Hyperkalaemia management and related costs in chronic kidney disease patients with comorbidities in Spain

ABSTRACT Background Hyperkalaemia (HK) is a common electrolyte disorder in patients with chronic kidney disease (CKD) and/or treated with inhibitors of the renin-angiotensin-aldosterone system (RAASi). The aim of this study is to determine the severity, current management and cost of chronic HK. Methods Retrospective cohort study of patients with chronic HK and CKD, heart failure or diabetes mellitus between 2011 and 2018. The study follow-up was 36 months. Results 1,499 patients with chronic HK were analysed, 66.2% presented mild, 23.4% moderate and 10.4% severe HK. The severity was associated with CKD stage. Most patients (70.4%) were on RAASi therapies, which were frequently discontinued (discontinuation rate was 39.8%, 49.8% and 51.8% in mild, moderate and severe HK, respectively). This RAASi discontinuation was similar with or without resin prescription. Overall, ion exchange resins were prescribed to 42.5% of patients with HK and prescription were related to the severity of HK, being 90% for severe HK. Adherence to resin treatment was very low (36.8% in the first year, 17.5% in the third year) and potassium persisted elevated in most patients with severe HK. The annual healthcare cost per patient with HK was 5,929€, reaching 12,705€in severe HK. Costs related to HK represent 31.9% of the annual cost per HK patient and 58.8% of the specialised care cost. Conclusions HK was usually managed by RAASi discontinuation and ion exchange resin treatment. Most patients with HK were non-adherent to resins and those with severe HK remained with high potassium levels, despite bearing elevated health care expenditures.

Modelling the Effect of Resin-Finishing Process Variables on the Dimensional Stability and Bursting Strength of Viscose Plain Knitted Fabric Using a Fuzzy Expert System

The application of cross-linking resin is an effective method for improving and controlling dimensional sta¬bility, such as the shrinkage of viscose single jersey knits. However, such treatment often leads to a significant deterioration in the bursting strength of treated fabrics. In this regard, resin treatment using a softening agent can be an additional potential solution for retaining the bursting strength of treated fabrics. Resin treatment is one kind of chemical finishing process that inhibits cellulosic textile fibre swelling during wetting, provides fibre resistance to deformation and prevents shrinkage. The key objective of this study was to model the effect of resin-finishing process variables for predicting the shrinkage control and bursting strength of viscose single jersey knitted fabrics. The MATLAB (Version 8.2.0.701) fuzzy expert system was used to model the optimum resin and softener concentrations, as well as the best curing time for the prediction of maximum shrinkage control with a minimum loss in fabric bursting strength. The optimal process variables were found to be a resin concentration of 75 g/l, a softener concentration of 45 g/l and a curing time of 225 seconds. The fuzzy expert model developed in this study was validated using experimental data. It was found that the model has the ability and accuracy to predict fabric shrinkage and bursting strength effectively in the non-linear field.

Influence of Epoxy Resin Treatment on the Mechanical and Tribological Properties of Hemp-Fiber-Reinforced Plant-Derived Polyamide 1010 Biomass Composites

In this study, we investigated the influence of epoxy resin treatment on the mechanical and tribological properties of hemp fiber (HF)-reinforced plant-derived polyamide 1010 (PA1010) biomass composites. HFs were surface-treated using four types of surface treatment methods: (a) alkaline treatment using sodium chlorite (NaClO2) solution, (b) surface treatment using epoxy resin (EP) solution after NaClO2 alkaline treatment, (c) surface treatment using an ureidosilane coupling agent after NaClO2 alkaline treatment (NaClO2 + A-1160), and (d) surface treatment using epoxy resin solution after the (c) surface treatment (NaClO2 + A-1160 + EP). The HF/PA1010 biomass composites were extruded using a twin-screw extruder and injection-molded. Their mechanical properties, such as tensile, bending, and dynamic mechanical properties, and tribological properties were evaluated by the ring-on-plate-type sliding wear test. The strength, modulus, specific wear rate, and limiting pv value of HF/PA1010 biomass composites improved with surface treatment using epoxy resin (NaClO2 + A-1160 + EP). In particular, the bending modulus of NaClO2 + A-1160 + EP improved by 48% more than that of NaClO2, and the specific wear rate of NaClO2 + A-1160 + EP was one-third that of NaClO2. This may be attributed to the change in the internal microstructure of the composites, such as the interfacial interaction between HF and PA1010 and fiber dispersion. As a result, the mode of friction and wear mechanism of these biomass composites also changed.