- Dialysis - An aging methodology
- The deficiencies of dialysis renal replacement therapy
- New blood purifying technology
- Advancements in renal science and medicine
Currently, dialysis is the only renal replacement therapy available to purify a patient’s blood. Simply explained, dialysis separates and removes toxins and excess water from the blood by diffusion. Although many technological advances in dialysis have taken place since its appearance in the 1943, to date, the methodology has remained virtually unchanged.
The invention of dialysis has helped extend the lives of millions of people with chronic renal failure. Its importance can’t be denied. Yet, replacement therapy are needed. Dialysis is an aging renal replacement methodology with inherent deficiencies, the foremost being water dependency.
Water used for dialysis treatments must be ultra-pure. To accomplish this, a vast water treatment infrastructure is required, e.g., a dedicated area to house large water tanks, piping to bring in local source water, reverse osmosis (R/O) water purification equipment, a water distribution system, maintenance, and trained staff. Additionally, materials and equipment used in the construction of the water treatment facility must meet strict FDA compliance standards.
Using mean figures provided by Kidney International, hemodialysis machines use an average of 0.5 liters per minute of the ultra-pure water produced by the R/O purification equipment. However, it requires 1.5 liters of R/O water to produce the 0.5 liters of ultra-pure water. Two thirds of the water is rejected by the R/O membrane filter. Before reaching the R/O membrane filter and being rejected, the water passed through a series of various filters to remove large and small particles, such as dirt, silt, colloidal dispersions, and chlorine. This filtered water (inaccurately called reject water) is routed into the drainage system and wasted.
In a 4 hour dialysis session the total amount of all water used is about 360 liters. 360 liters x 3 sessions per week x 52 weeks = 56,160 liters or approximately 14,866 gallons used annually per patient.
According to the US Renal Data System 2018 annual report, there are over 450,000 hemodialysis patients in the US alone. 450,000 patients x 14,866 gallons per patient = 6,689,700,000 total gallons of fresh water consumed annually! 4.6 billion gallons of unused filtered reject water and over 2 billion gallons of contaminated dialysate water are discarded into our drainage system on a yearly basis. Water waste from over 50,000 US peritoneal dialysis patients would add approximately 130,000,000 more gallons to the equation. This engenders a serious negative impact on the environment. Some reject water recycling is being done in the US and a few other countries, but the problem still persists.
Along with the water waste issues created from dialysis treatments, there are other intrinsic deficiencies related to dialysis:
- Dialyzers and the dialysate concentrate are needed to perform dialysis. They are disposables that must be constantly replenished creating a continuous ongoing expense to providers.
- Dialysis machines do not have the ability to provide data in real time. Therefore, treatments are not precise and only manage to bring a patient’s blood chemistry within acceptable safe ranges. To verify if acceptable results were achieved, a blood sample is taken before a dialysis session begins and compared to a sample taken after the session is completed.
- Having no alternative, researchers trying to develop a wearable artificial kidney must rely on methodology borrowed from dialysis. They are forced to use water, R/O water, dialysate concentrate solutions, and a dialyzer to develop a functional device.
Creating an implantable kidney is a separate issue that requires a totally different methodology, far beyond the capabilities of dialysis. Filtering blood, transporting various ions, water, glucose, and urea, each in their appropriate amounts to either the blood or urine stream are the major hurdles that have stifled its creation.
Discovering a new blood purification methodology that can be used to produce a truly artificial kidney has eluded researchers for decades. Fortunately, solutions to the deficiencies currently existing in the field of renal replacement therapy are becoming a reality.
A promising new technology is currently under development. Researchers with the US Kidney Research Corporation (USKRC) are developing the first advanced technology for blood purification that could potentially replace dialysis and become the next evolution of renal replacement therapy. Moreover, the same technology can be used to develop a standalone machine, a wearable artificial kidney and an implantable device.
Unlike peritoneal and hemodialysis, the new technology does not require water, dialysate concentrate solutions, or a dialyzer. Sorbent systems being developed to regenerate dialysate solutions are also not needed. The methodology combines new multiple mesh electrodeionization technology with pressure driven ultrafiltration, nanofiltration, and reverse osmosis modules that control the amount of water excretion from the body.
Each of the components performs unique functions that can be thought of as simulating key aspects of the native kidney’s filtration and transport functions. It will have the capability of adjusting the transport of ions and water under computer chip feedback/sensor control to prevent the changes in blood chemistry that result from alterations in dietary food and fluid intake. The technology has the ability to provide real time data for doctors and patients, resulting in more precise treatments and better outcomes.
Dr. Ira Kurtz, Chief of the Division of Nephrology at the University of California (UCLA), USKRC’s Medical/Science Adviser, has worked closely with researchers at the University of Arkansas to bring the new technology into existence.
“Here we introduce a novel technological advance in the field of renal replacement therapy that allows for the first time, the two key functional properties of the kidney i.e., filtration of blood and specific transport of ions and water to be simulated by a device that does not utilize biological-based components or a dialysate. Although the technology borrows certain functional principles from the physiology of the kidney, the device does not use living cells but rather completely synthetic engineered components.” -Dr. Ira Kurtz
The study of renal replacement therapy is ongoing and researchers and scientists will continue to make medical and technological advances. The Kidney Health Initiative’s Technology Roadmap for Innovative Alternatives to Renal Replacement Therapy provides a substantial overview on advances needed to improve renal treatment modalities both now and in the future with emphasis on the following:
- Improving Dialysis Therapy – Size, portability, home dialysis, medical improvements
- Wearable Artificial Kidney – Mobility for patients
- Synthetic Engineered – An artificial kidney made from non-bio components
- Implantable/Biohybrid – Mimic the native kidney functions, develop a bio-engineered kidney
Some other areas of renal research that could have a profound effect on the industry include:
- Regenerated Kidney – Restoration of endogenous biological kidney function
- Gene Expression Profiling – Research to eliminate kidney transplant rejection, & detect renal disease
- Cloning The Native Kidney – Genetically identical cells – Non-rejection of the organ by the body
Dialysis can extend the life of End Stage Renal Disease (ESRD) patients by several years. The humanitarian goal of researchers is to go beyond extending life and ultimately create an implantable kidney devised from living tissue or synthetic materials that won’t be rejected by the body or require extensive maintenance. The prime objective is to help patients live their normal life span while not limiting their quality of life.