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Ramada DL, de Vries J, Vollenbroek J, Noor N, Ter Beek O, Mihăilă SM, Wieringa F, Masereeuw R, Gerritsen K, Stamatialis D. Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges. Nat Rev Nephrol 2023:10.1038/s41581-023-00726-9. [PMID: 37277461 DOI: 10.1038/s41581-023-00726-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/07/2023]
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.
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Affiliation(s)
- David Loureiro Ramada
- Advanced Organ bioengineering and Therapeutics, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O Box 217, 7500, AE Enschede, The Netherlands
| | - Joost de Vries
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Vollenbroek
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- BIOS Lab on a Chip Group, MESA + Institute, University of Twente, Hallenweg 15, 7522, NH Enschede, The Netherlands
| | - Nazia Noor
- Advanced Organ bioengineering and Therapeutics, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O Box 217, 7500, AE Enschede, The Netherlands
| | - Odyl Ter Beek
- Advanced Organ bioengineering and Therapeutics, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O Box 217, 7500, AE Enschede, The Netherlands
| | - Silvia M Mihăilă
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Fokko Wieringa
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Autonomous Therapeutics, IMEC, Eindhoven, The Netherlands
- European Kidney Health Alliance (EKHA), WG3 "Breakthrough Innovation", Brussels, Belgium
| | - Rosalinde Masereeuw
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Karin Gerritsen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dimitrios Stamatialis
- Advanced Organ bioengineering and Therapeutics, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O Box 217, 7500, AE Enschede, The Netherlands.
- European Kidney Health Alliance (EKHA), WG3 "Breakthrough Innovation", Brussels, Belgium.
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Safety and Efficacy of Short Daily Hemodialysis with Physidia S 3 System: Clinical Performance Assessment during the Training Period. J Clin Med 2022; 11:jcm11082123. [PMID: 35456216 PMCID: PMC9031690 DOI: 10.3390/jcm11082123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: A growing body of scientific evidence indicates that clinical outcomes of hemodialysis patients can be improved with short daily dialysis treatment. Current in-center hemodialysis machines do not fulfill the requirements needed for self-care home hemodialysis (HHD) treatment. In line with the reviviscence of home therapy, several hemodialysis devices have been developed and deployed for treatment. Physidia S3 is one of these new dialysis delivery systems featuring an appealing design and functionalities intended for daily HHD treatment. Methods: In this French multicenter proof-of-concept study enrolling 13 training centers, we report our preliminary experience with a special focus on quantifying clinical performances in short daily HHD treatment performed during the training period of the patients. Results: Among the 80 patients included in this study, a total of 249 sessions could be analyzed. Dialysis dose, estimated from weekly standardized Kt/V, was maintained at 2.22 [1.95–2.61] with a normalized protein catabolic rate of 0.93 [0.73–1.18] g/kg/24 h. Furthermore, anemia and nutritional status were adequately controlled as indicated by 11.6 ± 1.4 g/dL of hemoglobin level and 39.4 ± 5.7 g/L of serum albumin as well as electrolyte disorders. Conclusions: The safety and efficacy of the S3 therapy concept relying on a short daily hemodialysis treatment using a bagged delivery system are in total agreement with daily HHD recommendations. Clinical performances are aligned to the metabolic needs of the vast majority of HHD patients. Currently ongoing studies at home will provide further evidence and value of this therapeutic approach.
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