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 More than 2 million people worldwide 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.
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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 (nighttime)
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.”
SOURCE: http://bit.ly/28i4Yvc JCI Insight, online June 2, 2016.
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