Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges

Abstract

Haemodialysis is life sustaining but expensive, provides limited removal of uraemic solutes, is associated with poor patient quality of life and has a large carbon footprint. Innovative dialysis technologies such as portable, wearable and implantable artificial kidney systems are being developed with the aim of addressing these issues and improving patient care. An important challenge for these technologies is the need for continuous regeneration of a small volume of dialysate. Dialysate recycling systems based on sorbents have great potential for such regeneration. Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of a broad range of uraemic toxins, with low levels of membrane fouling compared with currently available synthetic membranes. To achieve more complete therapy and provide important biological functions, these novel membranes could be combined with bioartificial kidneys, which consist of artificial membranes combined with kidney cells. Implementation of these systems will require robust cell sourcing; cell culture facilities annexed to dialysis centres; large-scale, low-cost production; and quality control measures. These challenges are not trivial, and global initiatives involving all relevant stakeholders, including academics, industrialists, medical professionals and patients with kidney disease, are required to achieve important technological breakthroughs.

Urea catalytic oxidation for energy and environmental applications

“…320 Electrooxidation is an attractive method for removing urea from dialysates, and its equipment is lightweight, durable, and reusable. 318,321 As discussed in Section 5, urea can be oxidized indirectly by oxidizing chlorine species, accompanied by toxic by-products chlorine, chloramine, and metal leaching from the electrode. 322 Thus, an efficient method to reduce chlorine by-products was explored by Wester et al They selected Pt, Ru, and graphite electrodes to compare urea removal, toxic chlorine release, and metal ion leaching.…”

“…Kidney failure is a life-threatening disease that has seriously affected more than 4.7 million patients worldwide. 318 Kidney transplantation is the best treatment; however, it is generally not possible due to factors such as patients' ineligibility and insufficient kidney resources. Therefore, most patients choose peritoneal dialysis or hemodialysis to replace kidney function.…”

“…26a). 318 The key issue for WAK development is the need to regenerate the patients’ dialysate continuously and efficiently in a closed-loop system. Removal of urea from these dialysates presents the most difficult challenge.…”

Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis

“… 113 The challenges limiting wide-spread development have included the need to enable continuous regeneration of a small volume dialysate, miniaturisation with current devices being around 10–30 kg and the optimisation of toxin removal. 114 …”

Wearable Artificial Kidneys: The First Choice for Portable Renal Replacement Therapy

“…An implantable artificial kidney is a compelling medical innovation made of nanomaterials. [18,21,22] This small device is similar in appearance to a chip and uses blood pressure to perform kinetic dialysis; it is surgically implanted in the patient's Table 1 The characteristics of different renal replacement therapy methods…”