Effect of Preparation of β2M Nano Antibody Adsorbent for Blood Purification on Dialysis Complications in Patients with Renal Failure

In order to purify blood and adsorb β2M, a highly selective immunosorbent biomaterial based on nano antibody was designed. First of all, nanoantibodies against β2M in patients with renal failure are screened by phage display library technology. After 4 rounds of screening, 12 kinds of monoclonal phage samples are compared by ELISA, and the highest affinity sequence A53 is obtained. Then, the nano antibody A53 is transferred into two kinds of host bacteria respectively, and the host E. coli Shuffle T7 is selected, and then purified by nickel column affinity, thus obtaining high purity nano antibody A53S. Five kinds of nano antibody adsorbents are prepared by using A53S as a component of adsorbent. The results show that the effect of D series adsorbent with ɛ-poly-L-lysine as spacer is better, but the ligand density should be adjusted reasonably to ensure the activity of nanoantibody protein. When the loading concentration of β2M is set to 1.8 mg/ml, adsorbent D-1 can adsorb 11.78 mg/ml of dynamic adsorption capacity of β2M. This index is significantly higher than the dynamic adsorption capacity of plasma system under the same conditions (P < 0.05), which proves that the nano antibody adsorbent biomaterial can effectively adsorb β2M, thus reducing the probability of dialysis complications.

Surgical complications of peritoneal dialysis in children with acute kidney failure

The dialysis department of the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies has been operating since 1977 and is the only specialized department in the North-West Region of the Russian Federation that provides assistance to children with both acute and chronic renal failure. Peritoneal dialysis is the treatment of choice for children with acute renal failure, the most common cause of which is hemolytic-uremic syndrome. Despite widely used measures to improve the results of peritoneal dialysis, complications are extremely common. The article analyzes the complications of peritoneal dialysis in children with acute renal failure who were treated in a hospital from 2008 to 2018. The emphasis in the study is on the analysis of complications of peritoneal dialysis, in the treatment of which the surgeon actively participated or should have taken part in. If the problem of acute renal failure is multidisciplinary in the sense that it requires the participation of nephrologists, resuscitators, infectious disease specialists, then if necessary, renal replacement therapy requires the surgeon to become not only a specialist providing access, but also a full-fledged participant in the treatment process. As follows from the foregoing, the surgeons actions depend not only on the quality of dialysis, but also the timeliness and adequacy of treatment of complications, which ultimately improves or worsens the quality of medical care in general.

Internações, óbitos e custos hospitalares pelas intercorrências dialíticas

Objetivo: descrever as internações, óbitos e custos hospitalares pelas intercorrências dialíticas em pacientes renais crônicos no Nordeste. Método: trata-se de um estudo quantitativo, descritivo e ecológico, voltado para a análise de dados do Sistema de Informações Hospitalares, organizados em frequências absolutas e relativas, a partir de tabelas construídas no software Excel. Resultados: notificaram-se 14.052 internações e 987 óbitos no Nordeste. Gerou-se, como consequência, um custo superior a R$ 19,6 milhões aos cofres públicos, com um valor médio de internação de R$ 1.543,09 e uma média de permanência de 9,1 dias. Destacaram-se os Estados de Alagoas, com a prevalência das internações (38,2%), e Bahia, em relação aos óbitos (40%), custos hospitalares (61,4%), média de permanência (14,4 dias) e valor médio de internação (R$ 2.794,42). Conclusão: aponta-se que as internações e óbitos pelas intercorrências dialíticas constituem um importante problema na Nefrologia, causando prejuízos diretos aos recursos financeiros públicos, especialmente, nos Estados da Bahia e Alagoas, por evidenciarem a maioria dos casos. Descritores: Saúde Pública; Nefrologia; Nefropatias; Diálise Peritoneal; Diálise Renal; Custos de Cuidados de Saúde.Abstract Objective: to describe hospitalizations, deaths and hospital costs due to dialysis complications in chronic renal patients in the Northeast. Method: this is a quantitative, descriptive and ecological study, focused on the analysis of data from the Hospital Information System, organized in absolute and relative frequencies, using tables built using Excel software. Results: 14,052 hospitalizations and 987 deaths were reported in the Northeast. As a result, the public coffers cost over R $ 19.6 million, with an average hospitalization value of R $ 1,543.09 and an average length of stay of 9.1 days. The states of Alagoas stood out, with the prevalence of hospitalizations (38.2%), and Bahia, in relation to deaths (40%), hospital costs (61.4%), average length of stay (14.4 days) and average value of hospitalization (R $ 2,794.42). Conclusion: it is pointed out that hospitalizations and deaths due to dialysis complications are an important problem in Nephrology, causing direct damage to public financial resources, especially in the states of Bahia and Alagoas, as they show the majority of cases. Descriptors: Public Health; Nephrology; Kidney Diseases; Peritoneal Dialysis; Renal Dialysis; Health Care Costs. Resumen Objetivo: describir las hospitalizaciones, muertes y costos hospitalarios por las intercurrencias dialíticas en pacientes renales crónicos en el noreste. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, destinado a analizar los datos del Sistema de Informaciones del Hospital, organizado en frecuencias absolutas y relativas, a partir de tablas construidas en el software Excel. Resultados: se reportaron 14.052 hospitalizaciones y 987 muertes en el noreste. Se generó como resultado de eso, un costo en exceso de R $ 19,6 millones para el gobierno, una hospitalización con costo promedio de R$1,543.09 y una estadía promedio de 9.1 días. Entre los estados, Alagoas tuvo una mayor prevalencia de hospitalizaciones (38,2%) y Bahía en las muertes (40%), costos hospitalarios (61,4%), duración media de la estancia (14,4 días) y media hospitalización (R $ 2.794,42). Conclusión: se observa que las hospitalizaciones y muertes debidas a las intercurrencias dialíticas se constituyen un problema importante en la nefrología, lo que implica directamente en los cofres públicos, especialmente en los Estados de Bahía y Alagoas, como evidencia de una mayor prevalencia de casos. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud.

Assessing the knowledge of caregivers of children undergoing peritoneal dialysis in Riyadh, Saudi Arabia

Background and objective: Children with end stage renal disease (ESRD) are commonly placed onto chronic peritoneal dialysis (PD) while awaiting a transplant. Those children require a caregiver to assume major responsibility for their treatment. Knowledge of those caregivers is very important to prevent complications. This study aimed to assess the knowledge of caregivers of children undergoing PD in Riyadh.Methods: A convenient sample of 41 caregivers of children on PD from three hospitals in Riyadh and who met the inclusion criteria participated in this study. Structured questions were developed by the researchers and used to collect data regarding the study that consisted of two parts. The first part included sociodemographic data of children and the caregivers. The second part contained 36 questions that assessed the knowledge of the caregivers.Results: The majority of caregivers were mothers who were not working. All caregivers were educated, and most were from the central region of Riyadh. It was found that the caregivers had more knowledge than expected, the source of this knowledge was from physicians. There was a high correlation between the knowledge and education level of caregivers. Moreover, there was a significantly statistical correlation between correct answer and sociodemographic data of caregivers’ water supply, type of services and distance between home and the nephrology center.Conclusions and recommendations: Most caregivers have adequate knowledge regarding the care of children with ESRD; however, some weaknesses were identified. The caregivers do not know the symptoms of the disease and they are unable to identify signs of dehydration and the importance of weight to prevent dialysis complications. One third of the sample did not know about the complications of PD. We recommend frequent sessions of PD management and care.

A Bayesian approach for the identification of patient-specific parameters in a dialysis kinetic model

Hemodialysis is the most common therapy to treat renal insufficiency. However, notwithstanding the recent improvements, hemodialysis is still associated with a non-negligible rate of comorbidities, which could be reduced by customizing the treatment. Many differential compartment models have been developed to describe the mass balance of blood electrolytes and catabolites during hemodialysis, with the goal of improving and controlling hemodialysis sessions. However, these models often refer to an average uremic patient, while on the contrary the clinical need for customization requires patient-specific models. In this work, we assume that the customization can be obtained by means of patient-specific model parameters. We propose and validate a Bayesian approach to estimate the patient-specific parameters of a multi-compartment model, and to predict the single patient’s response to the treatment, in order to prevent intra-dialysis complications. The likelihood function is obtained by means of a discretized version of the multi-compartment model, where the discretization is in terms of a Runge–Kutta method to guarantee convergence, and the posterior densities of model parameters are obtained through Markov Chain Monte Carlo simulation. Results show fair estimations and the applicability in the clinical practice.