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Stauss M, Htay H, Kooman JP, Lindsay T, Woywodt A. Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter? SENSORS (BASEL, SWITZERLAND) 2023; 23:1361. [PMID: 36772401 PMCID: PMC9919296 DOI: 10.3390/s23031361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Telemedicine and digitalised healthcare have recently seen exponential growth, led, in part, by increasing efforts to improve patient flexibility and autonomy, as well as drivers from financial austerity and concerns over climate change. Nephrology is no exception, and daily innovations are underway to provide digitalised alternatives to current models of healthcare provision. Wearable technology already exists commercially, and advances in nanotechnology and miniaturisation mean interest is also garnering clinically. Here, we outline the current existing wearable technology pertaining to the diagnosis and monitoring of patients with a spectrum of kidney disease, give an overview of wearable dialysis technology, and explore wearables that do not yet exist but would be of great interest. Finally, we discuss challenges and potential pitfalls with utilising wearable technology and the factors associated with successful implementation.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Jeroen P. Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Thomas Lindsay
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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de Vries JC, van Gelder MK, Monninkhof AS, Ahmed S, Hazenbrink DHM, Nguyen TQ, de Kort GAP, Vonken EJPA, Vaessen KRD, Joles JA, Verhaar MC, Gerritsen KGF. A Uremic Pig Model for Peritoneal Dialysis. Toxins (Basel) 2022; 14:toxins14090635. [PMID: 36136573 PMCID: PMC9503030 DOI: 10.3390/toxins14090635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
With increasing interest in home dialysis, there is a need for a translational uremic large animal model to evaluate technical innovations in peritoneal dialysis (PD). To this end, we developed a porcine model with kidney failure. Stable chronic kidney injury was induced by bilateral subtotal renal artery embolization. Before applying PD, temporary aggravation of uremia was induced by administration of gentamicin (10 mg/kg i.v. twice daily for 7 days), to obtain uremic solute levels within the range of those of dialysis patients. Peritoneal transport was assessed using a standard peritoneal permeability assessment (SPA). After embolization, urea and creatinine concentrations transiently increased from 1.6 ± 0.3 to 7.5 ± 1.2 mM and from 103 ± 14 to 338 ± 67 µM, respectively, followed by stabilization within 1–2 weeks to 2.5 ± 1.1 mM and 174 ± 28 µM, respectively. Gentamicin induced temporary acute-on-chronic kidney injury with peak urea and creatinine concentrations of 16.7 ± 5.3 mM and 932 ± 470 µM respectively. PD was successfully applied, although frequently complicated by peritonitis. SPA showed a low transport status (D/P creatinine at 4 h of 0.41 (0.36–0.53)) with a mass transfer area coefficient of 9.6 ± 3.1, 4.6 ± 2.6, 3.4 ± 2.3 mL/min for urea, creatinine, and phosphate respectively. In conclusion, this porcine model with on-demand aggravation of uremia is suitable for PD albeit with peritoneal transport characterized by a low transport status.
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Affiliation(s)
- Joost C. de Vries
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Maaike K. van Gelder
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Anneke S. Monninkhof
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Sabbir Ahmed
- Department of Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Diënty H. M. Hazenbrink
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Tri Q. Nguyen
- Department of Pathology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Gèrard A. P. de Kort
- Department of Radiology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Evert-Jan P. A. Vonken
- Department of Radiology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Koen R. D. Vaessen
- Central Laboratory Animal Research Facility, Utrecht University, 3584 CJ Utrecht, The Netherlands
| | - Jaap A. Joles
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Karin G. F. Gerritsen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-755-7329
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