New Algorithm to Design Real Time Optimal and Robust Ultrafiltration Rates in Chronic Kidney Disease to Prevent Cardiovascular Morbidity and Mortality

2018 ◽  
Author(s):  
Rammah M. Abohtyra ◽  
Y. Chait
Keyword(s):  
Kidney Disease ◽  
Real Time ◽  
Fluid Management ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Robust Performance ◽  
End Stage Kidney Disease ◽  
Cardiovascular Morbidity And Mortality ◽  
Time Optimal ◽  
End Stage

Hemodialysis (HD) is a necessary treatment for end-stage kidney disease (ESKD) patients in order to prevent cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Despite significant advances in HD technology, only half of ESKD patients treated with HD survive more than 3 years. Fluid management remains one of the most challenging aspects of HD care, with serious implications for morbidity and mortality. In this paper, we develop a novel algorithm to design real time optimal, robust ultrafiltration rates based on actual HD data to identifying the parameters of a fluid volume model of an individual patient during HD. Our design achieves, if exists, an optimal ultrafiltration profile for the identified nominal model under maximum ultrafiltration and hematocrit constraints and guarantees that these constraints are satisfied over a pre-defined set of parameter uncertainty. We demonstrate the robust performance of our algorithm through a combination of clinical data and simulations.

On the potential of wearable bioimpedance for longitudinal fluid monitoring in end-stage kidney disease

2021 ◽  
Author(s):  
Lucas Lindeboom ◽  
Seulki Lee ◽  
Fokko Wieringa ◽  
Willemijn Groenendaal ◽  
Carlo Basile ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Fluid Management ◽  
Wearable Devices ◽  
Invasive Technique ◽  
Haemodynamic Instability ◽  
End Stage Kidney Disease ◽  
Similar Frequency ◽  
Home Dialysis ◽  
Fluid Status ◽  
End Stage

Abstract Bioimpedance spectroscopy (BIS) has proven to be a promising non-invasive technique for fluid monitoring in haemodialysis (HD) patients. While current BIS-based monitoring of pre- and post-dialysis fluid status utilizes benchtop devices, designed for intramural use, advancements in micro-electronics have enabled the development of wearable bioimpedance systems. Wearable systems meanwhile can offer a similar frequency range for current injection as commercially available benchtop devices. This opens opportunities for unobtrusive longitudinal fluid status monitoring, including transcellular fluid shifts, with the ultimate goal of improving fluid management, thereby lowering mortality and improving quality of life for HD patients. Ultra-miniaturized wearable devices can also offer simultaneous acquisition of multiple other parameters, including haemodynamic parameters. Combination of wearable BIS and additional longitudinal multiparametric data may aid in the prevention of both haemodynamic instability as well as fluid overload. The opportunity to also acquire data during interdialytic periods using wearable devices likely will give novel pathophysiological insights and the development of smart (predicting) algorithms could contribute to personalizing dialysis schemes and ultimately to autonomous (nocturnal) home dialysis. This review provides an overview of current research regarding wearable bioimpedance, with special attention to applications in end-stage kidney disease patients. Furthermore, we present an outlook on the future use of wearable bioimpedance within dialysis practice.

Cardiovascular Protection in Chronic Kidney Disease

2019 ◽  
pp. 295-308
Author(s):  
Jonathan W. Waks ◽  
Rulan S. Parekh ◽  
Larisa G. Tereshchenko
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Morbidity And Mortality ◽  
High Risk Population ◽  
Cardiovascular Morbidity And Mortality ◽  
The Us ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease (CKD) affects over 15% of the US population, and over 650,000 people have end-stage renal disease requiring dialysis. Persons with CKD have an increased prevalence of all forms of cardiovascular disease, including coronary artery disease, cerebrovascular disease, hypertension, dyslipidemia, diabetes, congestive heart failure, and sudden cardiac death. CKD itself is also an independent risk factor for developing all forms of cardiovascular disease. The diagnosis of cardiovascular disease in persons with CKD presents unique difficulties, and many standard therapies for reducing cardiovascular morbidity and mortality, such as statins, also tend to be less successful in patients with severe CKD. This chapter will provide an overview of the epidemiology of cardiovascular disease in patients with CKD and will discuss strategies to diagnose cardiovascular disease and to reduce cardiovascular risk, morbidity, and mortality in this high-risk population.

scholarly journals Fibroblast Growth Factor-23: A Novel Biomarker for Cardiovascular Disease in Chronic Kidney Disease Patients

PRILOZI ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 19-27
Author(s):  
Aikaterini Papagianni
Keyword(s):  
Chronic Kidney Disease ◽  
Growth Factor ◽  
Kidney Disease ◽  
Fibroblast Growth Factor ◽  
Molecular Mechanisms ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Fibroblast Growth ◽  
Cardiovascular Morbidity And Mortality ◽  
Fgf 23

Abstract Fibroblast Growth Factor (FGF)-23 increase is considered one of the earliest biochemical abnormalities in chronic kidney disease-mineral bone disorder (CKD–MBD). Furthermore, accumulating data have provided evidence of a link between increased FGF-23 levels and cardiovascular morbidity and mortality in CKD patients as well as in several other populations including cardiology patients and general population. The cellular and molecular mechanisms underlying the deleterious effect of FGF-23 on the cardiovascular system are not yet completely defined and are the focus of intense research. However, animal and human studies have demonstrated important actions of FGF-23 in the heart and vessels through which could promote the development of cardiovascular complications in uremia. Moreover, significant interactions have been reported between FGF-23 and other well recognized cardiovascular risk factors such as renin-angiotensin system and inflammation which could account, at least in part, for the observed associations between FGF-23 and adverse clinical outcomes. Further studies are needed to clarify the mechanisms responsible for the pleiotropic actions of FGF-23 and moreover to identify whether it is a modifiable risk factor and a potential target of therapeutic interventions which could probably help to reduce the unacceptably high cardiovascular morbidity and mortality of CKD patients.

scholarly journals SP387INFLUENCE OF A NUTRITIONAL EDUCATION PROGRAM ON LONG-TERM MORBIDITY AND MORTALITY IN A POPULATION WITH END-STAGE KIDNEY DISEASE

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Elena Gonzalez Garcia ◽  
Almudena Pérez Torres ◽  
Maria Auxiliadora Bajo ◽  
Gloria Del Peso Gilsanz ◽  
Helena Garcia-Llana ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Education Program ◽  
Morbidity And Mortality ◽  
Nutritional Education ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Chronic kidney disease as cause of cardiovascular morbidity and mortality

2005 ◽  
Vol 20 (6) ◽  
pp. 1048-1056 ◽  
Author(s):  
R. Vanholder ◽  
Z. Massy ◽  
A. Argiles ◽  
G. Spasovski ◽  
F. Verbeke ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Cardiovascular Morbidity And Mortality

scholarly journals Early Recognition and Treatment of Diabetic Kidney Disease

2014 ◽  
Vol 26 (1) ◽  
pp. 56-62
Author(s):  
Sheikh Salahuddin Ahmed ◽  
Md Abu Saleh Mohammad Rizwan ◽  
Md Abdul Mahid Khan ◽  
Tarafdar Runa Laila ◽  
Md Abdul Hafez
Keyword(s):  
Risk Factor ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Early Stage ◽  
Kidney Damage ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Lipid Lowering ◽  
Diabetic Kidney ◽  
Cardiovascular Morbidity And Mortality

Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end stage renal disease (ESRD) as well as a risk factor for cardiovascular morbidity and mortality. This paper reviews various evidence based clinical guidelines, scientific papers and research studies on early detection and treatment of DKD. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the early stage of DKD. In addition to an earliest marker of kidney damage, microalbuminuria is an established high risk factor for cardiovascular morbidity and mortality. Patients with microalbuminuria who progress to macroalbuminuria are likely to progress to ESRD. However effective treatment in the early stage of DKD reduces the risk and slows the progression of kidney damage. There is general agreement that people with diabetes should be screened regularly to detect early markers of kidney damage. People with diabetes and microalbuminuria should be treated with a multifactorial intervention approach to retard the progression of DKD. Studies have clearly demonstrated that the use of angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers with improved glycemic control, hypertension control, lipid lowering, aspirin use, smoking cessation, exercise programs and dietary intervention reduced the development of overt nephropathy and ESRD. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21317 Medicine Today 2014 Vol.26(1): 56-62

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