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Reliable models of renal failure in large animals are critical to the successful translation of the next generation of renal replacement therapies (RRT) into humans. While models exist for the induction of renal failure, none are optimized for the implantation of devices to the retroperitoneal vasculature. We successfully piloted an embolization-to-implantation protocol enabling the first implant of a silicon nanopore membrane hemodialyzer (SNMHD) in a swine renal failure model. Renal arterial embolization is a non-invasive approach to near-total nephrectomy that preserves retroperitoneal anatomy for device implants. Silicon nanopore membranes (SNM) are efficient blood-compatible membranes that enable novel approaches to RRT. Yucatan minipigs underwent staged bilateral renal arterial embolization to induce renal failure, managed by intermittent hemodialysis. A small-scale arteriovenous SNMHD prototype was implanted into the retroperitoneum. Dialysate catheters were tunneled externally for connection to a dialysate recirculation pump. SNMHD clearance was determined by intermittent sampling of recirculating dialysate. Creatinine and urea clearance through the SNMHD were 76–105 mL/min/m2 and 140–165 mL/min/m2, respectively, without albumin leakage. Normalized creatinine and urea clearance measured in the SNMHD may translate to a fully implantable clinical-scale device. This pilot study establishes a path toward therapeutic testing of the clinical-scale SNMHD and other implantable RRT devices. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a worldwide public health problem related to adverse results of end-stage renal disease (ESRD), kidney failure, cardiovascular disease (CVD), and premature death. The study is aimed to investigate the knowledge, attitude, and practice toward the prevention and early detection of chronic kidney disease. Two ordinal variables and one nominal response variable with 20 predictor variables were independently fitted. Ordinal multicategories , such as proportional odds, continuation ratio, and partial proportional models for attitude and practice, whereas the baseline multicategory logit model for knowledge was fitted. The findings implied that some predictors have a significant effect on attitude, whereas other covariates have a significant effect on practice. Moreover, as there are two independent logit models for the nominal response, in the first logit model Monthly income and Diabetes2, whereas in the second logit model, Smo_R_CKD3 and Diabetes2 have a significant effect on knowledge. In conclusion, more educated ones have more knowledge and attitude toward the prevention and early detection of chronic kidney disease, also more likely to perform preventive and early detecting practices. People are inadequately informed on the prevention and early detection of CKD, especially those who are with low income, are at risk of developing CKD and its complications. [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) is the irreversible deterioration of renal function requiring renal replacement therapy by dialysis or transplant. Human leucocyte antigens (HLA) have been well examined however research still is required into the non-HLA antibodies. Antibody mediated rejection (AMR) can be seen in the absence of HLA antibodies on biopsies of patients who have received identical transplants; anti-endothelial cell antibodies may explain this. Investigation into endothelial cell antigens on donor and recipient endothelium may elucidate and stratify the degree of risk of any given transplant and may guide towards the best matched donor. Protein array analysis was carried out on 8 patient pairs using nitro-cellulose membranes and biotinylated detection antibodies. The fluorescence emitted was captured by X-Ray film and results were recorded with ImageJ software. A fold increase of more than 2 was considered to be positive. 11 proteins identified had a fold increase of increase ≥2 and were present in ≥2 patient pairs which may point to potential clinical utility. Nectin2/CD112 may be measured in order analyse graft survival time in transplant recipients. Prognosticating renal failure has clinical importance and potential markers that have been identified to aid which include MEPE, CRELD2, and TIMP-4. Novel pharmacological therapies for specific biomarkers identified in this study include JAM-A, E -Selectin, CD147, Galectin-3, JAM-C, PAR-1, and TNFR2. Protein analysis showed differences in expression of antigens between patients with and without Chronic Kidney Disease (CKD). This information could be used at the matching stage of renal transplantation and also in the treatment of rejection episodes. The results highlight biomarkers that potentially prognosticate and pharmacological therapies that may ameliorate kidney disease and rejection in ESRD and transplant recipients. [ABSTRACT FROM AUTHOR]