As a venue for announcingimportant medical developments,Kidney Week neverdisappoints. Hundreds of studiespresented at the 2015 conference inSan Diego, as in previous years, havethe potential for influencing clinicalpractice and moving nephrologyforward in a major way. One of thosestudies was a small exploratory trialof a wearable artificial kidney (WAK).
The study, by Victor Gura, MD,of Cedars-Sinai Medical Center in Los Angeles, and colleagues, was a24-hour trial of a device that the investigators described as a miniaturizedhemodialysis machine based on dialysate-regenerating sorbenttechnology. Their study included 7 patients with end-stage renal disease.According to the investigators, all patients remained hemodynamicallystable and experienced no serious adverse events over the 24-hour studyperiod. Fluid removal was consistent with prescribed ultrafiltration, Dr.Gura’s group stated in a poster presentation.
Five patients completed the planned 24 hours of study treatment; 2completed 4 hours and 10 hours. Of the 7 patients, 6 ambulated whilewearing the WAK. Patients ate a normal diet during the study, withad lib ingestion of water and without restricting salt, phosphate, orpotassium-rich foods, Dr. Gura and his colleagues noted.
“All patients reported that they would switch to the WAK if the devicewere commercially available,” the authors wrote.
The commercial availability of a wearable or implantable articial kidneyis likely years away, but the promising findings by Dr. Gura’s group providea reason for optimism because of the potential life-changing ramificationsfor ESRD patients. Many of these patients must adjust their workschedules or plan their recreational and social activities around dialyzingsessions, especially those receiving thrice-weekly in-center dialysis.
Currently, the only treatment that can free ESRD patients from dialysisis a kidney transplant. Only a fraction of patients receive one, however,in part because of a shortage of donor kidneys. The total number ofkidney transplants over the past decade has leveled off, according tothe U.S. Renal Data System 2015 Annual Data Report. The unadjustedtransplant rate per 100 dialysis patient years has been declining whilethe percentage of prevalent dialysis patients wait-listed for a kidneytransplant has been increasing, the report noted.
If ESRD patients face increasing difficulty getting a kidney transplantin coming years, they may see an artificial kidney as the next best alternative.Although nothing will replace having a real human kidney—evenwith the problems associated with immunosuppressive medications—aportable or implantable unit that enables ESRD patients to dialyzeanywhere would likely do wonders for their quality of life.