbreviation

Nephrol Dial Transplant

Publisher

Oxford University Press

Journal Volumes

ISSN

0931-0509
1460-2385

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2011 - 201952020 - 20212
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Publications 1 - 7 of 7
  • Identifying key predictors of mortality in young patients on chronic haemodialysis—a machine learning approach
    Item type: Journal Article
    Gotta, Verena; Tancev, Georgi; Marsenic, Olivera; et al. (2021)
    Nephrology Dialysis Transplantation
    Background The mortality risk remains significant in paediatric and adult patients on chronic haemodialysis (HD) treatment. We aimed to identify factors associated with mortality in patients who started HD as children and continued HD as adults. Methods The data originated from a cohort of patients <30 years of age who started HD in childhood (≤19 years) on thrice-weekly HD in outpatient DaVita dialysis centres between 2004 and 2016. Patients with at least 5 years of follow-up since the initiation of HD or death within 5 years were included; 105 variables relating to demographics, HD treatment and laboratory measurements were evaluated as predictors of 5-year mortality utilizing a machine learning approach (random forest). Results A total of 363 patients were included in the analysis, with 84 patients having started HD at <12 years of age. Low albumin and elevated lactate dehydrogenase (LDH) were the two most important predictors of 5-year mortality. Other predictors included elevated red blood cell distribution width or blood pressure and decreased red blood cell count, haemoglobin, albumin:globulin ratio, ultrafiltration rate, z-score weight for age or single-pool Kt/V (below target). Mortality was predicted with an accuracy of 81%. Conclusions Mortality in paediatric and young adult patients on chronic HD is associated with multifactorial markers of nutrition, inflammation, anaemia and dialysis dose. This highlights the importance of multimodal intervention strategies besides adequate HD treatment as determined by Kt/V alone. The association with elevated LDH was not previously reported and may indicate the relevance of blood–membrane interactions, organ malperfusion or haematologic and metabolic changes during maintenance HD in this population.
  • Device for continuous extracorporeal blood purification using target-specific metal nanomagnets
    Item type: Journal Article
    Herrmann, Inge K.; Bernabei, Riccardo E.; Urner, Martin; et al. (2011)
    Nephrology Dialysis Transplantation
  • SP508: Using UV-paint for evaluating touch-contamination of a patient-assistance device for peritoneal dialysis
    Item type: Other Conference Item
    Neumann, Sandra; Hess, Stephan; Babek, Dabaghchian; et al. (2019)
    Nephrology Dialysis Transplantation ~ 56th ERA-EDTA Congress Abstracts
    INTRODUCTION: Dealing with a new situation of a life-threating disease like a renal failure is challenging alone. Combining this with an unfamiliar handling procedure in the therapy and a permanent fear of an infection by touch contamination may quickly become overwhelming for the person affected. This may result in early dropouts or be a reason for not being treated at home. A novel patient assistance device aims to connect the peritoneal dialysis (PD) catheter and the PD tubing system touch free. The objective of this work is to evaluate, if untrained novices in PD are able to perform handling cycles with the patient assistance device without touching infection critical surfaces on the PD catheter or on the PD tubing system. METHODS: Ten volunteers (8 males and 2 females, average 26 years, range 23-37 years) were recruited and participated in one complete handling cycle, with no training in advance but aided by the device’s quick starting guide only. While interacting with the device, the volunteers had UV-paint on their hands, which is invisible in daylight but brightly colourful under UV-light. Subsequent to the handling cycle, the surfaces were analysed with a UV-light for contact with the volunteer’s hands. RESULTS: The volunteers touched all expected user interface features of the device such as the three buttons on the top, the lever on the right-hand side and the clamp of the PD catheter. The tip of the uncovered PD tubing system and the inside of the PD catheter were defined as critical surfaces for potential infections. The analysis of the touched surfaces showed no UV-paint on these surfaces. CONCLUSIONS: The results indicate that the patient assistance device enables even untrained novices to connect a PD catheter to a PD tubing system and performing the therapy handling safely without touching critical surfaces when using the patient assistance device.
  • Development of a Novel Connection Device for Patients on Peritoneal Dialysis (PD)
    Item type: Other Conference Item
    Segerer, Stephan; Neumann, Sandra; Hess, Stephan (2018)
    Nephrology Dialysis Transplantation
  • Acidosis and alkali therapy in patients with kidney transplant is associated with transcriptional changes and altered abundance of genes involved in cell metabolism and acid-base balance
    Item type: Journal Article
    Imenez Silva, Pedro H.; Wiegand, Anna; Daryadel, Arezoo; et al. (2021)
    Nephrology Dialysis Transplantation
    Background Metabolic acidosis occurs frequently in patients with kidney transplant and is associated with a higher risk for and accelerated loss of graft function. To date, it is not known whether alkali therapy in these patients improves kidney function and whether acidosis and its therapy are associated with altered expression of proteins involved in renal acid–base metabolism. Methods We retrospectively collected kidney biopsies from 22 patients. Of these patients, nine had no acidosis, nine had metabolic acidosis [plasma bicarbonate (HCO3− <22 mmol/L) and four had acidosis and received alkali therapy. We performed transcriptome analysis and immunohistochemistry for proteins involved in renal acid–base handling. Results We found that the expression of 40 transcripts significantly changed between kidneys from non-acidotic and acidotic patients. These genes are mostly involved in proximal tubule (PT) amino acid and lipid metabolism and energy homoeostasis. Three transcripts were fully recovered by alkali therapy: the Kir4.2 potassium channel, an important regulator of PT HCO3− metabolism and transport, acyl-CoA dehydrogenase short/branched chain and serine hydroxymethyltransferase 1, genes involved in beta oxidation and methionine metabolism. Immunohistochemistry showed reduced staining for the PT NBCe1 HCO3− transporter in kidneys from acidotic patients who recovered with alkali therapy. In addition, the HCO3− exchanger pendrin was affected by acidosis and alkali therapy. Conclusions Metabolic acidosis in kidney transplant recipients is associated with alterations in the renal transcriptome that are partly restored by alkali therapy. Acid–base transport proteins mostly from PT were also affected by acidosis and alkali therapy, suggesting that the downregulation of critical players contributes to metabolic acidosis in these patients.
  • SP530: Comparative Usability Evaluation Of A Novel Peritoneal Dialysis Assistance Device Using Mobile Eye Tracking
    Item type: Other Conference Item
    Neumann, Sandra; Hess, Stephan; Wahlen, Dimitri; et al. (2019)
    Nephrology Dialysis Transplantation ~ 56th ERA-EDTA Congress Abstracts
    INTRODUCTION: Patients in peritoneal dialysis (PD) have beside of their disease further comorbidities like diabetes, arthritis and more. This result in several limitations like tactile and visual restrictions or dexterity shortfalls. When developing a novel medical device, it is mandatory to consider such characteristic of later users and to focus on its safe and efficient use. This is only realisable by continuously developing the user interface of the medical device together with representative users. The aim is to evaluate the usability development by objectively comparing two different prototype status of a novel dialysis patient assistance device. The two raising questions are (1) Is the development of the user interface continuously gone in the direction of a safer and more efficient use? and (2) Where are the differences in the usability of the main interface features? METHODS: This is achieved with a usability study using mobile eye tracking and nine representative novice participants (77% younger 65 years (av. 25 years), 23% older than 65 years (av. 73 years)). In this study, the participants use the most recent prototype version and an older prototype version of the medical device in the PD handling cycle. RESULTS: Gaze data and task performances show that the challenges in the PD handling cycle with the device are comparable between the two user groups. The main user interface features of the device are the buttons and the lever on the right-hand side. When comparing the relating gaze data of the interaction, differences between the two prototype versions can be found. The lever is gazed at less than one second on average in the relevant handling stages for both versions, with slightly lower focus times for the older version. The buttons of the most recent version are gazed at between 33 percent (1.36 / 2.03 seconds) up to 51 percent (0.75 / 1.53 seconds) on average shorter. CONCLUSIONS: The gaze data of the main user interface features indicate for both prototype versions a low level of cognitive load. While the usability of the lever is comparable for both versions, the buttons of the most recent prototype version seem to need a lower level of concentration compared with the buttons of the older prototype version.
  • Determination of uromodulin in human Urine
    Item type: Journal Article
    Youhanna, Sonia; Weber, Julien; Beaujean, Viviane; et al. (2014)
    Nephrology Dialysis Transplantation
Publications 1 - 7 of 7