scholarly journals Technologies and Health Inequities

2020 ◽  
Vol 46 (1) ◽  
pp. 583-602
Author(s):  
Stefan Timmermans ◽  
Rebecca Kaufman
Keyword(s):  
Individualized Medicine ◽  
Health Inequities ◽  
Specific Design ◽  
Kidney Dialysis ◽  
Health Technologies ◽  
Advanced Technologies ◽  
Fundamental Causes ◽  
Practice Approach ◽  
Stage Renal Disease ◽  
End Stage

Health technologies aim to improve individual and population health, but they may also exacerbate health disparities. Focusing on the specific design features of technologies, their availability, and their use, we present a conceptual framework to examine how health technologies may benefit some groups more than others by combining the theory of fundamental causes with a technology-in-practice approach. We examine three classes of technologies that have been associated with health inequities: once-advanced technologies such as kidney dialysis and transplantation for end-stage renal disease, which have been plagued by issues of scarcity and fair distribution, generating racial disparities; the highly anticipated precision medicine promising to change the focus from population to individualized medicine; and digital technologies, which may herald a democratization of health care.

Predicting the Hermeticity of Compression Seals in Microchannel Hemodialysers

2014 ◽  
Author(s):  
Brian K. Paul ◽  
Dustin K. Ward
Keyword(s):  
Mass Transfer ◽  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Limiting Factor ◽  
Home Hemodialysis ◽  
Kidney Dialysis ◽  
Medical Facilities ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Most end stage renal disease patients receive kidney hemodialysis three to four times per week at central medical facilities. At-home kidney dialysis increases the convenience and frequency of hemodialysis treatments which has been shown to produce better patient outcomes. One limiting factor in realizing home hemodialysis treatments is the cost of the hemodialyser. Microchannel hemodialysers produced using compression sealing techniques show promise for reducing the size and cost of hemodialysers. Challenges include the use of a 25 μm thick elastoviscoplastic mass transfer membrane for gasketing. This paper provides a framework for predicting the hermeticity of these compression seals. The mechanical properties of a Gambro AN69ST membrane are determined and used to establish limits on the dimensional tolerances of the polycarbonate laminae containing sealing boss used to seal the hemodialyser. The resulting methods are applied to the fabrication of a hemodialysis device showing constraints on the scaling of this method to larger device sizes. The resulting hemodialysis device is used to perform urea mass transfer experiments without leakage.

scholarly journals The Hermeticity of Compression Seals in Microchannel Hemodialyzers

2014 ◽  
Vol 2 (3) ◽  
Author(s):  
Brian K. Paul ◽  
Dustin K. Ward
Keyword(s):  
Mass Transfer ◽  
Patient Outcomes ◽  
End Stage Renal Disease ◽  
Limiting Factor ◽  
Home Hemodialysis ◽  
Kidney Dialysis ◽  
Medical Facilities ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Most end stage renal disease patients receive kidney hemodialysis three to four times per week at central medical facilities. At-home kidney dialysis increases the convenience and frequency of hemodialysis treatments which has been shown to produce better patient outcomes. One limiting factor in realizing home hemodialysis treatments is the cost of the hemodialyzer. Microchannel hemodialyzers produced using compression sealing techniques show promise for reducing the size and cost of hemodialyzers. Challenges include the use of a 25 μm thick elastoviscoplastic (EVP) mass transfer membrane for gasketing. This paper provides a framework for understanding the hermeticity of these compression seals. The mechanical properties of a Gambro AN69ST membrane are determined and used to establish limits on the dimensional tolerances of the polycarbonate (PC) laminae containing sealing bosses used to seal the hemodialyzer. The resulting methods are applied to the fabrication of a hemodialysis device showing constraints on the scaling of this method to larger device sizes. The resulting hemodialysis device is used to perform urea mass transfer experiments without leakage.

scholarly journals A multi-domain shear-stress dependent diffusive model of cell transport-aided dialysis: analysis and simulation

2021 ◽  
Vol 18 (6) ◽  
pp. 8188-8200
Author(s):  
Alex Viguerie ◽  
◽  
Sangita Swapnasrita ◽  
Alessandro Veneziani ◽  
Aurélie Carlier ◽  
...  
Keyword(s):  
Shear Stress ◽  
Computational Models ◽  
Cell Monolayer ◽  
Treatment Method ◽  
Health Condition ◽  
Cell Transport ◽  
Kidney Dialysis ◽  
Stage Renal Disease ◽  
Stress Dependent ◽  
End Stage

<abstract><p>Kidney dialysis is the most widespread treatment method for end-stage renal disease, a debilitating health condition common in industrialized societies. While ubiquitous, kidney dialysis suffers from an inability to remove larger toxins, resulting in a gradual buildup of these toxins in dialysis patients, ultimately leading to further health complications. To improve dialysis, hollow fibers incorporating a cell-monolayer with cultured kidney cells have been proposed; however, the design of such a fiber is nontrivial. In particular, the effects of fluid wall-shear stress have an important influence on the ability of the cell layer to transport toxins. In the present work, we introduce a model for cell-transport aided dialysis, incorporating the effects of the shear stress. We analyze the model mathematically and establish its well-posedness. We then present a series of numerical results, which suggest that a hollow-fiber design with a wavy profile may increase the efficiency of the dialysis treatment. We investigate numerically the shape of the wavy channel to maximize the toxin clearance. These results demonstrate the potential for the use of computational models in the study and advancement of renal therapies.</p></abstract>

Serum Thiamine Values in End-Stage Renal Disease Patients under Maintenance Hemodialysis

2015 ◽  
Vol 85 (5-6) ◽  
pp. 348-355 ◽  
Author(s):  
Masamitsu Ubukata ◽  
Nobuyuki Amemiya ◽  
Kosaku Nitta ◽  
Takashi Takei
Keyword(s):  
Thiamine Deficiency ◽  
Risk Index ◽  
Nutritional Risk ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Serum Aspartate Aminotransferase ◽  
Stage Renal Disease ◽  
End Stage

Abstract. Objective: Hemodialysis patients are prone to malnutrition because of diet or many uremic complications. The objective of this study is to determine whether thiamine deficiency is associated with regular dialysis patients. Methods: To determine whether thiamine deficiency is associated with regular dialysis patients, we measured thiamine in 100 patients undergoing consecutive dialysis. Results: Average thiamine levels were not low in both pre-hemodialysis (50.1 ± 75.9 ng/mL; normal range 24 - 66 ng/mL) and post-hemodialysis (56.4 ± 61.7 ng/mL). In 18 patients, post-hemodialysis levels of thiamine were lower than pre-hemodialysis levels. We divided the patients into two groups, the decrease (Δthiamine/pre thiamine < 0; - 0.13 ± 0.11) group (n = 18) and the increase (Δthiamine/pre thiamine> 0; 0.32 ± 0.21)) group (n = 82). However, there was no significance between the two groups in Kt/V or type of dialyzer. Patients were dichotomized according to median serum thiamine level in pre-hemodialysis into a high-thiamine group (≥ 35.5 ng/mL) and a low-thiamine group (< 35.4 ng/mL), and clinical characteristics were compared between the two groups. The low-thiamine value group (< 35.4 ng/ml; 26.8 ± 5.3 ng/ml) exhibited lower levels of serum aspartate aminotransferase and alanine aminotransferase than the high-thiamine value group (≥ 35.4 ng/ml; 73.5 ± 102.5 ng/ml) although there was no significance in nutritional marker, Alb, geriatric nutritional risk index , protein catabolic rate and creatinine generation rate. Conclusion: In our regular dialysis patients, excluding a few patients, we did not recognize thiamine deficiency and no significant difference in thiamine value between pre and post hemodialysis.

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