From portable dialysis to a bioengineered kidney

Abstract

Since the advent of peritoneal dialysis (PD) in the 1970s, the principles of dialysis have changed little. In the coming decades, several major breakthroughs are expected. Areas covered: Novel wearable and portable dialysis devices for both hemodialysis (HD) and PD are expected first. The HD devices could facilitate more frequent and longer dialysis outside of the hospital, while improving patient's mobility and autonomy. The PD devices could enhance blood purification and increase technique survival of PD. Further away from clinical application is the bioartificial kidney, containing renal cells. Initially, the bioartificial kidney could be applied for extracorporeal treatment, to partly replace renal tubular endocrine, metabolic, immunoregulatory and secretory functions. Subsequently, intracorporeal treatment may become possible. Expert commentary: Key factors for successful implementation of miniature dialysis devices are patient attitudes and cost-effectiveness. A well-functioning and safe extracorporeal blood circuit is required for HD. For PD, a double lumen PD catheter would optimize performance. Future research should focus on further miniaturization of the urea removal strategy. For the bio-artificial kidney (BAK), cost effectiveness should be determined and a general set of functional requirements should be defined for future studies. For intracorporeal application, water reabsorption will become a major challenge.

Protein-Bound Uremic Toxins in Hemodialysis Patients Relate to Residual Kidney Function, Are Not Influenced by Convective Transport, and Do Not Relate to Outcome

“…The kidney has two mechanisms to excrete uremic toxins into the urine. Small water-soluble solutes (e.g., urea) are primarily eliminated by glomerular filtration and protein-bound uremic toxins (PBUTs) primarily by tubular secretion mediated by transporters, including organic anion transporters (OAT) and organic cation transporters (OCT) for removal of PBUTs [1][2][3]. Hemodialysis (HD) is a life-sustaining renal replacement therapy that partially replaces renal glomerular filtration, but not renal tubular function.…”

Paracrine Proangiogenic Function of Human Bone Marrow-Derived Mesenchymal Stem Cells Is Not Affected by Chronic Kidney Disease

“…Indeed, BM MSC-based regenerative medicine approaches are being developed to treat CKD, aiming to halt progression of fibrosis by vascular regeneration, stimulate kidney regeneration, or enhance immunomodulation after renal transplantation. These therapies include administration of cells or products secreted by cells [9][10][11]. BM MSCs are an effective treatment for CKD in a range of preclinical animal models [12].…”

Fabrication of Kidney Proximal Tubule Grafts Using Biofunctionalized Electrospun Polymer Scaffolds

“…FDA‐approved phase I/II clinical studies with a RAD suggested a potential added value of such a device in the treatment of critically ill subjects . The development, current status, and technical challenges of RADs have been extensively reviewed elsewhere . Unfortunately, the efficiency of current RADs is limited to short‐time extracorporeal applications.…”