NEW ORLEANS — A wearable artificial kidney (Blood Purification Technologies, Inc.) enables greater mobility for dialysis patients, reducing their time in the chair and improving their quality of life, according to research presented here at the American Society of Nephrology 35th Annual Dialysis Conference.
The device, invented by nephrologist Victor Gura, MD, from the David Geffen School of Medicine at the University of California in Los Angeles, is currently undergoing its first human trial in the United States. Human clinical trials conducted in Italy and London have already been successfully concluded.
"Unmet needs in dialysis have remained relatively unchanged for the past 5 or 6 decades," Dr. Gura pointed out. There is still a need to reduce mortality, improve quality of life, reduce cost, improve access, and simplify care, he said.
Although better technology has been developed to treat patients with end-stage renal disease, this has not translated into better patient outcomes, he stressed.
Dr Gura helps assistant John Kundzins don a demo version of the wearable artificial kidney (Source: Stephen Brashear)
To improve quality of life for dialysis patients, pill burden and time in the chair need to be reduced, dietary restrictions need to be less stringent, and patient fatigue needs to be addressed. "The day after dialysis, patients might have a life, but then the following day, they're on dialysis again. This is not quality of life," Dr. Gura explained. Patients may also suffer from sleep apnea, fear, and depression.
"When we tell a patient that dialysis will be necessary, the human reaction to hearing those words is, uniformly, devastation," he said.
Patients in need of dialysis have myriad questions about their quality of life, life expectancy, cost, and assistance. "We as a nephrology community are not doing very well, and the answers that we have for this conundrum of human suffering are not good enough," he said.
The artificial kidney was developed to allow patients to be more mobile during a dialysis session and to go about some of their daily activities while the device runs. Currently, patients are tethered to a cumbersome machine for 3 to 4 hours at a time, several days a week.
Miniature Battery-Powered Device
The dialysis device slowly and continuously removes fluids from the body at the same pace as healthy kidneys. When fluid is removed from a patient too quickly, the patient will crash, Dr. Gura noted. "If we remove it nice and slowly, as the kidneys do — over 24 hours instead of 3 hours — then mortality and morbidity are improved."
The miniature battery-powered dialysis device is worn like a tool belt. It is connected to the patient by a catheter, weighs about 10 pounds, and uses only 400 cc of sterile water. "Because we have a recirculating loop, we have 24/7 use of only 400 cc of water," he explained. Blood is filtered by our kidneys 24 hours a day, 7 days a week. "So if you only filter your blood 9 to 12 times a week, it doesn't work too well."
"We know that quality of life is better when we dialyze more frequently," Dr. Gura said. However, he pointed out, there are logistical obstacles to frequent dialysis. Although the number of patients in need of dialysis continues to grow, there is a lack of funds to pay for treatment and a lack of space in clinics.
"Only 10% of patients will dialyze at home," he reported. "If 90% of dialysis patients will not dialyze at home, how are they going to dialyze every day? Are we going to build twice the units to house them? Do we have the nurses or the capital to do that? The answer is no."
If we have less fluid to remove, less hypotension, a lower pill burden, and less hospital use, we could save some money, he said.
"Dialysis revolutionized medicine by showing us that even the failure of a vital organ can be replaced by appropriately timed medicine. And it didn't require a kidney transplant; a machine could do it," said session moderator Eli Friedman, MD, from the SUNY Downstate Medical Center in Brooklyn, New York.
"Dialysis, which first was cumbersome and difficult and required a surgeon, can now be moved to a wearable device, and that's pretty exciting," Dr. Friedman told Medscape Medical News.
When body fluids are at normal levels, health conditions such as pulmonary edema and hypertension will likely be improved or completely eradicated. And because users of the dialysis device receive continuous hemodialysis, patients can potentially be relieved of dietary and fluid restrictions and of the binders that control phosphorus and potassium levels.
"Daily continuous dialysis is beneficial if you can find a way to do it," Dr. Gura said. "In 5 years, I hope to see the national use of this device."
Dr. Gura is chief medical officer and scientific advisor to Blood Purification Technologies, Inc., the developer of the wearable artificial kidney dialyzer. Dr. Friedman has disclosed no relevant financial relationships.
American Society of Nephrology 35th Annual Dialysis Conference. Presented February 1, 2015.
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Cite this: New Wearable Artificial Kidney Improves Mobility - Medscape - Feb 09, 2015.
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