Daily hemodialysis practices in Australia/New Zealand and in France: a comparative cohort study

[REIN: a tool to evaluate practices]

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of its role in practices evaluation, the following key messages were retained. The evaluation of our practices allows improving them as proposed by the concept of the Edward Deming wheel (Plan, Do, Check, Act). Measurement also allows setting goals and targets. Where there are recommendations available, the REIN indicators allow comparison with the identified targets. The REIN registry is an interesting tool to observe the deployment and impact of the recommendations in dialysis units and to evaluate the professional practices taking into account the patients’ characteristics and the changes in the recommendations. Finally, the treatment indicators analysed using REIN data show the great diversity of practices from one region to another, the result of habits, training of nephrologists, the history of the care offered and sometimes the geography of the region and its population.

The Role of Registries in Kidney Transplantation Across International Boundaries

Transplant professionals strive to improve domestic kidney transplantation rates safely, cost efficiently, and ethically, but to increase rates further may wish to allow their recipients and donors to traverse international boundaries. Travel for transplantation presents significant challenges to the practice of transplantation medicine and donor medicine, but can be enhanced if sustainable international registries develop to include low- and low-middle income countries. Robust data collection and sharing across registries, linking pretransplant information to post-transplant information, linking donor to recipient information, increasing living donor transplant activity through paired exchange, and ongoing reporting of results to permit flexibility and adaptability to changing clinical environments, will all serve to enhance kidney transplantation across international boundaries.

National and international kidney failure registries: characteristics, commonalities, and contrasts

Registries are essential for health infrastructure planning, benchmarking, continuous quality improvement, hypothesis generation, and real-world trials. To date, data from these registries have predominantly been analyzed in isolated "silos," hampering efforts to analyze "big data" at the international level, an approach that provides wide-ranging benefits, including enhanced statistical power, an ability to conduct international comparisons, and greater capacity to study rare diseases. This review serves as a valuable resource to clinicians, researchers, and policymakers, by comprehensively describing kidney failure registries active in 2021, before proposing approaches for inter-registry research under current conditions, as well as solutions to enhance global capacity for data collaboration. We identified 79 kidney-failure registries spanning 77 countries worldwide. International Society of Nephrology exemplar initiatives, including the Global Kidney Health Atlas and Sharing Expertise to support the set-up of Renal Registries (SharE-RR), continue to raise awareness regarding international healthcare disparities and support the development of universal kidney-disease registries. Current barriers to inter-registry collaboration include underrepresentation of lower-income countries, poor syntactic and semantic interoperability, absence of clear consensus guidelines for healthcare data sharing, and limited researcher incentives. This review represents a call to action for international stakeholders to enact systemic change that will harmonize the current fragmented approaches to kidney-failure registry data collection and research.

An integrated model using the Taguchi method and artificial neural network to improve artificial kidney solidification parameters

BACKGROUND

Hemodialysis mainly relies on the "artificial kidney," which plays a very important role in temporarily or permanently substituting for the kidney to carry out the exchange of waste and discharge of water. Nevertheless, a previous study on the artificial kidney has paid little attention to the optimization of factors and levels for reducing the solidification of the artificial kidney during the hemodialysis procedure. Thus, this study proposes an integrated model that uses the Taguchi method, omega formula, and back-propagation network to determine the optimal factors and levels for addressing this issue.

METHODS

First, we collected the recommendations of medical doctors and nursing staff through a small group discussion, and used the Taguchi method to analyze the key factors at different levels. Next, the omega formula was used to convert the analysis results from the Taguchi method to assess the defect rate. Finally, we utilized back-propagation network algorithms to predict the optimal factors and levels for artificial kidney solidification, in order to confirm that the key factors and levels identified can effectively improve the solidification rate of the artificial kidney and thereby enhance the effect of hemodialysis.

RESULTS

The research finding proposes the following as the optimal factors and levels for artificial kidney solidification: the amount of anticoagulation should be set at 500 units, the velocity of blood flow at 300 ml/min, the dehydration volume at 2.5 kg, and the vascular access type as autologous blood vessels. We obtained 270 sets of data from the patients of End Stage Renal Disease (ESRD) under the setting of the optimal combination of the factors at different levels; the defect rate of artificial kidney solidification is 12.9%, which is better than the defect rate of 32% in the original experiment. Meanwhile, the patient characteristics for physiological status in BMI, serum calcium, hematocrit, ferritin, and transferrin saturation percentage are improved by this study.

CONCLUSION

This conclusion validates the ability of the proposed model in this study to improve the solidification rate of the artificial kidney, thereby confirming the model's use as a standard operation procedure in the hemodialysis experiment. The ideas behind and the implications of the proposed model are further discussed in this study.