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Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.

Objective To systematically explore the barriers and facilitators experienced by patients with heart failure when using the most popular commercially-accessible digital exergaming platforms for self-management. Methods A systematic literature search was conducted in: Embase , SCOPUS , PubMed , and ProQuest . Qualitative/mixed methods studies published in English between 2000 and 2024, including adults >18 years with heart failure using digital gaming platforms for exercise as self-management (i.e. Microsoft Xbox/Kinect, Sony PlayStation®, Nintendo™ Wii) were considered. Risk of bias was assessed using the Critical Appraisal Skills Program. The grounded theory method was used to extract, analyze, and synthesize the data. Results Three articles which qualitatively reported on the experiences of the patients with heart failure when using Nintendo™ Wii for self-management were included. Seventy-nine participants (male and female, age 32–81 years) were included in the studies. The three included studies were of high quality. Extracted qualitative data were grouped into subthemes, which were grouped into main themes, namely, Engagement, A pathy, Convenience, Health-related benefits and Gaming Platforms . The main themes were categorized into Barriers and Facilitators. Patients reported that gaming platforms were simple, easy to use, interesting, and motivating ( Facilitators ). Boredom while playing specific games, preferring other activities and technical issues were reported as Barriers . Conclusion This review provides the first insights into the barriers and facilitators patients with heart failure experience when using popular digital exergaming platforms to participate in exercise programs in the self-management of their condition. However, few high-quality studies exist which limits the conclusions made and warrants further research in this area.

IntroductionAquaponics provide multiple benefits due to the simultaneous yield of vegetables and fish, however they are characterized by increased greenhouse gas emissions owing to intensive production system. The most appropriate method for quantifying the environmental effects of these systems is Life Cycle Assessment with which the identification of hotspots and the suggestion of improved production plans can be achieved. The purpose of the present study was to evaluate the environmental impact of a pilot high-tech aquaponic system utilized for the simultaneous production of baby lettuce and rocket as well as rainbow trout, in indicators such as Global Warming Potential.Materials and methodsTo achieve this goal, data on inputs and outputs were collected from 12 case studies that were implemented, combining different fertilizer treatments, substrate choices, plant species cultivated and water source provision. Life Cycle Assessment was performed using SimaPro v.9.4.0.2 software.ResultsThe results showcase that the optimal case studies include the cultivation of baby lettuce and rocket in perlite substrate using wastewater from fish and partial use of synthetic fertilizers. Indicatively, Global Warming Potential of these cases was calculated at 21.18 and 40.59 kg CO2-eq/kg of vegetable respectively. The parameter with the greatest impact on most of the environmental indicators was electricity consumption for the operation of the oxygen supply pump for the fish tanks, while greenhouse infrastructure had the greatest impact in Abiotic Depletion and Human Toxicity impact categories. In an alternative production scenario tested where renewable energy sources were used, system impacts were reduced by up to 50% for Global Warming Potential and 86% for Eutrophication impact. The results of this study aspire to constitute a significant milestone in environmental impact assessments of aquaponic production systems and the adoption of more sustainable farming practices.

IntroductionAquaponics is an integrated food production system that links recirculating aquaculture with hydroponics, leading to higher water use efficiency than conventional food production systems while also saving on fertilizers. In the present study, baby lettuce and baby rocket plants cultivated hydroponically in a deep water culture system using wastewater from rainbow trout were evaluated as part of a vertical decoupled aquaponic system.Materials and methodsMore specifically, three different nutrient solutions were supplied: a) using fish wastewater only (designated as Fish); b) fish wastewater enriched with synthetic fertilizers (Mix); and c) a typical nutrient solution (Hoagland) as the control. Both lettuce and rocket plants were monitored in these nutrient solutions and in two different substrates, peat and perlite, as an organic and an inert substrate, respectively. The purpose of this study was to assess a vertical decoupled aquaponic system with regard to the resource use efficiency, such as water, land, and energy, while evaluating plant cultivation in the different treatments in terms of yield, growth, nitrate concentration on the leaf tissue, and foliar analysis. The photosynthetic rate and leaf color indices were also considered in the plant evaluation.ResultsThe Mix–Peat treatment was the most efficient growing combination in terms of land and water use efficiency, with approximately 7% better land use efficiency while using 38% less water and 10% less fertilizer than Hoagland–Peat. Moreover, lettuce plants had the highest yield in the Mix–Peat treatment, at 2,497 g m−2, which was approximately 6% higher than that of Hoagland–Peat while not being inferior in the quality measures. On the other hand, the yield of rocket was significantly higher in the Hoagland–Peat treatment, being 18% higher than that of Mix–Peat and 30% higher than that of Fish–Peat. Overall, the study confirmed that aquaponic systems could lead to higher water use efficiency and savings in fertilizers without undermining the yield and quality of lettuce, while the vertical arrangement developed within the scope of this study can increase the land useefficiency of the system.

The demand for the preparation of functional and nutrients-rich juice or beverages for the boosting immunity is the prime focus of consumers. So, this study was aim to optimization of different proportion for the preparation of blended juice from beetroots, grapes, turmeric, and lemons by using response surface methodology (RSM) and assessment of the quality parameters such as acidity, ascorbic acid, antioxidant activity and overall acceptability of blend juice were considered. Beetroot is widely recognized for its pigments known as betalains and have been utilized in the development of functional food and beverage products. Beetroots, grapes, turmeric, and lemons have been used in this study to prepare functional drinks, known for their nutritional value and medicinal properties. To optimize the blend juice, the dependent variables mainly beetroot juice, grapes juice, turmeric juice, and lemon juice in the range of 50–60, 30–40, 1–5, and 1–5 mL, were selected respectively. The optimized formulation for blended juice with a maximum desirability value of 0.921, an acidity of 0.60 %, an ascorbic acid of 14.17 mg/100 mL, an antioxidant activity of 93.94 %, and an overall acceptability of 8.07 was finalized at 53.12 mL of beetroot juice, 40 mL of grapes juice, 1.88 mL of turmeric juice and 5 mL of lemon juice.

Abstract Background Modality transitions represent a period of significant change that can impact health related quality of life (HRQoL). We explored the HRQoL of adults transitioning to new or different dialysis modalities. Methods We recruited eligible adults (≥ 18) transitioning to dialysis from pre-dialysis or undertaking a dialysis modality change between July and September 2017. Nineteen participants (9 incident and 10 prevalent dialysis patients) completed the KDQOL-36 survey at time of transition and three months later. Fifteen participants undertook a semi-structured interview at three months. Qualitative data were thematically analyzed. Results Four themes and five sub-themes were identified: adapting to new circumstances (tackling change, accepting change), adjusting together, trading off, and challenges of chronicity (the impact of dialysis, living with a complex disease, planning with uncertainty). From the first day of dialysis treatment to the third month on a new dialysis therapy, all five HRQoL domains from the KDQOL-36 (symptoms, effects, burden, overall PCS, and overall MCS) improved in our sample (i.e., those who remained on the modality). Conclusions Dialysis transitions negatively impact the HRQoL of people with kidney disease in various ways. Future work should focus on how to best support people during this time.

Background: Kidney transplant recipients are commonly prescribed proton-pump inhibitors (PPIs), but due to concern for polypharmacy, chronic use should be limited. Objective: The objective was to describe PPI use in kidney transplant recipients beyond their first year of transplant to better inform and support deprescribing initiatives. Design: We conducted a retrospective, population-based cohort study using linked health care databases. Setting: This study was conducted in Alberta, Canada. Patients: We included all prevalent adult, kidney-only transplant recipients between April 2008 and December 2017 who received their transplant between May 2002 and December 2017. Measurements: The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use. Methods: We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN). We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither. Results: We identified 1823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on an H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] = 2.6-9.3), there were almost 45 000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR = 70-98) of their graft survival time on a PPI in follow-up, and nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of recipients with the most common indication being concurrent antiplatelet use (26%). Limitations: Our kidney transplant recipients have access to universal health care coverage which may limit generalizability. We identified common gastrointestinal indications for PPI use but did not include rare conditions due to concerns about the validity of diagnostic codes. In addition, symptoms suggestive of reflux may not be well coded as the focus of follow-up visits is more likely to focus on kidney transplant. Conclusions: Many kidney transplant recipients are prescribed a PPI at, or beyond, the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy.

Rationale & Objective: Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy. Study Design: Retrospective, population-based cohort study. Setting & Participants: Kidney donors in Alberta, Canada. Exposure: Donor nephrectomy between May 2001 and December 2017. Outcome: Two eGFR measurements

Echolucency, a measure of plaque instability associated with increased cardiovascular risk, can be assessed in both the carotid plaque and the plaque-free common carotid intima–media (IM) complex as a gray-scale median (plaque-GSM and IM-GSM, respectively). The impact of specific vascular risk factors on these two phenotypes remains uncertain, including the nature and extent of their influence. This study aims to seek the determinants of plaque-GSM and IM-GSM. Plaque-GSM and IM-GSM were measured in subjects from the IMPROVE study cohort (aged 54–79, 46% men) recruited in five European countries. Plaque-GSM was measured in subjects who had at least one IMTmax ≥ 1.5 mm (n = 2138), whereas IM-GSM was measured in all subjects included in the study (n = 3188). Multiple regression with internal cross-validation was used to find independent predictors of plaque-GSM and IM-GSM. Plaque-GSM determinants were plaque-size (IMTmax), and diastolic blood pressure. IM-GSM determinants were the thickness of plaque-free common carotid intima–media complex (PF CC-IMTmean), height, systolic blood pressure, waist/hip ratio, treatment with fibrates, mean corpuscular volume, treatment with alpha-2 inhibitors (sartans), educational level, and creatinine. Latitude, and pack-yearscode were determinants of both plaque-GSM and IM-GSM. The overall models explain 12.0% of plaque-GSM variability and 19.7% of IM-GSM variability. A significant correlation (r = 0.51) was found between plaque-GSM and IM-GSM. Our results indicate that IM-GSM is a weighty risk marker alternative to plaque-GSM, offering the advantage of being readily measurable in all subjects, including those in the early phases of atherosclerosis where plaque occurrence is relatively infrequent.

Background: Updates to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access emphasize the “right access, in the right patient, at the right time, for the right reasons.” Although this implies a collaborative approach, little is known about how patients, their caregivers, and health care providers engage in vascular access (VA) decision-making. Objective: To explore how the perspectives of patients receiving hemodialysis, their caregivers, and hemodialysis care team align and diverge in relation to VA selection. Design: Qualitative descriptive study. Setting: Five outpatient hemodialysis centers in Calgary, Alberta. Participants: Our purposive sample included 19 patients receiving maintenance hemodialysis, 2 caregivers, and 21 health care providers (7 hemodialysis nurses, 6 VA nurses, and 8 nephrologists). Methods: We conducted semi-structured interviews with consenting participants. Using an inductive thematic analysis approach, we coded transcripts in duplicate and characterized themes addressing our research objective. Results: While participants across roles shared some perspectives related to VA decision-making, we identified areas where views diverged. Areas of alignment included (1) optimizing patient preparedness—acknowledging decisional readiness and timing, and (2) value placed on trusting relationships with the kidney care team—respecting decisional autonomy with guidance. Perspectives diverged in the following aspects: (1) differing VA priorities and preferences—patients’ emphasis on minimizing disruptions to normalcy contrasted with providers’ preferences for fistulas and optimizing biomedical parameters of dialysis; (2) influence of personal and peer experience—patients preferred pragmatic, experiential knowledge, whereas providers emphasized informational credibility; and (3) endpoints for VA review—reassessment of VA decisions was prompted by access dissatisfaction for patients and a medical imperative to achieve a functioning access for health care providers. Limitations: Participation was limited to individuals comfortable communicating in English and from urban, in-center hemodialysis units. Few informal caregivers of people receiving hemodialysis and younger patients participated in this study. Conclusions: Although patients, caregivers, and healthcare providers share perspectives on important aspects of VA decisions, conflicting priorities and preferences may impact the decisional outcome. Findings highlight opportunities to bridge knowledge and readiness gaps and integrate shared decision-making in the VA selection process.

BackgroundPeriprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain.MethodsWe performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed.ResultsEighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30–1.65, p

Rationale & Objective: To evaluate follow-up care of critically ill patients with acute kidney injury (AKI). Study Design: Retrospective cohort study. Setting & Participants: Patients admitted to the intensive care unit (ICU) with AKI in Alberta, Canada from 2005 to 2018, who survived to discharge without kidney replacement therapy or estimated glomerular filtration rate

Introduction Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking.Methods and analysis The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners’ offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed.Ethics and dissemination This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study’s course and findings through regular meetings.Trial registration number NCT05339841.

Rationale & Objective: The benefit–risk profile of rivaroxaban versus warfarin for atrial fibrillation (AF) in patients with chronic kidney disease is uncertain. We compared rivaroxaban with warfarin across the range of kidney function in adults with AF. Study Design: Multicenter retrospective cohort. Setting & Participants: Adults with AF and a measure of estimated glomerular filtration rate (eGFR); using administrative data from 5 jurisdictions across Australia and Canada (2011-2018). Kidney function was categorized as eGFR ≥60, 45-59, 30-44, and

Coccolithophores are an important component of phytoplankton abundance and biomass in the brackish environments of the Black Sea. Here, the abundance, composition, and distribution of coccolithophores were investigated in water samples taken from the first 50 m at 18 stations in the western Black Sea during a coccolithophore bloom, in June 2016. The total cell abundances ranged from 2 to 763 × 104 coccospheres L−1; Emiliania huxleyi was the most dominant species, but also Syracosphaera spp. (S. dilatata and S. molischii), Acanthoica (A. acanthifera and A. quattrospina), and Algirosphaera robusta displayed remarkably high concentrations. The formation of the seasonal thermocline significantly affects the vertical distribution of coccolithophores. Emiliania huxleyi, Syracosphaera spp., and Acanthoica spp. were restricted to the upper part of the water column, whereas high abundances of Algirosphaera robusta occurred below the thermocline. Overall, our results show significant differences in the vertical (ANOSIM R = 0.50, p = 0.0001) and spatial (ANOSIM R = 0.18, p = 0.0006) distribution of coccolithophores. Higher abundances of E. huxleyi and Syracosphaera spp. were recorded in the northwestern inner shelf region when compared to the open-sea samples. The observed coccolithophore spatial distribution is suggested to be mostly associated with the influx of less saline river water with high nutrient concentrations.

In this study, a novel and efficient bienzymatic method for the quantification of uric acid in serum and urine samples was developed. This method is based on the bienzymatic reaction of uricase and peroxidase in the presence of substrates pyrocatechol and 3-methyl-2-benzothiazolinone hydrazone to produce a red colored product. Under optimized conditions, a linearity of uric acid assay was obtained in the ranges of 4 to 384 [micro]M and 2 to 256 [micro]M by kinetic method and fixed time method, respectively. The low limit of detection and limit of quantification were found to be 0.5 and 1.6 [micro]M, respectively. The developed assay was used to quantify uric acid in human serum and urine samples. The present method has good recovery range of 98.3-101.8% and accuracy range of 92.0-101.4%. Hence, the proposed method could be successfully adopted for the quantification of uric acid in clinical laboratories., Author(s): Ravani Ananda Roopa [sup.1], Kempegowda Mantelingu [sup.2], Mridula Guin [sup.3], Sridhar Bilgumba Thimmaiah [sup.4] Author Affiliations: (1) Department of Chemistry, Pooja Bhagavat Memorial Mahajana Education Centre, , 570016, Mysuru, [...]

Background: Few studies have assessed outcomes in transplant recipients with failing grafts as most studies have focused on outcomes after graft loss. Objective: To determine whether renal function declines faster in kidney transplant recipients with a failing graft than in people with chronic kidney disease of their native kidneys. Design: Retrospective cohort study. Setting: Alberta, Canada (2002-2019). Patients: We identified kidney transplant recipients with a failing graft (2 estimated glomerular filtration rate [eGFR] measurements 15-30 mL/min/1.73 m 2 ≥90 days apart). Measurements: We compared the change in eGFR over time (eGFR with 95% confidence limits, LCL eGFR UCL ) and the competing risks of kidney failure and death (cause-specific hazard ratios [HRs], LCL HR UCL ). Methods: Recipients (n = 575) were compared with propensity-score-matched, nontransplant controls (n = 575) with a similar degree of kidney dysfunction. Results: The median potential follow-up time was 7.8 years (interquartile range, 3.6-12.1). The hazards for kidney failure (HR 1.10 1.33 1.60 ) and death (HR 1.21 1.59 2.07 ) were significantly higher for recipients, while the eGFR decline over time was similar (recipients vs controls: –2.60 –2.27 –1.94 vs –2.52 –2.21 –1.90 mL/min/1.73 m 2 per year). The rate of eGFR decline was associated with kidney failure but not death. Limitations: This was a retrospective, observational study, and there is a risk of bias due to residual confounding. Conclusions: Although eGFR declines at a similar rate in transplant recipients as in nontransplant controls, recipients have a higher risk of kidney failure and death. Studies are needed to identify preventive measures to improve outcomes in transplant recipients with a failing graft.

Background: Current guidelines recommend that living kidney donors receive lifelong annual follow-up care to monitor kidney health. In the United States, the reporting of complete clinical and laboratory data for kidney donors has been mandated for the first 2 years post-donation; however, the long-term impact of early guideline-concordant care remains unclear. Objective: The primary objective of this study was to compare long-term post-donation follow-up care and clinical outcomes of living kidney donors with and without early guideline-concordant follow-up care. Design: Retrospective, population-based cohort study. Setting: Linked health care databases were used to identify kidney donors in Alberta, Canada. Patients: Four hundred sixty living kidney donors who underwent nephrectomy between 2002 and 2013. Measurements: The primary outcome was continued annual follow-up at 5 and 10 years (adjusted odds ratio with 95% confidence interval, LCL aOR UCL ). Secondary outcomes included mean change in estimated glomerular filtration rate (eGFR) over time and rates of all-cause hospitalization. Methods: We compared long-term follow-up and clinical outcomes for donors with and without early guideline-concordant care, defined as annual physician visit and serum creatinine and albuminuria measurement for the first 2 years post-donation. Results: Of the 460 donors included in this study, 187 (41%) had clinical and laboratory evidence of guideline-concordant follow-up care throughout the first 2 years post-donation. The odds of receiving annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR 0.18 0.24 0.32 ) and 68% lower at 10 years (aOR 0.23 0.32 0.46 ) compared with donors with early care. The odds of continuing follow-up remained stable over time for both groups. Early guideline-concordant follow-up care did not appear to substantially influence eGFR or hospitalization rates over the longer term. Limitations: We were unable to confirm whether the lack of physician visits or laboratory data in certain donors was due to physician or patient decisions. Conclusions: Although policies directed toward improving early donor follow-up may encourage continued follow-up, additional strategies may be necessary to mitigate long-term donor risks.