Search Results (171)

Tinea is a superficial fungal infection of keratinized structures caused by specific filamentous fungi called dermatophytes. Terbinafine, a drug used to treat tinea, is poorly soluble in water, and its delivery into the skin via nanoparticle formulation usingpoly(lactic-co-glycolic acid) (PLGA) has been demonstrated. In this study, we investigated the preparation conditions for nanoparticles (NPs) to achieve efficient intradermal delivery of terbinafine. Terbinafine-loaded PLGA NPs were prepared using the nanoprecipitation method, and the particle size distribution and average particle size were measured using dynamic light scattering. Skin permeability tests were conducted using mouse dorsal skin, and the amount of terbinafine delivered into the skin was measured to evaluate the release behavior in the skin. In the preparation of terbinafine-loaded PLGA NPs, under conditions where the external solution was purified water, the mean volume diameter was 40.49 ± 15.63 nm, the terbinafine-loaded content was 3.31 ± 0.29%, and the entrapment efficiency was 55.08 ± 4.88%. Under conditions of an external solution containing 1.0 × 10⁻³ w/v% arginine(Arg) aq. solution, the mean volume diameter was 41.71 ± 16.08 nm, the terbinafine-loaded content was 5.17 ± 0.37%, and the entrapment efficiency was 86.48 ± 6.01%. The entrapment efficiency and content were higher under the condition using 1.0 × 10⁻³ w/v% Arg aq. solution compared to purified water. In addition, in the skin permeability test, no drug was detected in the receptor solution sampled from both the NPs suspension group and the simple solution group, and no drug was detected in the intradermal solution in the simple solution group. The intradermal drug concentration was 77.94 ± 10.66 µg/g under conditions where purified water was used as the dialysate, and 96.42 ± 61.62 µg/g under conditions using 1.0 × 10⁻³ w/v% arginine, exceeding the reported minimum inhibitory concentration (MIC) of 8.87 µg/g, suggesting the efficacy of terbinafine-loaded PLGA NPs for the treatment of tinea versicolor. Since tinea treatment is a long-term process, it is desirable to deliver a stable amount of drug to the treatment site at all times. Therefore, the nanoparticle preparation conditions using purified water as the external solution, where the intradermal drug concentration exceeded the MIC and remained stable in the skin permeability test, were suggested to be suitable for tinea treatment. Full article

The ever-increasing number of discarded end-of-life dialysate polyamide thin-film composite membranes (DEoLMs) from presents both environmental and economic challenges for health centers. Traditional thermo-chemical cleaning techniques have been deployed for the rehabilitation of DEoLMs. This study further investigated the application of chemo-ultrasonication rehabilitation of dialysate-production-related DEoLM for potential reuse in spent dialysate recovery considering salt and creatinine—a typical uremic toxin-removal from water. The DEoLM was rehabilitated using low-concentration citric acid (CA) and sodium lauryl sulfate (SLS) under ultrasonic waves (45 kHz, 30 min agitation). Considering different rehabilitation protocols, the synergistic effects of heating (HT) and the chemical agents, with and without and ultrasonic waves (SC) were evaluated through FTIR, SEM, and EDX analyses, and the performance of the rehabilitated DEoLM was assessed via water flux and permeance, and efficiencies for conductivity and creatinine rejection. The fully integrated protocol chemo-ultrasonication (HT + SC + chemical agents) yielded the highest performance, achieving 93.56% conductivity and 96.83% creatinine removal, with water flux of 113.48 L m⁻² h⁻¹ and permeances of 6.31 L m⁻² h⁻¹ bar⁻¹, at markedly reduced pressures. The chemo-sonic-rehabilitated-DEoLM removed the organic–inorganic foulants beyond thermo-chemical cleaning. This suggests that the sonication waves had a great impact regarding rejuvenating the fouled DEoL dialysate membrane, offering a sustainable, cost-effective pathway for extending membrane life, and supporting sustainable water management to achieve circular economy goals within healthcare centers. Full article

Background/Objectives: Protein–energy wasting (PEW) is a common complication in patients with chronic kidney disease (CKD) receiving renal replacement therapy by dialyses. This condition is associated with higher morbidity, mortality, and poorer quality of life. The aim of this systematic review was to evaluate the effectiveness of different nutritional strategies—such as oral nutritional supplements and intra-dialytic parenteral nutrition—in improving the nutritional status of these patients. Methods: A systematic review was carried out in accordance with the PRISMA statement. Searches were performed in PubMed, BVS, and Scopus between January and March 2025. Randomised or controlled clinical trials published in English or Spanish, available in full text, involving adults on haemodialysis (HD) or peritoneal dialyses (PD) were included. Fourteen studies met the inclusion criteria. Results: The nutritional interventions assessed produced consistent benefits in biochemical markers (e.g., serum albumin), muscle mass, inflammatory indices, and perceived quality of life. Intra-dialytic supplementation and multidisciplinary management were particularly effective in patients with moderate-to-severe malnutrition. Conclusions: Malnutrition is frequent and clinically significant in dialyses patients. Nutritional strategies—including oral supplementation, IDPN, and personalised counselling—effectively prevent and treat PEW. Early, tailored, evidence-based, and multidisciplinary implementation could decisively improve clinical prognosis and quality of life in this population. Full article

Background and objectives: Cast nephropathy is the main cause of acute renal failure in patients with multiple myeloma. There are conflicting data on whether removal of serum free light chains (sFLCs) with a high-cutoff (HCO) dialyzer has a favorable effect on the recovery of renal function. This may in part be explained by differences in the efficacy of sFLC removal by HCO dialysis and treatment responses to anti-plasma cell therapy between studies. We studied the removal of sFLCs during HCO treatment in detail in relation to treatment response. Materials and methods: Pre-dialysis serum and dialysate levels of sFLCs were simultaneously and repeatedly measured during the first two HCO treatments in 10 patients with kappa (κ)- and 5 patients with lambda (λ)-producing myeloma that presented with dialysis-dependent renal failure at our institution between 2009 and 2024. Results: The average change in sFLCs during 6 h treatments was −57 ± 13%, but it varied widely between −29% and −77%. Mean reductions in sFLCs were comparable for κ and λ (−61.4 ± 19.1% and −55 ± 16.7%, respectively; p = 0.78). The average clearance of sFLCs at 15 min after the start of HCO dialysis was 42.1 ± 8.5 and 27.4 ± 15.6 mL/min for κ and λ, respectively (p < 0.01). Clearances decreased to 27.2 ± 11.3 for κ and 13.8 ± 7.9 mL/min for λ after 6 h of HCO treatment (p = 0.042). Renal function recovered in 11 patients (73%). In three of the four patients whose renal function did not recover, sFLC levels were >5 g/L at any time beyond 2 weeks after the start of HCO treatment. Conclusions: Although the clearance of κ was higher compared to λ, reductions in sFLCs were similar for κ and λ. We speculate that this discrepancy is explained by greater adherence of λ to the HCO membrane. Patients whose renal function did not recover had less of a reduction in sFLC levels during HCO treatment, probably due to a suboptimal hematological response to anti-plasma cell therapy. Full article

Polymeric reverse osmosis (RO) membranes are critical for producing ultrapure water for hemodialysis process, but once they reach their end-of-life (EoL) stage, mainly due to fouling, they are usually discarded—adding to the growing challenges of medical waste management. This study explores a sustainable alternative by rehabilitating EoL thin-film composite (TFC) membrane and its reuse in recovery of spent dialysate. Using different cleaning agents that included citric acid (CA), EDTA, sodium lauryl sulfate (SLS), and sodium dodecyl sulfate (SDS), the mixture of CA and SLS (1:1) exhibited the most effective combination for balanced flux recovery, salt rejection, and creatinine clearance at lower TMP, achieving 90% conductivity reduction, 46.89 L/m²/h water flux, and 1.24 L/m²/h/bar permeance. FTIR, SEM, and EDX results confirmed the removal of both organic and inorganic foulants, while further process optimization revealed the critical role of cleaning temperature, SLS ratio and pressure on water permeability and improving creatinine removal. Under the optimal operational conditions, 99.89% creatinine removal, while restoring up to 80% hydraulic performance, yielding water flux and permeance of 59.36 L/m²/h and 1.79 L/m²/h/bar, respectively. These findings suggest that reduced dialysate production costs and minimize environmental impact can be significantly, achieved by extending the useful life of dialysate membranes, thereby opening a pathway toward implementing closed-loop water management and circular economy practices at dialysis centers. Full article

Objective: To explore the lived experiences of type 2 diabetes mellitus (T2DM) patients undergoing peritoneal dialysis (PD) or hemodialysis (HD) using continuous glucose monitoring (CGM). Research Design and Methods: A qualitative phenomenological study was conducted with 50 adult T2DM patients on PD or HD who used CGM for at least 14 days. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis framework was applied to identify major themes regarding insulin management, CGM utilization, and emotional and social dimensions. Results: Four main themes emerged, each with multiple subthemes. PD patients emphasized enhanced autonomy and frequent insulin adjustments due to dialysate glucose absorption. Conversely, HD patients reported severe post-dialysis fatigue, emotional distress, and limited social engagement often associated with intra-dialytic hypoglycemia. CGM was valued by 85% of participants for improving metabolic awareness and self-management. However, 15% reported barriers such as device cost and technical difficulties. The insights clearly distinguish the differential impact of dialysis modality on daily glucose control and patient well-being. Conclusions: These findings underscore the critical need for patient-centered care incorporating access to CGM and tailored insulin regimens. Equitable implementation of CGM in dialysis settings could significantly enhance glycemic control, emotional resilience, and overall quality of life. Full article

The number of patients with end-stage renal disease continues to grow worldwide, placing increasing demands on dialysis technologies. Conventional hemodialysis remains the dominant modality but is often limited by frequent intradialytic hypotension and the insufficient removal of medium-sized toxins. Intermittent infusion hemodiafiltration (I-HDF) is an emerging, hybrid dialysis technique that combines standard hemodialysis with the cyclic backfiltration of ultrapure dialysate. This approach enables dynamic blood volume control and periodic backflushing of the dialyzer membrane. Recent clinical studies demonstrate that I-HDF can reduce intradialytic hypotension incidence, improve systemic and microcirculatory perfusion, and enhance the clearance of middle molecules such as β₂-microglobulin, while minimizing albumin loss. These benefits are particularly relevant to toxin clearance and hemodynamic stabilization, key priorities in optimizing dialysis outcomes. Large-scale cohort data suggest that I-HDF may be linked to improved long-term survival in dialysis patients. Given its physiological advantages and operational flexibility, I-HDF may also offer a practical solution in healthcare systems with limited access to high-volume online hemodiafiltration or kidney transplantation. Further research is warranted to develop individualized infusion protocols and validate its broader applicability. Full article

Background and Objectives: This study aimed to compare the effects of HIPEC procedures using oxaliplatin and mitomycin C on serum electrolyte, glucose, and lactate levels, with a specific focus on the carrier solutions employed. Materials and Methods: A retrospective analysis was performed on 82 patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases. Patients were assigned to one of two groups based on the chemotherapeutic agent used: oxaliplatin (n = 63) or mitomycin C (MMC, n = 19). The oxaliplatin group was further subdivided based on the carrier solution used: 5% dextrose (D5W, n = 29) or peritoneal dialysate (n = 34). The assignment of regimens was based on institutional protocols and surgeon preference. Pre- and post-HIPEC serum levels of sodium, potassium, bicarbonate, glucose, and lactate were compared. Results: Significant biochemical changes were observed across groups, depending on both the chemotherapeutic agent and carrier solution. In the MMC group (peritoneal dialysate), only lactate increased significantly post-HIPEC (p = 0.001). In the oxaliplatin–peritoneal dialysate group, significant changes were observed in bicarbonate (p = 0.009), glucose (p = 0.001), and lactate (p < 0.001), whereas sodium and potassium remained stable. The oxaliplatin–D5W group showed significant changes in all parameters: sodium (p = 0.001), potassium (p = 0.001), bicarbonate (p = 0.001), glucose (p < 0.001), and lactate (2.4 → 7.6 mmol/L, p < 0.001). Between-group comparisons revealed significant differences in sodium, potassium, glucose, and lactate changes (p < 0.05), but not in bicarbonate (p = 0.099). Demographic and clinical characteristics—including age, sex, primary disease, ICU stay, and 90-day mortality were similar across groups. Conclusions: The use of dextrose-containing solutions with oxaliplatin was associated with marked metabolic disturbances, including clinically meaningful hyponatremia, hypokalemia, and hyperglycemia in the early postoperative period. These findings suggest that the choice of carrier solution is as important as the chemotherapeutic agent in terms of perioperative safety. Closer postoperative electrolyte monitoring is recommended when using dextrose-based regimens. The retrospective design and sample size imbalance between groups are acknowledged limitations. Nonetheless, this study offers clinically relevant insights and lays the groundwork for future prospective research. Full article

This review highlights recent insights into the pathophysiology and therapeutic strategies for improving biocompatibility in hemodialysis. Hemodialysis activates the innate immune system, particularly the complement cascade and neutrophils, leading to acute microinflammation. Interleukin-8 (IL-8), which increases during dialysis, promotes neutrophil chemotaxis and neutrophil extracellular trap (NET) formation, triggering myeloperoxidase (MPO) release and oxidative stress. Neutrophil accumulation in atherosclerotic plaques exacerbates vascular inflammation through IL-6 upregulation. Elevated levels of IL-8, MPO, and NET-related biomarkers are associated with increased all-cause and cardiovascular mortality in dialysis patients. Strategies to mitigate these effects include the use of advanced membrane materials (e.g., AN69, vitamin E-coated, polymethyl methacrylate), novel dialysis modalities (e.g., high-volume online hemodiafiltration, cool dialysate, hydrogen-enriched dialysate), and citrate-based anticoagulation. These approaches aim to suppress complement activation, reduce oxidative stress, and limit neutrophil-induced damage. Enhancing biocompatibility is crucial for reducing cardiovascular complications and improving outcomes in dialysis patients. Suppressing the innate immune response during dialysis may become a future cornerstone in extracorporeal blood purification therapy. Full article

Computational models of peritoneal dialysis (PD) are increasingly useful for optimizing treatment in patients with kidney disease requiring dialysis (KDRD). However, although several mathematical models have been developed in the past few decades, a direct comparison of the models’ accuracy with respect to predicting in vivo data is needed to further create robust personalized models. Here, we used a dataset obtained in a previous in vivo experimental model of PD in pigs (23 sessions of 4 h 2 L dwells in four pigs) and humans (20 sessions in 20 patients) to compare six computational models of PD: the Graff model (UGM), the three-pore model (TPM), the Garred model (GM), and the Waniewski model (WM), as well as two variations of these (UGM-18, SWM). We conducted this comparison to predict the dialysate concentrations of key uremic toxins and electrolytes (four in humans) throughout a 4 h dwell. The model predictions can provide insight into inter-individual differences in ultrafiltration, which are critical for tailoring PD regimens in KDRD. While TPM offered improved physiological reality, its computational cost suggests a trade-off between model complexity and clinical applicability for real-time or portable kidney support systems. In future applications, such models could provide adaptive PD regimens for tailored care based on patient-specific toxin kinetics and fluid dynamics. Full article

Calcium ion sensors are essential in clinical diagnosis, particularly in the management of chronic kidney disease. Multiple approaches have been developed to measure calcium ions, including flame photometry and ion chromatography. However, these devices are bulky and require specialized staff for operation and evaluation. The integration of all-solid-state ion-selective determination allows the design of miniaturized and low-cost sensing that can be used for the continuous monitoring of electrolytes. However, clinical use has been limited due to the low electrochemical stability and selectivity and high noise rate. This manuscript reports for the first time a novel miniaturized Ca²⁺ ion-selective sensor, developed by using a two-layer nanocomposite thin film (5 µm thick). The device consists of functionalized silica nanoparticles embedded in a poly(vinyl chloride) (PVC) film, which was deposited onto a nanoporous zirconium silicate nanoparticle layer that served as the sensing surface. Systematic evaluation revealed that perfluoroalkane-functionalized silica nanoparticles enhanced Ca²⁺ selectivity by minimizing K⁺ diffusion, confirmed by both potentiometric measurements and quartz microbalance studies. The final sensor demonstrated a super-Nernstian sensitivity of 37 mV/Log[Ca²⁺], a low signal drift of 28 µV/s, a limit of detection of 1 µM, and exceptional selectivity against Na⁺, K⁺, and Mg²⁺ ions. Long-term testing showed stable performance over three months of continuous operation. Clinical testing was conducted on patients with chronic kidney disease. An accurate real-time monitoring of electrolyte dynamics in dialysate samples was observed, where final concentrations matched those observed in physiological conditions. Full article

Urea level determination in biological fluids provides nutritional information regarding the body metabolism and/or the renal condition. In order to propose a rapid determination of this biomarker at low levels in biological fluid samples, the present work developed an electrochemical sensor based on a simple arrangement of a nickel-nanoparticle-modified glassy carbon electrode (GCE/NiNPs). Under optimal conditions for selective urea detection, a linear response was obtained in the range of 0.085 to 3.10 mmol L⁻¹ (R = 0.9993), with a limit of detection of 60.0 µmol L⁻¹ and limit of quantification of 198.0 µmol L⁻¹. The GCE/NiNPs sensor showed recovery rates from samples from 105 ± 0.2% (hemodialysis wastewater) to 111 ± 0.3% (dialysate) for urea determination in biological fluid samples. The results obtained showed that the proposed method is relatively easy to operate and has a good degree of reliability and the satisfactory sensitivity required for monitoring urea, as well as exhibiting excellent detection capacity in the presence of possible interferents in both samples. Full article

Worldwide, environmental pollution is a major contributor to illness and mortality, encompassing toxic elements, air pollutants, agricultural pesticides, and contaminated food and water. In patients with end-stage kidney disease, several factors—including impaired renal excretion, the degree of renal impairment, medication use, dialysate contamination, the quality of dialysis water, and metabolic changes—may lead to the accumulation of toxic elements in hemodialysis patients. This study aimed to assess toxic element levels in adults undergoing hemodialysis compared to a control group and to investigate the correlation between parathyroid hormone (PTH) levels, uremic pruritus, anemia and toxic element concentrations. A cross-sectional study was conducted on 60 adult patients undergoing regular hemodialysis for at least three months. Another group of 60 apparently healthy adult voluntaries with matched age and sex with the patient group served as the control. The Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method was used to measure the concentrations of serum levels of aluminum (Al), lead (Pb), cadmium (Cd), chromium (Cr), and arsenic (As) for both groups, as well as in drinking water and dialysate water. The hemodialysis group exhibited significantly higher levels of Al, Pb, Cd, Cr, and As compared to the control group. Serum Pb levels showed a significant negative correlation with PTH, while serum ferritin levels were negatively correlated with Cr. However, no significant correlation was found between toxic element levels and uremic pruritus or anemia. Toxic element concentrations in dialysis and drinking water samples were within acceptable limits and below the detection threshold set by the World Health Organization (WHO) and the Association for the Advancement of Medical Instrumentation/American National Standards Institute (AAMI/ANSI). Therefore, elevated toxic element levels in hemodialysis patients may not be primarily attributable to drinking water or dialysis. Full article

Background: Interdialytic weight gain (IDWG), defined as the accumulation of salt and water intake between dialysis sessions, is a critical parameter of fluid management and a marker of adherence to dietary and fluid restrictions in hemodialysis patients. Excessive IDWG has been strongly associated with increased cardiovascular risk, including left ventricular hypertrophy, cardiac dysfunction, and cerebrovascular complications. Additionally, it necessitates more aggressive ultrafiltration, potentially compromising hemodynamic stability, impairing quality of life, and escalating healthcare costs. Despite international guidelines recommending an IDWG target of <4–4.5% of body weight, many patients struggle to achieve this due to barriers in adhering to dietary and fluid restrictions. This review explores the current state-of-the-art strategies to mitigate IDWG and evaluates emerging diagnostic and therapeutic perspectives to improve fluid management in dialysis patients. Methods: A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify studies on IDWG in hemodialysis. Keywords and MeSH terms were used to retrieve peer-reviewed articles, observational studies, RCTs, meta-analyses, and systematic reviews. Non-English articles, case reports, and conference abstracts were excluded. Study selection followed PRISMA guidelines, with independent screening of titles, abstracts, and full texts. Data extraction focused on IDWG definitions, risk factors, clinical outcomes, and management strategies. Due to study heterogeneity, a narrative synthesis was performed. Relevant data were synthesized thematically to evaluate both established strategies and emerging perspectives. Results: The current literature identifies three principal strategies for IDWG control: cognitive–behavioral interventions, dietary sodium restriction, and dialysis prescription adjustments. While educational programs and behavioral counseling improve adherence, their long-term effectiveness remains constrained by patient compliance and logistical challenges. Similarly, low-sodium diets, despite reducing thirst, face barriers to adherence and potential nutritional concerns. Adjustments in dialysate sodium concentration have yielded conflicting results, with concerns regarding hemodynamic instability and intradialytic hypotension. Given these limitations, alternative approaches are emerging. Thirst modulation strategies, including chewing gum to stimulate salivation and acupuncture for autonomic regulation, offer potential benefits in reducing excessive fluid intake. Additionally, technological innovations, such as mobile applications and telemonitoring, enhance self-management by providing real-time feedback on fluid intake. Biofeedback-driven dialysis systems enable dynamic ultrafiltration adjustments, improving fluid removal efficiency while minimizing hemodynamic instability. Artificial intelligence (AI) is advancing predictive analytics by integrating wearable bioimpedance sensors and dialysis data to anticipate fluid overload and refine individualized dialysis prescriptions, driving precision-based volume management. Finally, optimizing dialysis frequency and duration has shown promise in achieving better fluid balance and cardiovascular stability, suggesting that a personalized, multimodal approach is essential for effective IDWG management. Conclusions: Despite decades of research, IDWG remains a persistent challenge in hemodialysis, requiring a multifaceted, patient-centered approach. While traditional interventions provide partial solutions, integrating thirst modulation strategies, real-time monitoring, biofeedback dialysis adjustments, and AI-driven predictive tools represent the next frontier in fluid management. Future research should focus on long-term feasibility, patient adherence, and clinical efficacy, ensuring these innovations translate into tangible improvements in quality of life and cardiovascular health for dialysis patients. Full article

Background and Objectives: Sarcopenia is exceedingly frequent in end-stage kidney disease (ESKD) patients on dialysis, including those undergoing peritoneal dialysis (PD), and is of multifactorial origin. MOTS-c is a mitochondrial-derived peptide that promotes muscle growth whose levels are unbalanced in ESKD. In this study, we evaluated MOTS-c balance and its relationship with sarcopenia risk in an ESKD-PD cohort. Materials and Methods: MOTS-c was measured in serum, urine, and dialysate samples of 32 chronic PD patients. Patients were thus screened for sarcopenia risk by the SARC-F tool, anthropometric measurements, and physical performance tests. Results: PD patients with a very high sarcopenia risk (SARC-F ≥ 2) had significantly lower serum (sMOTS-c) and higher dialysate (dMOTS-c) levels, suggesting an increased peritoneal clearance of this substance (d/s MOTS-c). sMOTS-c levels were directly correlated with muscle performance in physical tests, while an opposite relationship was found with dMOTS-c and d/sMOTS-c. ROC analyses demonstrated the diagnostic potential of MOTS-c, particularly in combination with physical and anthropometric assessments, to identify PD patients at very high risk of sarcopenia. Conclusions: Chronic PD may negatively affect MOTS-c balance, which, in turn, may contribute to enhanced sarcopenia risk. Larger studies are needed to confirm these observations and to validate the potential utility of this substance as a biomarker for improving sarcopenia risk stratification in PD patients. Full article