In a recently published article, researchers provided an overview of ambulatory hemodialysis devices, which they suggest “offer the potential for self-care treatment outside the clinical setting as well as frequent and prolonged sessions.” However, they argued that ongoing efforts related to technological improvements and safety are required before implementation.
“The suffering and death experienced by patients who are treated with conventional in-center hemodialysis are partly due to the on-again/off-again — or intermittent — nature of the treatment,” Shuvo Roy, PhD, of the University of California, San Francisco, said in a related press release. “Prolonged and frequent dialysis helps reduce the stress on the heart and the dietary restrictions of dialysis, but patients cannot spend their whole lives tied to a large heavy machine and hundreds of pounds of water for dialysis. With ambulatory devices, it will be possible for kidney failure patients to lead more normal and healthier lives.”
In the article, researchers described several key features and technologies of “an ideal ambulatory hemodialysis device.” These included manageable equipment size and weight that allow for mobility, as well as the ability to fit under clothing while delivering sufficient clearance of uremic toxins (creatinine clearance and ultrafiltration targets of 30 mL/min). In addition, they maintained that the device should be safe and meet technical requirements for dialysis membrane characteristics, dialysate regeneration, vascular access and patient monitoring.
"Much of the future work will not necessarily need new scientific discoveries."
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Roy and colleagues are developing an implantable artificial kidney (described here as a “two-stage system that combines a high-efficiency membrane for hemofiltration with a bioreactor of kidney tubule cells for electrolyte balance”), key features of which they contend have demonstrated feasibility in preclinical testing.
They wrote that, for implantable devices, future work needs to address implantation technique, device lifetime, ultrafiltration control and periodic maintenance. For both wearable and implantable devices, consideration of how to safely administer anticoagulation therapy is necessary. Based on recent clinical evaluation of a wearable device, the researchers wrote that advances also need to be made in hemofiltration membranes, dialysate regeneration, vascular access and patient monitoring systems.
“Much of the future work will not necessarily need new scientific discoveries,” Roy said in the release. “Instead, a concerted focus on engineering tasks can lead to the technology improvements to facilitate ambulatory implementation and clinical evaluation of wearable and implantable devices.”– by Melissa J. Webb
Disclosures: Roy reports receiving grants from NIH/NIBIB and being a founder of Silicon Kidney LLC. Please see the study for all other authors’ relevant financial disclosures.