Wearable and implantable artificial kidney devices for end‐stage kidney disease treatment: Current status and review

• Published in: Artificial organs 2023-04, Vol.47 (4), p.649-666
• Main Authors: Groth, Thomas, Stegmayr, Bernd G., Ash, Stephen R., Kuchinka, Janna, Wieringa, Fokko P., Fissell, William H., Roy, Shuvo
• Format: Article
• Language: English
• Subjects: Artificial kidneys; Artificial organs; chronic kidney disease; Dialysis; Homeostasis; Humans; Kidney diseases; Kidney Failure, Chronic - surgery; kidney replacement therapies; Kidneys; Kidneys, Artificial; Life expectancy; Life span; Medical treatment; Political factors; Quality of Life; Renal Insufficiency, Chronic - therapy; Toxins; Transplantation; wearable and implantable artificial kidneys; Wearable Electronic Devices; Wearable technology
• ISSN: 0160-564X; 1525-1594; 1525-1594
• DOI: 10.1111/aor.14396

Background Chronic kidney disease (CKD) is a major cause of early death worldwide. By 2030, 14.5 million people will have end‐stage kidney disease (ESKD, or CKD stage 5), yet only 5.4 million will receive kidney replacement therapy (KRT) due to economic, social, and political factors. Even for those who are offered KRT by various means of dialysis, the life expectancy remains far too low. Observation Researchers from different fields of artificial organs collaborate to overcome the challenges of creating products such as Wearable and/or Implantable Artificial Kidneys capable of providing long‐term effective physiologic kidney functions such as removal of uremic toxins, electrolyte homeostasis, and fluid regulation. A focus should be to develop easily accessible, safe, and inexpensive KRT options that enable a good quality of life and will also be available for patients in less‐developed regions of the world. Conclusions Hence, it is required to discuss some of the limits and burdens of transplantation and different techniques of dialysis, including those performed at home. Furthermore, hurdles must be considered and overcome to develop wearable and implantable artificial kidney devices that can help to improve the quality of life and life expectancy of patients with CKD. Wearable and implantable artificial kidneys (WIAK) can provide long‐term, effective kidney functions like the removal of uremic toxins, electrolyte homeostasis, and fluid regulation improving quality of life of patients. Wearable devices are based on peritoneal or hemodialysis with extracorporeal adsorption of waste products and return of purified ultrafiltrate to the patient. Implantable devices combine an ultrafiltration unit with a re‐adsorptive bioartificial kidney tubule component. The review provides a survey on the limitation of current kidney replacement therapies and recent developments of WIAK.