Virtual Care in Nephrology: An In-Depth Retrospective Analysis of Outcomes Using the Reset Kidney Health Model.

The advent of virtual healthcare has reshaped patient management paradigms across various medical domains. This analysis examines the potential effectiveness of treating chronic kidney disease (CKD) using Reset Kidney Health's virtual, multidisciplinary, and integrated care approach. The pilot study concentrated on evaluating the impact of this care model on the estimated Glomerular Filtration Rate (eGFR) of CKD patients over an eight-month period. The analyses showed that a majority of patients managed with the Reset Kidney Health Model experienced stability or improvements in their kidney function, as measured by eGFR. While this pilot study has several limitations, these early results suggest the potential benefits of digital healthcare innovations in chronic disease management and provide an argument for the broader integration of virtual care strategies in healthcare systems. These initial findings could lay the groundwork for further research into effectively integrating digital healthcare in chronic disease management.

A comparison of dual dialyzers in parallel and series to improve urea clearance in large hemodialysis patients.

BACKGROUND: Dialysis adequacy targets frequently are difficult to achieve in large hemodialysis patients. Dual dialyzers can be used to improve clearance. It is unknown whether series or parallel configurations are superior. METHODS: Eighteen large hemodialysis patients (mean weight, 92.4 kg) were enrolled in a randomized, crossover trial to directly compare dual dialyzers in parallel and series configurations. Treatment times, blood flow rates, and dialysate flow rates were kept constant. RESULTS: Compared with a single dialyzer, parallel dual dialyzers increased the single-pool Kt/V (spKt/V) from 1.25 +/- 0.22 to 1.43 +/- 0.29 (P < 0.003). Series dual dialyzers improved urea clearance measured by spKt/V (spKt/V(urea)) to 1.46 +/- 0.26 (P < 0.0003 compared with a single dialyzer). Kt/V and urea reduction ratio of dual dialyzers in parallel were not significantly different from those of dual dialyzers in series. Half the subjects failed to meet the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative recommended adequacy target for spKt/V(urea) of 1.2 or less using a single dialyzer. With the use of dual dialyzers, 83% of subjects achieved this adequacy target. Serum levels of a middle molecule, beta2-microglobulin, were reduced 34% after 2 months of dual-dialyzer therapy. Cost analysis estimates annual net savings of 1,260 dollars with dual-dialyzer therapy, primarily from projected savings in inpatient expenses. CONCLUSION: In large hemodialysis patients, our study shows that dual dialyzers in parallel and series are equally effective at improving urea clearance without prolonging dialysis treatment times.

Processing of the major pancreatic zymogen granule membrane protein, GP2.

INTRODUCTION: The pancreatic exocrine secretory granule, the zymogen granule, releases digestive enzymes into the intestine. GP2 is the most abundant zymogen granule membrane protein. Coincident with exocrine secretion, GP2 is released from the membrane and secreted into the pancreatic duct. AIM: To characterize changes in the structure of GP2 as it progresses through the secretory pathway. METHODOLOGY: Polarized MDCK cells that express the rat GP2 gene were used to examine the sequential processing of the polypeptide backbone. RESULTS: Within the cell, GP2 is initially proteolytically processed from a 55- to a 53-kd form at or before the trans-Golgi network. The protein is then processed to a 51-kd form, which is found on the apical plasma membrane and in secretions. Similar processing was also observed in primary rat pancreatic cultures and in MDCK cells that express human GP2. The amino-terminal sequence of human GP2 derived from pancreatic secretions was determined for two human patients and began at Gly39, revealing a potential processing site. CONCLUSIONS: In contrast to other digestive enzymes secreted by the pancreas that are activated by proteolysis in the intestine, GP2 undergoes sequential intracellular cleavage. Alterations in GP2 structure by proteolysis may regulate GP2 function at specific sites within the pancreatic cell.