An experimental wearable artificial kidney shows promise as a substitute for dialysis machines, researchers report. More than 2 million people world-wide with kidney failure require chronic dialysis. They must follow strict limitations as to what they eat and drink.
Longer, more frequent dialysis would offer better outcomes, but current dialysis machines aren't portable. They limit patients' freedom of movement and ability to engage in the normal activities of daily living.
"As a physician who cares for patients with kidney disease, it is my hope that in the future we have something better to offer than we do today for dialysis therapy," Dr Jonathan Himmelfarb from the University of Washington in Seattle told Reuters Health.
He would like to see "a treatment that can enhance quality of life, allow for more autonomy and opportunity for full rehabilitation, and possibly to extend life as well, compared to today's available therapeutic options."
"We owe it to our patients to do everything we can to make this a reality," Himmelfarb said by email.
He and his colleagues created a continuously operating wearable artificial kidney that was effective in earlier pilot studies where treatment was limited to 8 hours.
Now they report the results of a 24-hour test of the wearable artificial kidney in 11 patients with end-stage kidney disease who had been on dialysis for an average of 15 months.
Five patients completed the planned 24-hour treatment period, during which the device performed as expected.
There were challenges along the way, though. One patient had to stop treatment because of clotting of the blood circuit. In two patients, the machines needed new batteries before the end of the 24 hours. Three patients had to interrupt treatment to have gas bubbles removed from the blood circuit.
Because of a variety of device-related technical problems, the trial was stopped early, the authors reported in JCI Insight.
There were no serious complications, and all subjects were able to walk around freely while receiving artificial kidney treatment. The patients reported satisfaction with the few side effects, the convenience and flexibility of treatment, the discomfort associated with treatment, and the freedom allowed by the wearable artificial kidney.
The researchers say the technical problems will need to be addressed through device redesign and refinement before further long-term studies can be done.
"We would hope to be able to conduct a follow-up trial beginning sometime in the next several years," Dr Himmelfarb said. "It will be a number of years before such a treatment can be proven safe and effective, and be readily available to patients living with kidney disease."
Dr Karin Gerritsen and Dr Jaap Joles from University Medical Center Utrecht in The Netherlands, who recently reviewed the current status of wearable kidney development, told Reuters Health by email, "Wearable and portable artificial kidneys are certainly on the horizon, but it will still take a few years before they become widely available."
"The device may be a very good alternative for daily (night-time) hemodialysis while operating in a bedside mode," they said. "This would already be a great step forward compared to conventional in-(clinic) hemodialysis three times a week."
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