Portable and wearable dialysis devices for the treatment of patients with end-stage kidney failure: Wishful thinking or just over the horizon?

Abstract

Dialysis is a life-sustaining treatment for patients with end-stage kidney disease. In a different context, for many patients this treatment is the focal point around which their life revolves, not only due to the time spent travelling to and from treatment sessions and the time dedicated to the dialysis treatment itself, but also due to the accompanying dietary and fluid restrictions and medication burden. Wearable and portable dialysis devices could potentially improve patient quality of life by allowing patients to continue with their daily activities of life while undergoing dialysis, as well as by loosening-or removing entirely-dietary and fluid restrictions and reducing pill burden. Advances in nanotechnology manufacturing coupled with advances in electronics and miniaturisation have allowed a new generation of wearable and portable dialysis devices to be developed which are now undergoing large animal and patient clinical trials. We are therefore potentially at a new dawn in the treatment of dialysis patients with the first generation of wearable and portable dialysis devices, which may well revolutionise the treatment and quality of life for patients with end-stage kidney disease.

Keywords: Haemodialysis; Haemofiltration; Peritoneal dialysis; Portable; Wearable.

Fig. 1

Patients with chronic kidney disease fail to adequately excrete the products of cellular metabolism. The volume of the intracellular compartment exceeds that of the plasma volume, and the clearance of most middle-sized and charged solutes by the dialyser is time dependent, so favouring more effective clearance with a continuous dialysis system

Fig. 2

The automated wearable artificial kidney (AWAK) has a discontinuous flow of peritoneal dialysate. a Outflow circuit with spent dialysate effluents pumped through a fibrin filter and sorbents and then through a degassing chamber before being retained in a storage chamber. There is a separate collecting chamber for ultrafiltrate. b The AWAK in-flow circuit with spent dialysate refreshed by the addition of glucose, bicarbonate and electrolytes before being passed through an ammonia sensor and then pumped back into the patient

Fig. 3

A prototype wearable haemofiltration device using a plasma haemofilter silica-based nanoclay sorbent

Fig. 4

The wearable artificial kidney (WAK) utilises a dual chamber shuttle pump which either pumps blood or dialysate in a counter-current direction

Fig. 5

The WAK has both a blood side and a dialysate side, with spent dialysate regenerated by passage through a series of sorbents, followed by the addition of bicarbonate and electrolytes