Author: Henry Feeser (Page 4 of 51)

Those of you who have been reading this blog for some time know that I am an engineer very interested in AI. I use it quite often to gather background for my blog entries and generally know it has a real place in the future. I am so avidly convinced of its future that I have invested six figures in two AI-related stocks, NVDY and AIYY. Given this background, it should not be surprising that the current and future application of AI to peritoneal dialysis is also of interest. The following is provided to increase our knowledge in this important area.

Peritoneal dialysis (PD) is a vital renal replacement therapy for patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD). It utilizes the peritoneum (as a natural semipermeable membrane to remove waste products and excess fluid from the blood. The advent of artificial intelligence (AI) in healthcare has the potential to revolutionize PD by enhancing patient outcomes, personalizing treatment, and optimizing clinical workflows. This blog explores the current applications of AI in PD and its projected future. 

Current Applications of AI in Peritoneal Dialysis 

Predictive Analytics: 

AI algorithms can analyze large datasets to predict complications in PD patients, such as peritonitis (, catheter dysfunction, and fluid overload. Machine learning models can identify patterns that might go unnoticed by human clinicians, allowing for timely interventions. 

Personalized Treatment: 

AI can help tailor PD regimens to individual patients by analyzing historical data and real-time information. For instance, AI-driven tools can optimize dialysate ( composition and the frequency of exchanges based on a patient’s unique physiological characteristics, leading to improved biochemical control and quality of life. 

Telehealth and Remote Monitoring: 

AI is enhancing telehealth capabilities for PD patients by enabling remote monitoring of vital signs and dialysis parameters. Smart devices equipped with AI can alert healthcare providers to potential issues, facilitating proactive management of patient health and reducing hospital visits. 

Decision Support Systems: 

AI-based decision support systems (DSS) assist healthcare providers in making informed clinical decisions. These systems can integrate various data sources, including laboratory results and patient history, to recommend optimal treatment plans and improve overall patient management. 

Projected Future of AI in Peritoneal Dialysis 

Enhanced Patient Engagement: 

The future of AI in PD will likely focus on improving patient engagement through personalized applications. These apps could provide patients with real-time feedback on their treatment, dietary recommendations, and reminders for dialysis exchanges, enhancing adherence to therapy. 

Integration with Wearable Technology: 

The integration of AI with wearable devices may allow continuous monitoring of biomarkers such as blood pressure, heart rate, and fluid status. This data can be used to adjust PD prescriptions dynamically, promoting individualized care and minimizing complications. 

Natural Language Processing (NLP): 

NLP technologies could revolutionize patient-provider communications by analyzing patient-reported symptoms and concerns, thus allowing for more nuanced and timely interventions. This could lead to more personalized care plans based on patients’ subjective experiences. 

Data-Driven Research: 

AI can facilitate data-driven research by identifying trends and correlations in large datasets that are often too complex for traditional statistical analyses. This could lead to new insights into patient outcomes and a better understanding of factors influencing the success of PD. 

Automated Workflow Optimization: 

Future AI systems could automate various administrative aspects of PD management, such as scheduling, documentation, and billing, allowing healthcare providers to focus more on patient care rather than administrative tasks. 

Conclusion 

The integration of AI into peritoneal dialysis is already showing promising results, with advancements in predictive analytics, personalized treatment, and remote monitoring. As technology continues to evolve, the future holds immense potential for AI to enhance patient engagement, improve clinical decision-making, and optimize workflows in PD management. The ongoing collaboration between healthcare professionals and AI developers will be crucial in harnessing these technologies to improve outcomes for patients with kidney disease. The journey towards fully realizing the potential of AI in PD is just beginning, and it promises to reshape the landscape of renal care in profound ways. 

In summary, the synergy between AI and peritoneal dialysis could lead to a more effective, patient-centered approach to managing chronic kidney disease, ultimately improving the quality and longevity of patients’ lives. 

In review, last week I traveled to Ft Worth for a nuclear stress test on my heart. The results were available this past Saturday. The salient part of the reported result is quoted below:

“Procedures Date Name Performed by 10/16/2024 Tte W/doppler Complete
Notes: Studycast study 52688127 conclusions (added Sat, 19 Oct 2024 11:26:29 -0400) Normal LV systolic function with EF 53%. Left ventricle cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is normal in size. No significant wall motion abnormalities in the areas visualized. Left atrial cavity is moderately dilated at 4.9 cm. RVSP measures 21 mmHg. Impaired left ventricular relaxation”

So what does all this gibberish mean? I copied the above text to Google’s NotebookLLM where I received the following plain English summary:

The patient’s cardiovascular health status presents a mixed picture with both positive and concerning aspects.
Positive Findings:
●The patient’s left ventricle (LV) exhibits normal systolic function with an ejection fraction (EF) of 53%, indicating the heart effectively pumps blood out to the body.
●The left ventricle is also normal in size, and no significant wall motion abnormalities are observed in the visualized areas.
●The right ventricular systolic pressure (RVSP) is measured at 21 mmHg, which falls within the normal range.
Concerning Findings:
●Despite normal LV function, the patient exhibits impaired left ventricular relaxation. This suggests a problem with the heart’s ability to fill with blood properly during the relaxation phase (diastole).
●The left atrium is moderately dilated at 4.9 cm. This enlargement may result from impaired relaxation of the left ventricle, as blood backs up into the left atrium.
Overall:
The patient’s cardiovascular health status is not entirely healthy. While his heart is pumping efficiently, the impaired relaxation and dilated left atrium raise concerns. These findings could be indicative of conditions such as diastolic heart failure or other cardiac abnormalities. Further investigation and monitoring are likely necessary to determine the underlying cause and appropriate management for this patient’s cardiovascular health.

It will be interesting to hear what the cardiologist has to say about all of this during our teleconference later this week which I will share. Keep in mind I am an 85-year-old veteran on 100% disability who was exposed to Agent Orange in Vietnam, have had a triple bypass and am currently on PD. In this regard, I bet that we will get a “Let’s keep an eye on it.”

Last week I had an interesting conversation with someone from my (previous) Continuous Glucose Monitor (CGM) supplier. They called initially to inform me that they needed a new script to supply me with Libre 3s for the next year. I wrote a text to my GP requesting they contact the supplier which they did. The supplier got back to me and informed me that I was NOT eligible to receive Libre3s via Medicare now because the FDA had not approved them for use by patients on dialysis, regardless of the type, hemo, or PD.

Seems that inaccurate results were being provided by the Libre3 CGMs. I can vouch for that. For at least 6 early mornings in a row last week I was awakened to a low glucose alarm while I felt fine and knew such NOT to be the case.

So now, at least, it’s back to the finger prick, method of yesterday to ascertain my glucose. And this is in the age of AI etc. It just doesn’t seem right.

It is always of interest to me as a quasi-researcher where today’s topic title is headed. I quizzed my Perplexity-Pro subscription with the title as a prompt and this is what returned:

The number one topic in peritoneal dialysis (PD) research today appears to be the management and prevention of complications, particularly peritoneal dialysis-associated peritonitis (PDAP), as well as improving patient outcomes and quality of life.

1. Peritoneal Dialysis-Associated Peritonitis (PDAP): PDAP is a significant complication of peritoneal dialysis that leads to increased morbidity and mortality. Research is focused on understanding its epidemiology, risk factors, and economic implications and developing strategies to reduce its incidence and improve treatment outcomes[2]. This includes examining hospital-level factors influencing PDAP outcomes and exploring interventions to mitigate these risks.
2. Life Participation: Another emerging area of interest is enhancing life participation for patients on PD. This involves interventions aimed at improving the ability of patients to engage in valued life activities, which has been identified as a top priority by patients themselves. Research in this area seeks to address cognitive, affective, and environmental barriers to participation[5].
3. Patient Education and Training: Ensuring that patients are well-informed about their treatment options and the management of PD is crucial. Studies emphasize the importance of patient education in choosing PD over other modalities, as well as ongoing training to manage PD effectively at home[3].
4. Technique Survival and Quality of Life: The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) aims to improve technique survival and quality of life for PD patients by studying clinical practices globally. This research is crucial for identifying best practices and standardizing care across different regions[1].

These topics reflect a broader trend in PD research towards optimizing patient outcomes, minimizing complications, and enhancing the overall quality of life for individuals undergoing this form of dialysis therapy.

Citations:
[1] https://www.dopps.org/OurStudies/PeritonealDialysisPDOPPS.aspx
[2] https://karger.com/ajn/article-abstract/55/4/472/908144/Trends-Outcomes-and-Economic-Implications-of?redirectedFrom=fulltext
[3] https://ajkdblog.org/2024/03/01/nephmadness-2024-peritoneal-dialysis-region/
[4] https://www.mdpi.com/journal/life/special_issues/AH36CFXE5J
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292723/

This past Monday and Tuesday, the Fresenius Complaint people contacted me regarding my letter to their CEO, Helen Giza. Their interest was strictly limited to ascertaining the nature and extent of my complaint(s). This arm of Fresenius has nothing to do with the resolution of any shortfalls but only acts as a fact-gathering, independent agency within Fresenius.

During Monday’s call, the  complaint-gathering person made a statement that is really bothersome to me as a patient. She stated that Fresenius bears no responsibility for the cassette fiasco in that it was perpetuated by a vendor and they had nothing to do with it. I cannot explain all the ways this does meet any smell test. The CEO of Fresenius is a bean counter – background in accounting and finance – it is a given that the C-Suite is under the gun to keep costs down. Given price pressures on vendors, their response, much like we see at the grocery store and reduced amount of product in a package at the old price, is to cut corners to maintain their margins. How this took place without recognition by Fresenius continues to be a mystery.

In that Fresenius is still in the “fact-gathering phase” of resolution, I don’t see any merit to rumors on such places as PatientHub that Fresenius will be going back to the former cassettes in the short term. Perhaps this is based on wishful thinking.

In today’s blog, I am straying from peritoneal dialysis to present readers with a source of predictive data about future events, such as the US presidential election. First, I will present what Perplexity has to say about Polymarket.com, then show you some screenshots about the coming presidential election. This is not a political statement but is meant to provide readers with the latest tools to spread knowledge.

Polymarket.com has emerged as a prominent player in the world of prediction markets, offering users a unique platform to trade on the outcomes of real-world events. Founded in 2020 by Shayne Coplan, Polymarket has quickly gained traction as a decentralized information market that leverages blockchain technology and the wisdom of crowds to forecast future events57.

How Polymarket Works

Polymarket allows users to buy and sell shares based on the likelihood of specific outcomes occurring. The platform covers a wide range of topics, including politics, sports, pop culture, and science5. For example, in the current 2024 U.S. Presidential Election market, users can trade on the likelihood of various outcomes, with prices reflecting the perceived probabilities1. The platform operates on the Polygon blockchain, ensuring transparency and security in transactions4. Users can deposit USDC cryptocurrency to participate in the markets, with share prices ranging from $0 to $1, representing the probability of an event occurring.

Accuracy and Performance

Polymarket has gained a reputation for accuracy in predicting outcomes, often outperforming traditional polls and surveys. This accuracy is attributed to the “wisdom of crowds” principle, where collective intelligence tends to produce more accurate forecasts than individual experts7. Notable figures have praised Polymarket’s predictive power:

1. Elon Musk, the billionaire entrepreneur, recently stated that Polymarket is “more accurate than polls, as actual money is on the line”8.
2. Thomas Miller, a data science professor at Northwestern University, asserted that “Political betting websites excel in reflecting the collective intelligence of the public”3.

The platform’s accuracy has been particularly notable during significant events like the 2020 U.S. Presidential Election, attracting considerable attention and trading volume5.

Growth and Funding

Despite facing regulatory challenges, including a $1.4 million fine from the Commodity Futures Trading Commission in 2022, Polymarket has continued to grow and attract investment25. In 2024, the company raised $45 million in a Series B funding round led by Peter Thiel’s Founders Fund, with participation from Ethereum co-founder Vitalik Buterin5.

Current Status and Future Outlook

As of October 2024, Polymarket has become a significant player in election forecasting. The platform has seen over $1.9 billion wagered on the 2024 U.S. Presidential race alone4. To enhance its credibility and expertise, Polymarket has brought on board notable figures such as Nate Silver, founder of FiveThirtyEight, as an advisor4. While Polymarket continues to operate its election prediction markets offshore due to regulatory constraints, it has shown resilience and adaptability in the face of challenges. The platform’s growing popularity and perceived accuracy suggest that it may play an increasingly important role in shaping public understanding of event probabilities and outcomes in the future. As prediction markets like Polymarket continue to evolve, they offer a compelling alternative to traditional polling methods, providing real-time insights into public sentiment and event probabilities across a wide range of topics9.

I wrote today’s blog as much for me as readers of the blog. While I have never had Peritonitis, I know research has shown it to be the number one most serious problem PD patients face. Below is a summary of my research taken from Google’s NotebookLM and accompanied by a Podcast of the findings. Below that is the original seed I obtained from the DoctorSage Bot in Poe that I fed into NotebookLM.

Summary

This Podcast explains the serious health complication of peritonitis, which is an inflammation of the peritoneum lining the abdominal cavity. It focuses on the specific dangers of peritonitis for patients undergoing peritoneal dialysis, as it can significantly impact the effectiveness of their treatment. The Podcast then delves into the causes, symptoms, diagnosis, treatment, and prevention of peritonitis in peritoneal dialysis patients, highlighting the importance of proper hygiene, technique, and regular medical check-ups to minimize the risk of developing this complication.

Peritonitis is an inflammation of the peritoneum, the abdominal cavity’s membrane. For patients undergoing peritoneal dialysis (PD) , peritonitis is a significant concern, as it can lead to severe complications and impact the effectiveness of the dialysis treatment. This blog post aims to provide a comprehensive overview of peritonitis, including its definition, causes, symptoms, diagnosis, treatment, and preventive measures specifically for PD patients.

What is Peritonitis?
Peritonitis is an inflammatory response of the peritoneum, which can occur due to infection or other irritants. In the context of peritoneal dialysis, peritonitis often arises from bacterial infection introduced into the peritoneal cavity through the catheter used for dialysis.

Causes of Peritonitis in PD Patients
Bacterial Infection: The most common cause of peritonitis in PD patients is the introduction of bacteria during the exchange process. Common pathogens include:
Staphylococcus aureus
Streptococcus species
Escherichia coli
Pseudomonas aeruginosa
Non-infectious Causes: While less common, peritonitis can also result from:
Chemical irritation from dialysis solutions.
Presence of foreign bodies or materials in the peritoneal cavity.
Pancreatitis or other inflammatory conditions affecting the abdomen.
Symptoms of Peritonitis
Patients should be vigilant for the following signs and symptoms, which may indicate the onset of peritonitis:

Abdominal pain: Often diffuse and can be severe.
Fever: Elevated body temperature (typically above 38°C or 100.4°F).
Nausea and vomiting: May accompany abdominal discomfort.
Changes in dialysis effluent: Such as cloudiness or the presence of an unusual odor.
Decreased appetite: Often a result of discomfort.
Diarrhea: Sometimes present, although not universally.
How to Ascertain if You Have Peritonitis
Diagnosis of peritonitis typically involves:

Clinical Assessment: A thorough history and physical examination by a healthcare professional.
Dialysate Analysis: Examination of the peritoneal dialysis effluent for:
Cell count: An elevated white blood cell (WBC) count, especially with a predominance of neutrophils (>100 cells/mm³), suggests infection.
Gram stain and culture: To identify the causative organism.
Biochemical analysis: To check for glucose and lactate levels.
Blood Tests: To assess for systemic infection, including:
Complete blood count (CBC)
Blood cultures
Treatment of Peritonitis
The treatment of peritonitis is critical and typically involves:

Antibiotic Therapy: Empirical (initial) antibiotics are started promptly, and adjustments are made based on culture results. Common regimens include:
Intravenous antibiotics for severe cases.
Intraperitoneal antibiotics for mild to moderate cases.
Supportive Care: This may include:
Pain management.
Volume resuscitation if needed.
Nutritional support.
Catheter Management: In some cases, the PD catheter may need to be removed or replaced, especially if the infection is recurrent or severe.
Surgery: Rarely, surgical intervention may be necessary if there are complications such as abscess formation or bowel perforation.
Prevention of Peritonitis
Preventing peritonitis is crucial for PD patients. Key strategies include:

Proper Technique: Adhering to strict aseptic techniques during dialysate exchanges.
Training and Education: Patients should receive comprehensive training on PD techniques and recognize the signs of infection.
Regular Follow-ups: Frequent check-ups with healthcare providers to monitor for potential complications.
Good Hygiene: Maintaining clean hands, catheter site, and surroundings.
Conclusion
Peritonitis remains a significant risk for patients on peritoneal dialysis, but with proper knowledge and preventive measures, the risks can be minimized. Understanding the signs and symptoms and prompt treatment are essential in managing this potential complication. Regular communication with healthcare providers and adherence to recommended practices will enhance the safety and effectiveness of peritoneal dialysis.

Key Takeaways:
Peritonitis is a serious complication of PD, primarily caused by bacterial infections.
Symptoms include abdominal pain, fever, and changes in dialysate appearance.
Diagnosis involves clinical assessment and analysis of dialysate.
Treatment typically includes antibiotics and supportive care.
Prevention focuses on aseptic technique and patient education.
By remaining vigilant and proactive, PD patients can significantly reduce their peritonitis risk and ensure better dialysis treatment outcomes.

A website named www.homedialysis.org has some good info for everyone involved with or concerned about dialysis. One of the bits of information offered is a resource named PATH-D. PATH-D was developed to help patients and caregivers codify who is responsible for what regarding the care and feeding, so to speak, of all the effort that goes into adding up to successful dialysis. The site states “…PATH-D acts as a behavioral contract between the patient and the partner that explicitly defines the tasks at hand and determines what tasks each person is willing to take on.” If you read down the list, you can get a feeling of all that is involved in successful PD if nothing else. A PDF of PATH-D is available below: