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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