Providing Better Care for Kidney Patients

Authorities in the field of providing care for patients with severe kidney disease presented at the CIMIT Forum on Jan. 15 at Simches Research Center of Massachusetts General Hospital.

The title of the Forum was “The Quest for a Wearable Kidney and Renal Assist Devices: Will Nanotechnology Make a Difference.”

Nearly 400,000 patients in the U.S. have end-stage kidney disease requiring dialysis or transplantation. Health officials agree there is a scarcity of organs, so dialysis remains the major therapy.

Wearable dialysis units have been discussed for close to 40 years, and yet experts say little progress as been name. Now the advent of nanotechnology has infused new hope into this area of medicine.

Dr. Theodore Steinman, of Beth Israel Deaconess Medical Center, who is clinical professor of medicine at Harvard Medical School, spoke on “Continuously Functioning Artificial Nephron: The Promise of Nanotechnology.”

He suggested that nanotechnology researchers are getting close to developing a human nephron filter that mimics the function of the human glomerulus and tubule.

Compared to current technology, the newest nano-membranes will be two to three times greater in efficiency than current dialyzers, and will be more compact and lightweight so as to be adaptable for portable use. The goal for the future is to make such a device implantable.

Greg Erman, an entrepreneur who launched a company called Renalworks Medical Corp. to develop renal-care devices, said that progress has been slow in aiding dialysis patients despite the need. He said that developing a small, “wearable” dialysis unit has not been successful due to issues including infection and efficiency.

Erman said that that developing the implantable unit could be the best route aiding kidney-failure patients, given the complexity of the kidney and its functions.

     

Creating an Artificial Kidney

The mortality rate for patients with end-stage renal disease is around 22 % per year.  At the moment, the only way to treat the disease is with dialysis, usually three times a week for four hours at a time, and dialysis machines are far from perfect.  Their efficiency is only around 10 % of that of a functioning kidney, and they lead to a variety of complications both during and between dialysis treatments.  Being on a dialysis machine activates cytokines in the body, and these cytokines cause inflammation that can destroy residual kidney function in the patient.  Dialysis treatments also pose risks associated with infection, bleeding, clotting, and cardiac disease.  On top of everything else, long and frequent dialysis sessions severely reduce a patient’s quality of life.  Designing a wearable artificial kidney would make dialysis a more effective therapy. 

Nanotechnology offers enticing possibilities in this area.  Dialysis membranes used today are thick and permit a low flux of particles to pass through them.  Thinner “nanomembranes” would be more permeable.  These new membranes could also be carefully engineered to contain highly selective pores, instead of the almost randomly sized pores present in membranes used today.  Particular pores, for example, could be designed to help filter middle-sized molecules from the blood.  Some middle-sized molecules, such as beta-microglobulin, can cause debilitating health problems when they accumulate in the body, and traditional dialysis machines do a poor job of filtering these molecules from the blood.  Creating a library of engineered pores would allow nephrologists to come up with customized dialysis regimens tailored to their individual patients.  Incorporating nanomembranes into a wearable device would allow patients to receive almost continuous dialysis, which would eliminate damaging fluctuations in the blood’s urea concentration.  Before wearable devices enter clinical use, however, the challenge of safely accessing the blood must be overcome.            

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