Continuous Arterio-venous Hemofiltration in a Wearable Device to Treat End-stage Renal Disease

Murisasco, A; Reynier, Jean-Pierre; Ragon, Alain; Boobes, Y.; Baz, M.; Durand, C; Bertocchio, P.; Agenet, C.; Mehdi, M.

doi:10.1097/00002480-198609000-00040

Cited by 23 publications

(14 citation statements)

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“…The WAK V1.1 operates with two 9-volt batteries, 375 ml of dialysate, and is small and light enough to be wearable. Previous attempts at building a WAK were overwhelmed by technical problems (8,9). This study describes the solute-removal capabilities of the sorbent dialysate regenerating WAK, demonstrating that the technical problems of the past are being addressed successfully.…”

Section: Discussionmentioning

confidence: 87%

“…However, implementation of daily dialysis is largely impractical (1)(2)(3)(4)(5)(6)(7). The development of a wearable artificial kidney (WAK) that would allow for longer and more frequent dialysis has been ongoing for decades, but has resulted in failure due almost entirely to insurmountable technical problems (8,9). A previously described (10 -17) miniaturized WAK ( Figure 1) intended to be worn continuously was analyzed in vitro and in vivo.…”

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confidence: 99%

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Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Gura¹,

Macy²,

Beizai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

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Background: The wearable artificial kidney (WAK) has been a holy grail in kidney failure for decades. Described herein are the breakthroughs that made possible the creation of the WAK V1.0 and its advanced versions V 1.1 and 1.2.Design: The battery-powered WAK pump has a double channel pulsatile counter phase flow. This study clarifies the role of pulsatile blood and dialysate flow, a high-flux membrane with a larger surface area, and the optimization of the dialysate pH. Flows and clearances from the WAK pump were compared with conventional pumps and with gravity steady flow.Results: Raising dialysate pH to 7.4 increased adsorption of ammonia. Clearances were higher with pulsatile flow as compared with steady flow. The light WAK pump, geometrically suitable for wearability, delivered the same clearances as larger and heavier pumps that cannot be battery operated. Beta 2 microglobulin (␤ 2 M) was removed from human blood in vitro. Activated charcoal adsorbed most ␤ 2 M in the dialysate. The WAK V1.0 delivered an effective creatinine clearance of 18.5 ؎ 3.2 ml/min and the WAK V1.1 27.0 ؎ 4.0 ml/min in uremic pigs.Conclusions: Half-cycle differences between blood and dialysate, alternating transmembrane pressures (TMP), higher amplitude pulsations, and a push-pull flow increased convective transport. This creates a yet undescribed type of hemodiafiltration. Further improvements were achieved with a larger surface area high-flux dialyzer and a higher dialysate pH. The data suggest that the WAK might be an efficient way of providing daily dialysis and optimizing end stage renal disease (ESRD) treatment.

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Technical Breakthroughs in the Wearable Artificial Kidney (WAK)

Gura¹,

Macy²,

Beizai³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

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“…There is also the possibility that continuous extracorporeal circulation may negatively affect the longevity of the limited vascular access sites. Of the two hemofiltrationbased wearable kidneys reported, both clotted within a week in face of aggressive heparinization [7,8].…”

Section: Awak: Conceptual Backgroundmentioning

confidence: 99%

A peritoneal-based automated wearable artificial kidney

Lee

Roberts

2008

Clin Exp Nephrol

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Work on wearable kidneys has evolved around the technology of hemodialysis or hemofiltration, which call for continuous anticoagulation of the extracoporeal circulation and are encumbered with potential immunologic and non-immunologic complications of continuous blood-artificial membrane interactions. A peritoneal-based automated wearable artificial kidney (AWAK) requires no extracorporeal circulation and is therefore "bloodless." Because AWAK is designed to continuously regenerate and reuse the spent dialysate in perpetuity, it is also "waterless." A sorbent-based assembly regenerates both the aqueous and the protein components (AqC and PrC) of the spent dialysate, producing a novel, autologous protein-containing dialysate. The regenerated AqC has the same composition as the commercially available peritoneal dialysate, but contains bicarbonate instead of lactate and has a more physiological pH. The regenerated PrC is recycled back into the peritoneal cavity, thereby ameliorating or eliminating protein loss. Depending on the steady-state protein concentrations that can be achieved (under the condition of continuous dialysate regeneration and recycling), the PrC also has the potential of both augmenting ultrafiltration and mediating the removal of protein-bound toxins. Additional sorbents can be incorporated into AWAK for the removal of middle molecular weight uremic toxins. At a regeneration rate of 4 l/h, AWAK provides a dialysate flow of 96 l/day (8-12 times the current rate). Round-the-clock dialysis and ultrafiltration provide steady-state metabolic-biochemical and fluid balance regulation, thereby eliminating "shocks" of abrupt changes in these parameters that characterize the current dialytic modalities. Dialysis-on-the-go, made possible by AWAK's "wearability" and automation, frees end-stage renal failure patients from the servitude that is demanded by the current dialytic regimentations.

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“…Before reviewing the extensive uncited prior references [7][8][9], we will speculate upon the possible motivation of this eminently successful staged media event. Clearly renommé would be the kindest explanation.…”

mentioning

confidence: 99%

“…Thus, the claims of originality are difficult to substantiate and in effect add very little to the pioneering description by Murisasco and colleagues in 1986 that was presented as a poster at the annual meeting of the American Society of Artificial Organs in Anaheim and subsequently published in the society's journal [7]. They described two ESRD patients treated continuously for 3 months and 1 month, respectively, by a wearable device consisting of a minicartridge containing zirconium phosphate, zirconium oxide, activated carbon and urease.…”

mentioning

confidence: 99%