The Path to Wearable Ultrafiltration and Dialysis Devices

Abstract

Wearable blood processing devices offer an attractive solution to problems inherent in clinic-based, intermittent end-stage renal disease therapies. What is involved in transitioning even a part of the current clinic-based population to ambulatory therapy has not been clearly enumerated. This paper addresses what a first-generation wearable device might accomplish, how issues of safety will need to be addressed, and what will make the device attractive to, and manageable by, the patient. Medical, technological, and economic issues are identified.

Recent advances in flexible sensors for wearable and implantable devices

“…For this purpose, the integration of various functional parts seems essential; this has been demonstrated in a number of ultrathin electronic devices by the integration of multiple components, including sensors, lightemitting diodes, signal transmitters, and power generators. 24,[69][70][71][72][73] A wearable diagnostic or therapeutic device has the potential to transform future ubiquitous healthcare, where technology can monitor and improve a patient's condition. 8,9,74 Recently, bio-inspired approaches have been used for skin-attachable sensors through the mimicking of unique structural features from the gecko lizard.…”

Microfluidic Organ/Body-on-a-Chip Devices at the Convergence of Biology and Microengineering

“…Among them, chronic kidney disease often results in end-stage renal failure, requiring renal replacement therapy and eventually transplantation, causing a massive burden on the healthcare systems. Microfluidic systems, as the one developed by Leonard and collaborators, appear as innovative tools to improve the outcome of classical approaches [ 150 , 151 ]. For instance, a membraneless dialysis strategy was developed, opening possibilities to create wearable blood processing devices [ 150 , 151 ].…”

“…Microfluidic systems, as the one developed by Leonard and collaborators, appear as innovative tools to improve the outcome of classical approaches [ 150 , 151 ]. For instance, a membraneless dialysis strategy was developed, opening possibilities to create wearable blood processing devices [ 150 , 151 ]. Other microfluidic systems enable the culture of kidney cells in tubular structures, mimicking the organ structure and function [ 109 , 121 , 123 , 160 ] ( Figure 1 F).…”

Creating a wearable artificial kidney: where are we now?

“…Negative intravascular pressure in a prone position may hamper the supply of blood to the HD device when using a central venous catheter. The use of 'single needle' applications, needle ports with check valve systems, subcutaneous access devices and safety measures within the device itself may circumvent some of these problems [13,14]. These problems can be partly circumvented by the use of a portable instead of a wearable device, which would allow for more flexibility for the patient (e.g., no adjustments for the home situations would be necessary and easy transport outside home would be possible without the need for tap water access).…”

“…Developments toward a portable dialysis device, based on the collaboration between the Dutch Kidney Foundation and AWAKDebiotech, are ongoing [15]. Besides access, the balance between anticoagulation and clotting risk, as well as the safety and control features of wearable or portable devices all require careful consideration [5,13,14]. This also holds true for costs and reimbursement, as well as regulatory aspects.…”