Expanded Hemodialysis and Its Effects on Hospitalizations and Medication Usage: A Cohort Study.

INTRODUCTION: Expanded hemodialysis (HDx) effectively removes large middle molecular uremic toxins (>25 kDa) while still retaining albumin, potentially reducing their adverse effects. We compare the clinical laboratory parameters, hospitalization rates, and medication use in a cohort of patients switched from high-flux HD to HDx. METHODS: This is a multicenter, observational cohort study of 81 adult patients, across 3 clinics, with end-stage kidney disease (ESKD) on chronic hemodialysis (HD). Patients received high-flux HD for at least 1 year and then switched to HDx and were followed up for 1 year. Patients were excluded if they discontinued therapy, changed provider, underwent kidney transplant, recovered kidney function, or changed to peritoneal dialysis, another dialyzer, or renal clinic. RESULTS: Twelve months after switching to HDx, the rate of hospitalization events per patient-year decreased from 0.77 (95% CI: 0.60-0.98, 61 events) to 0.71 (95% CI: 0.55-0.92, 57 events) (p = 0.6987). The hospital day rate per patient-year was significantly reduced from 5.94 days in the year prior to switching compared with 4.41 days after switching (p = 0.0001). The mean dose of erythropoiesis-stimulating agent (SC epoetin-α) and intravenous iron also significantly decreased (p = 0.0361 and p = 0.0003, respectively). CONCLUSION: Switching to HDx was associated with reductions in hospital day rate and medication use, suggesting HDx has the potential to reduce the burden of ESKD on patients and healthcare systems.

An initial evaluation of expanded hemodialysis on hospitalizations, drug utilization, costs, and patient utility in Colombia.

To examine new evidence linking expanded hemodialysis (HDx) using a medium cut-off (MCO) membrane with hospitalizations, hospital days, medication use, costs, and patient utility. This retrospective study utilized data from Renal Care Services medical records database in Colombia from 2017 to 2019. Clinics included had switched all patients from high flux hemodialysis (HD HF) to HDx and had at least a year of data on HD HF and HDx. Data included demographic characteristics, comorbidities, years on dialysis, hospitalizations, medication use, and quality of life measured by the 36 item and Short Form versions of the Kidney Disease Quality of Life survey at the start of HDx, and 1 year after HDx, which were mapped to EQ-5D utilities. Generalized linear models were run on the outcomes of interest with an indicator for being on HDx. Annual cost estimates were also constructed. The study included 81 patients. HDx was significantly associated with lower dosing of erythropoietin stimulating agents, iron, hypertension medications, and insulin. HDx was also significantly associated with lower hospital days per year (5.94 on HD vs. 4.41 on HDx) although not with the number of hospitalizations. Estimates of annual hospitalization costs were 23.9% lower using HDx and patient utilities did not appear to decline. HDx was statistically significantly associated with reduced hospitalization days and lower medication dosages. Furthermore, this preliminary analysis suggested potential for HDx being a dominant strategy in terms of costs and utility and should motivate future work with larger samples and better controls.

Designing Structural Electrochemical Energy Storage Systems: A Perspective on the Role of Device Chemistry.

Structural energy storage devices (SESDs), designed to simultaneously store electrical energy and withstand mechanical loads, offer great potential to reduce the overall system weight in applications such as automotive, aircraft, spacecraft, marine and sports equipment. The greatest improvements will come from systems that implement true multifunctional materials as fully as possible. The realization of electrochemical SESDs therefore requires the identification and development of suitable multifunctional structural electrodes, separators, and electrolytes. Different strategies are available depending on the class of electrochemical energy storage device and the specific chemistries selected. Here, we review existing attempts to build SESDs around carbon fiber (CF) composite electrodes, including the use of both organic and inorganic compounds to increase electrochemical performance. We consider some of the key challenges and discuss the implications for the selection of device chemistries.

Ionic liquid based battery electrolytes using lithium and sodium pseudo-delocalized pyridinium anion salts.

The electrolyte salt plays an important role for the overall performance and safety of lithium- and sodium-ion batteries (LIBs and SIBs, respectively). Here, two new lithium and sodium pseudo-delocalized pyridinium anion based salts were used to prepare ionic liquid (IL) based electrolytes. The Li and Na salts of the 1-methylpyridinum 2,6-dicarboxylate anion (MM26py) were synthesized and dissolved in an IL matrix (Pyr14TFSI) - hence creating mixed anion electrolytes. The obtained electrolytes are stable up to 150 and 200 °C and show ion conductivities of 2.8 and 3.2 mS cm-1 at room temperature, for the LIB and SIB electrolytes, respectively. A competitive effect between the MM26py and the TFSI anions to coordinate the alkali metal cations is observed. Finally, the electrochemical stability windows of 2.3 and 2.5 V, respectively, confirm that these electrolytes can be used practically in medium-voltage LIBs and SIBs.