CHICAGO, IL / ACCESSWIRE / March 31, 2021 / Belding Scribner and Willem Kolff are the founding fathers of hemodialysis. Their aim was to provide a lease of life to patients with End-Stage Renal Disease who would otherwise die for lack of dialysis, explained Dr. Munavvar Izhar. Dialysis methods and dialysis machines housed in dialysis centers were perfected over decades. The hemodialysis business has resulted in thousands and thousands of dialysis centers all over the country where patients are bound to the dialysis machines 3 to 4 times a week. If you talk to the dialysis patients, they will uniformly complain of inconvenience causing limitations in their lifestyle, quality of life, and limitations of their travel and entertainment. It's a dialysis patient's dream to get dialyzed without being tethered to the dialysis machine or the dialysis unit. How do we achieve that??
Abraham Lincoln has famously said, "the best way to predict the future is to create it." Nephrologists and researchers around the world are busy trying to provide a way and means to the dialysis patients so that they are not bound by dialysis machines and dialysis units. Dr. Munavvar Izhar explained that a healthy individual's kidneys filter blood 24 hours/day, 168 hours/week compared to an individual with end-stage renal disease whose dialysis treatment plan is approximately 12 hours a week. If continuous and slow dialysis can be provided to the ESRD patients in a manner that they can carry on their day-to-day life activities without any limitations and tethering to the huge and bulky dialysis machines, then that would be an ideal situation!!
One of the big problems with modern dialysis is that the machines require vast amounts of water: 120-180 Ltrs for each 4-hour session, Himmelfarb says. "Obviously nobody can carry that around them because it would weigh tons." Hence, the concept of "Kidney in a Back Pack" emerged. There are a few in-home models marketed as portable: Fresenius sells a device that it says gives patients more mobility. Dr. Munavvar Izhar explained that it weighs 34 kilograms and can be used with a home tap, as long as the water meets certain quality standards. But the first priority in making dialysis more convenient is to remove the need for an external water supply. In Singapore, researchers at the medical-technology company AWAK have been testing an even lighter device, one that weighs no more than 3 kilograms. It's designed for peritoneal dialysis, a technique that uses a catheter to send dialysis solution into the abdominal cavity, where a lining (the peritoneum) filters out toxins from the blood so they can drain, along with the solution, into an empty bag. The AWAK device relies on a pump and a cartridge to absorb toxins from the used solution so that it can be recirculated. Each daily treatment would last seven to ten hours.
Dr. Munavvar Izhar explained that this can also be achieved by the use of nanotechnology, which will offer smaller, lightweight, affordable, and mobile units which can be worn by ESRD patients offering them freedom of mobility and yet providing them with renal clearances of 20-30 mls/min. There are three types of artificial kidneys being produced at the current time: a wearable artificial kidney for hemodialysis purposes, a wearable artificial peritoneal dialysis option, and a bio transplantable kidney which involves silicon nanotechnology and tissue engineering.
The power-play of money is hugely impacting the development of these Wearable and implantable kidneys. The development of these options would severely affect thousands of dialysis units all across the country and globe greatly impacting the bottom line for major dialysis companies. According to the FDA "They have a cash cow and there's no need to do any innovation." Lobbying efforts are also into play in these dynamics. Artificial kidney projects have some funding from NIH, NHLBI, and other government bodies in addition to some philanthropic funds. Kidney X is a $10 million initiative which will help propel the development of wearable kidneys and bio transplantable kidneys, explained Dr. Munavvar Izhar.
Researchers at the University of California, San Francisco (UCSF), and Vanderbilt University in Nashville, Tennessee, have bypassed external devices and instead focused on developing a kidney prototype that they hope will one day be surgically implanted into a patient's body. Dr. Munavvar Izhar explained that it wouldn't require a pump because it would be attached to key arteries and powered by blood pressure, says Vanderbilt nephrologist William Fissell, who co-directs the research with UCSF's Shuvo Roy. The device contains two key parts: a blood-filtration system and a cell-infused recalibration module. The filter is made of silicon membranes with nanometre-scale pores that are designed to mimic the glomerulus. The recalibration module uses tubule cells from discarded human kidneys to rebalance the blood's components, Fissell says.
REFERENCES:
- Shao, G., Zang, Y. & Hinds, B. Appl. Nano Mater. 2, 6116-6123 (2019).
- Nature 579,186-188 (2020).
- https://doi.org/10.1038/d41586-020-00671-8.
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SOURCE: Dr. Munavvar Izhar