A wearable hemodialysis device aimed at improving the quality of life of kidney failure patients has had some promising results, according to an article published in The Lancet, this week’s edition.
Approximately 1.3 million people globally have chronic kidney failure that requires either renal transplantation or dialysis – for such patients, the established treatment is hemodialysis. However, as their risk of cardiovascular disease is high, their survival outlook remains poor, the authors explain.
Survival rates can be improved if both the dose and frequency of dialysis is increased, from three times weekly to five times weekly, or even every day.
In the 1970s the idea of a wearable hemodialysis device was born. The idea being that patients could treat themselves at home. With more modern technologies the system can now be miniaturized.
Dr Andrew Davenport, University College London (UCL) Centre for Nephrology, Royal Free and University College Medical School, London, UK, and team looked at eight volunteers, five men and three women. They all had end-stage kidney failure and had an average age of 52. They were established on regular hemodialysis and had wearable a hemodialysis device fitted for 4-8 hours.
No significant cardiovascular changes or adverse changes in serum electrolytes were detected by the researchers. They added that the acid-base balance in the patient’s blood was not affected either.
Rates of blood flow, dialysate flow and urea and creatine clearance were all acceptable, although they were all significantly lower than in conventional dialysis.
The longer the patients wore the device the differing flow rate became less of a concern. This is because a long period at a low flow rate can clear as much, or even more blood toxins as a shorter period with a higher flow rate experienced 3 times a week in conventional dialysis.
Even though the aim of the study wasn’t to return the patient to his/her post-dialysis target weight, fluid was removed during treatment successfully. No adverse cardiovascular changes were detected despite the fact that patients were encouraged to eat/drink during treatment. None of the eight patients had any complaints about the treatment – all their feedbacks were positive. Patients were also able to sleep without difficulty with the device on. All eight said they would recommend the device to other patients.
Larger trials are needed to confirm the safety and efficacy of the treatment, the researchers concluded. “The device has the potential to become a practical means of delivering extended and more frequent dialysis to patients with end-stage kidney failure,” they said.
Accompanying Comment
“The wearable artificial kidney reported today is a small first step in the long road to wearable blood-cleansing devices. Lessons learned from further study should pave the way for realizing the future promise of dialysis with artificial kidneysm,” Dr Garabed Eknoyan, Baylor College of Medicine, Houston, Texas. USA, wrote in an Accompanying Comment.
Article
“A wearable hemodialysis device for patients with end-stage renal failure: a pilot study”
The Lancet 2007; 370:2005-2010 DOI:10.1016/S0140-6736(07)61864-9
Dr Andrew Davenport MD, Victor Gura MD, Claudio Ronco MD, Masoud Beizai PhD, Carlos Ezon MD and Edmond Rambod PhD
Accompanying Comment
“Artificial kidneys: progress and promise”
Dr Garabed Eknoyan
Written by – Christian Nordqvist