Search Results (4)

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

Water scarcity is a challenging global risk. Urban wastewater treatment technologies, which utilize processes based on single-stage ultrafiltration (UF) or nanofiltration (NF), have the potential to offer lean-and-green cost-effective solutions. Robustifying the effectiveness of water treatment is a complex multidimensional characteristic problem. In this study, a non-linear Taguchi-type orthogonal-array (OA) sampler is enriched with an emergent stigmergic clustering procedure to conduct the screening/optimization of multiple UF/NF aquametric performance metrics. The stochastic solver employs the Databionic swarm intelligence routine to classify the resulting multi-response dataset. Next, a cluster separation measure, the Davies–Bouldin index, is used to evaluate input and output relationships. The self-organized bionic-classifier data-partition appropriateness is matched for signatures between the emergent stigmergic clustering memberships and the OA factorial vector sequences. To illustrate the proposed methodology, recently-published multi-response multifactorial L₉(3⁴) OA-planned experiments from two interesting UF-/NF-membrane processes are examined. In the study, seven UF-membrane process characteristics and six NF-membrane process characteristics are tested (1) in relationship to four controlling factors and (2) to synchronously evaluate individual factorial curvatures. The results are compared with other ordinary clustering methods and their performances are discussed. The unsupervised robust bionic prediction reveals that the permeate flux influences both the UF-/NF-membrane process performances. For the UF process and a three-cluster model, the Davies–Bouldin index was minimized at values of 1.89 and 1.27 for the centroid and medoid centrotypes, respectively. For the NF process and a two-cluster model, the Davies–Bouldin index was minimized for both centrotypes at values close to 0.4, which was fairly close to the self-validation value. The advantage of this proposed data-centric engineering scheme relies on its emergent and self-organized clustering capability, which retraces its appropriateness to the fractional factorial rigid structure and, hence, it may become useful for screening and optimizing small-data wastewater operating conditions. Full article

Hyperthermic intraperitoneal chemoperfusion (HIPEC) is an established form of locoregional chemotherapy of peritoneum tumors. However, its efficacy and safety status remain a controversy, partially, due to scarce data on pharmacokinetics and toxicity profile of drugs under HIPEC. In the current study, 24 female Wistar rats were randomly assigned to receive cisplatin as HIPEC (n = 12, 20 mg/kg) or intravenously (i.v., n = 9, 4 mg/kg). The subgroups of three animals were used for the initial, intermediate, and late phases of the pharmacokinetic assessment. The animals were sacrificed on days 1 and 5. Blood, liver, kidney, and ovaries were evaluated for platinum content. Histological and immunohistochemical evaluation was undertaken in the liver and kidney. A trend for higher blood plasma platinum levels was observed for HIPEC compared to i.v. Significantly lower (p < 0.001) relative platinum binding to the proteins was observed in HIPEC animals compared to the i.v. administration. A five-fold higher concentration of cisplatin in HIPEC resulted in a ca. 2.5-fold increase in total blood platinum and ca. two-fold increase in blood ultrafitrable platinum (“free” Pt). Immunohistochemistry revealed higher kidney and liver damage after i.v. administration of cisplatin compared to HIPEC, although a five-fold higher dose of cisplatin was applied in HIPEC. Together with relatively lower absorption to the systemic circulation in HIPEC, higher protein binding is probably the primary reason for lower observed toxicity in HIPEC animals. Full article

Our previous studies have shown that Coix glutelin pepsin hydrolysate can effectively inhibit angiotensin converting enzyme (ACE) activity in vitro. The main purpose of this study was to obtain potent anti-hypertensive peptides from Coix glutelin. The Coix glutelin hydrolysates (CGH) were prepared by pepsin catalysis and further separated by an ultrafitration (UF) system, gel filtration chromatography (GFC) and reversed-phase high performance liquid chromatography (RP-HPLC). As a result, the sub-fraction F5-3 had the highest ACE-inhibitory activity. Six ACE inhibitory peptides were identified using nano-liquid chromatography coupled to tandem mass spectrometry. The most potent peptide GAAGGAF (IC₅₀ = 14.19 μmol·L⁻¹) was finally obtained by further molecular simulation screening and a series of division and optimization. Single oral administration of synthesized GAAGGAF at 15 mg/kg body weight (BW) in spontaneously hypertensive rats (SHR) could reduce the systolic blood pressure (SBP) around 27.50 mmHg and the effect lasted for at least 8 h. The study demonstrated for the first time that the ACE inhibitory peptide GAAGGAF from Coix glutelin has a significant antihypertensive effect, and it could be a good natural ingredient for pharmaceuticals against hypertension and the related diseases. Full article