ARTIFICIAL KIDNEYS: THE END OF KIDNEY DIALYSIS?

A major global health concern, kidney disease affects millions worldwide. According to the American Society of Nephrology, over 37 million Americans have chronic kidney disease, and over 807,000 have kidney failure.

These numbers are expected to rise in the coming years, making it crucial to find more effective treatment options.

Up to 90% of those with kidney disease are unaware they have it. Symptoms of ongoing kidney disease worsen slowly over time due to progressive kidney damage.

Common kidney disease symptoms include nausea, fatigue, urinary issues, high blood pressure, and swelling in the feet and ankles (edema). These also often mimic symptoms of other diseases. Those with some of the most common chronic diseases are at the highest risk, including those with obesity, diabetes, and heart disease, as well as smokers.^[1]

Kidney disease treatment usually involves managing symptoms, slowing disease progression, and improving outcomes through lifestyle changes, steroids, kidney dialysis, and transplantation.

Late-stage kidney disease patients often wait for several years for a kidney transplant while on kidney dialysis. The mortality rate for those on dialysis is high, with studies showing a 5-year survival rate of around 35% (25% in patients with diabetes).

One promising solution is the development of an artificial kidney. In this article, we will explore the latest advancements in artificial kidney technology and how it could revolutionize the treatment of kidney disease.

What Is an Artificial Kidney?

A medical device that simulates the functions of a natural kidney is called an artificial kidney. It is designed to filter waste and excess fluid from the blood, just like a healthy kidney would.

Kidney dialysis is almost like an artificial kidney, yet the equipment cannot easily move around, is very heavy, requires a lot of water and electricity to power and does not always filter the blood perfectly.^[2] Yet, it does not truly compensate for a real kidney. Over the last decade, millions of dollars worth of funding has gone into initiatives pushing for the world's first true artificial kidney.

After many years of development, the first artificial kidneys are currently being tested. They have the potential to revolutionize kidney disease treatment for good.

Types of Artificial Kidneys

Artificial kidneys can be made from synthetic materials or a mixture of synthetic components and living cells. Devices that make use of living cells are called bioartificial kidneys.

There are currently two types of artificial kidneys in development: wearable and implantable.

Implantable artificial kidneys: These are surgically implanted devices that mimic the functions of a natural kidney. They are designed with the goal of providing kidney failure patients with a long-term fix that does not require dialysis or a kidney transplant.

Wearable artificial kidneys: These are portable dialysis machines that the patient can wear to remove extra fluid and waste from their bodies. They are designed to provide continuous kidney function, resembling the ultimate portable dialysis solution. Wearable kidneys will allow patients to be more mobile than if on regular dialysis and to lead a more normal life.

5 Benefits of Artificial Kidneys

Artificial kidneys offer several benefits for patients with kidney failure. Here are some of the key advantages:

1. Improved Quality of Life: Artificial kidneys could enhance patients’ quality of life by reducing the need for frequent dialysis treatments. With a more efficient and effective blood filtration system, patients may experience fewer symptoms and have more energy to engage in daily activities.
2. Increased Survival Rates: The use of artificial kidneys may potentially increase the life expectancy of patients with kidney failure. By providing a continuous and reliable method of blood filtration, these devices can help manage the complications associated with kidney disease and improve overall survival rates.
3. Fewer Treatment-related Complications: Dialysis can lead to various complications such as infection, blood clots, and cardiovascular issues. Artificial kidneys have the potential to minimize these complications by providing a more refined and precise filtration process.
4. Cost-Effectivity: The cost of dialysis treatments can be a significant burden for patients with kidney failure. An artificial kidney could potentially reduce the cost of long-term treatments, making it more accessible for patients.
5. Less Need for Live Kidney Donations: There are roughly 6500 kidney donations in the US each year from living donors.^[3] With artificial kidney replacement, the need for live donors will be eradicated, allowing even more people to live with a viable set of kidneys.

It is important to note that the development of bioartificial kidneys is still ongoing, and more research is needed to fully realize their potential benefits. Nonetheless, these advancements hold promise for improving the treatment outcomes and quality of life for individuals with kidney failure.

Latest Advancements in Artificial Kidney Technology

The development of an artificial kidney has been a long-standing goal in the medical community.

When designing an artificial kidney, there are three main challenges that scientists need to overcome^[4]:

1. Filtering the blood, which is normally carried out in the kidney by glomerular cells.
2. Absorbing water to mimic the tubule cells of the kidney.
3. Metabolic and hormonal activities, mediated by kidney interstitial cells.

In recent years, there have been significant advancements in this field, bringing us closer to solving the above obstacles and producing a viable solution for kidney disease treatment.

The latest breakthroughs in artificial kidney development have managed to overcome some of the above challenges: blood filtration, water absorption, and partial renal hormone replacement.

Here are some of the latest breakthroughs in treatments for kidney disease:

The WAK: Wearable Artificial Kidney

Several years have passed since the FDA approved the first wearable artificial kidney for clinical trials^[5]. The device, developed by the company Blood Purification Technologies, Inc., is a wearable artificial kidney that works like a compact, portable dialysis machine.

It was ergonomically designed to be worn all day, every day, helping those on kidney dialysis regain a lot more functionality while cutting down on trips to the nephrologist's office.

It is a lot more efficient than conventional dialysis, allowing for the patient's body to better expel excess fluids, salt, and toxins.

According to the founder's website, the WAK^[6]:

• Weighs under 10 pounds vs. over 300 pounds of normal dialysis machines.
• Consumes less than 400 ml of fluid compared to 120 liters of water.

Since the completion of the first human clinical trial in 2017, ongoing trials have been rolled out on the WAK.

Superior Tabletop Home Dialysis

Another portable dialysis machine is currently underway that will likely be an upgrade from the mechanisms used in the WAK, with a trade-on portability.

The waterless artificial kidney is a wearable artificial kidney device that can separate ions in the blood through electrodeionization. The machine uses charged filters to guide ions, water, urea, and toxins and allows filtered blood to pass back into the patient's body. This is intended to mimic the filtration of ions in the same way the kidney does using artificial components.^[7]

The benefits are that it uses no water or biological components, yet it comes with the drawback of being less portable. The team is still currently perfecting the technology, with the intention that patients will be able to use it on a desktop, at home when sitting, or near their beds while asleep.

Transplantable BioArtificial Kidney

The Kidney Project launched the development of a transplantable bioartificial kidney over a decade ago, with the final product now set to enter preclinical trials. The implantable artificial kidney is a small, surgically implanted device that uses a combination of living kidney cells and artificial components to filter the blood.^[8]

What makes the device unique is that it does not need water or electricity. It makes use of the heart, which supplies it with blood like any other organ. The blood enters the artificial kidney and passes through membranes, called bioreactors, that consist of renal tubule cells from donor kidney tissue. The bioreactors filter blood in an identical way to an ordinary kidney and even produce many of the major kidney hormones that help to balance blood chemistry. The scientists responsible for its development managed to find a way to keep renal cells hermetically sealed in the device in an environment that keeps them alive. They have so far managed to replace the kidney of a pig for a week without complications^[9].^[10]

The only drawback of the device is that it cannot supplement erythropoietin, which is a vital hormone produced by kidney interstitial cells needed for red blood cell production. A synthetic supplemental version of this hormone is available for kidney disease patients. In the future, the Kidney Project intends to fill their bioartificial kidney with a mix of renal cells that fulfill this function as well, doing away with the need for supplementation and potential side effects.

The Kidney Project team is aiming to have their artificial kidney on the market by 2030 and is currently putting it through further rigorous testing and refinement.^[11] It has the potential to be a game-changer in the treatment of kidney disease, as it could provide a permanent solution for patients with kidney failure.

The Future of Kidney Disease Treatment

The development of an artificial kidney is still in its early stages, but the potential for this technology is immense. With continued research and advancements, we could see a significant shift in the treatment of kidney disease in the near future.

Other advances in kidney disease treatment and diagnosis include:

Better Early Stage CKD Detection

Several biomarkers and diagnostic methods are being studied to assess how well they can reveal whether someone is suffering from early-stage kidney disease or not^[12].

3D Retina Imaging: One cutting-edge approach developed by a team at the University of Edinburgh is to use 3D scans of the retina in the back of the eye. The retina is one of the few places in the body that can show signs of damage to the tiniest blood vessels in the body. This is a prime reason why it is so difficult to detect early-stage kidney disease, as the kidneys are also home to some of the smallest and most sensitive blood vessels.

AI-Assisted Imaging: Another is the use of artificial intelligence in kidney imaging devices. AI can better predict signs of early kidney disease when assessing MRI scans. In time, the technology will get to a point where it will be widely available in every clinic and able to predict kidney disease with high accuracy.^[13]

Viable Kidney Tissue Grafting

In addition to artificial kidneys, viable kidney grafts are likely to become available to patients who would prefer to regenerate their kidneys before requiring a full transplant. A kidney tissue graft is a partial transplant where a piece of viable kidney tissue replaces a damaged area of the kidney.

Despite the fact that many patients receive successful kidney transplants, the kidney is one organ that cannot be partially transplanted due to a high rate of graft rejection or even fatality.

Scientists are still working on making kidney grafts viable by looking at stem cell modifications and factors that can improve immune acceptance and graft integration.

Conclusion

The development of viable artificial kidneys is a significant step forward in the treatment of kidney disease. With the potential to improve the quality of life for patients, reduce the risk of infection, and increase life expectancy, this technology could have a profound impact on the lives of millions of people worldwide.

The future of kidney disease treatment is looking brighter now than ever before. With continued research and advancements, we can hope to see an implantable artificial kidney become a reality by 2030.

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