Abstract
Work on wearable kidneys has evolved around the technology of hemodialysis or hemofiltration, which call for continuous anticoagulation of the extracoporeal circulation and are encumbered with potential immunologic and non-immunologic complications of continuous blood–artificial membrane interactions. A peritoneal-based automated wearable artificial kidney (AWAK) requires no extracorporeal circulation and is therefore “bloodless.” Because AWAK is designed to continuously regenerate and reuse the spent dialysate in perpetuity, it is also “waterless.” A sorbent-based assembly regenerates both the aqueous and the protein components (AqC and PrC) of the spent dialysate, producing a novel, autologous protein-containing dialysate. The regenerated AqC has the same composition as the commercially available peritoneal dialysate, but contains bicarbonate instead of lactate and has a more physiological pH. The regenerated PrC is recycled back into the peritoneal cavity, thereby ameliorating or eliminating protein loss. Depending on the steady-state protein concentrations that can be achieved (under the condition of continuous dialysate regeneration and recycling), the PrC also has the potential of both augmenting ultrafiltration and mediating the removal of protein-bound toxins. Additional sorbents can be incorporated into AWAK for the removal of middle molecular weight uremic toxins. At a regeneration rate of 4 l/h, AWAK provides a dialysate flow of 96 l/day (8–12 times the current rate). Round-the-clock dialysis and ultrafiltration provide steady-state metabolic-biochemical and fluid balance regulation, thereby eliminating “shocks” of abrupt changes in these parameters that characterize the current dialytic modalities. Dialysis-on-the-go, made possible by AWAK’s “wearability” and automation, frees end-stage renal failure patients from the servitude that is demanded by the current dialytic regimentations.
Similar content being viewed by others
References
Vanholder R, De Smet R, Glorieux G, et al. Review on uremic toxins: classification, concentration, and interindividual variability. Kidney Int. 2003;63(5):1934–43.
Gura V, Beizai M, Ezon C, Polaschegg HD. Continuous renal replacement therapy for end-stage renal disease. The wearable artificial kidney (WAK). Contrib Nephrol. 2005;149:325–33.
Nissenson AR, Ronco C, Pergamit G, Edelstein M, Watts R. The human nephron filter: toward a continuously functioning, implantable artificial nephron system. Blood Purif. 2005;23(4):269–74.
Saito A, Aung T, Sekiguchi K, et al. Present status and perspectives of bioartificial kidneys. J Artif Organs. 2006;9(3):130–5.
Lande AJ, Roberts M, Pecker EA. In search of a 24 hrs/day, 7 days/week wearable hemodialyzer. Trans Am Soc Artif Intern Organs. 1977;23:185–90.
Yamamoto K, Hiwatari M, Kohori F, Sakai K, Fukuda M, Hiyoshi T. Membrane fouling and dialysate flow pattern in an internal filtration-enhancing dialyzer. J Artif Organs. 2005;8(3):198–205.
Murisasco A, Reynier JP, Ragon A, et al. Continuous arterio-venous hemofiltration in a wearable device to treat end-stage renal disease. ASAIO Trans. 1986;32(1):567–71.
Neff MS, Sadjadi S, Slifkin R. A wearable artificial glorerulus. ASAIO Trans. 1979;25:71–3.
Lee DBN, Roberts M. A peritoneal-based wearable dialysis system. Continuous dialysis using a protein-containing dialysate In: Agarwal S, ed. Scientific Proceedings, South-Asian Nephrology Congress at New Millennium and International CME-2000. New Delhi, 2000:94–9.
Roberts M, Lee DBN. A proposed peritoneal-based wearable artificial kidney. Home Hemodialysis Int. 1999;3:65–7.
Roberts M, Lee DBN. Wearable artificial kidneys. A peritoneal-dialysis approach. Dialysis and Transplantation. 2006;36:780–2.
Roberts M, Niu PC, Lee DBN. Regeneration of peritoneal dialysate (PD): a step towards a continuous wearable artificial kidney (CWAK). J Am Soc Nephrol. 1991;2(3):367.
Vychytil A, Horl WH. The role of tidal peritoneal dialysis in modern practice: A European perspective. Kidney Int Suppl. 2006(103):S96–103.
Fernando SK, Finkelstein FO. Tidal PD: its role in the current practice of peritoneal dialysis. Kidney Int Suppl 2006(103):S91–5.
Roberts M, Ash SR, Lee DB. Innovative peritoneal dialysis: flow-thru and dialysate regeneration. ASAIO J. 1999;45(5):372–8.
Villarroel F. Kinetics of intermittent and continuous peritoneal dialysis. J Dial. 1977;1(4):333–47.
Lange K, Treser G, Mangalat J. Automatic continuous high flow rate peritoneal dialysis. Arch Klin Med. 1968;214(3):201–6.
Lee DB, Brown DL, Baker LR, Littlejohns DW, Roberts PD. Haematological complications of chlorate poisoning. Br Med J. 1970;2(5700):31–2.
Blumenkrantz MJ, Gordon A, Roberts M, Lewin AJ, Pecker EA, Moran JK, Coburn JW, Maxwell MH. Applications of the Redy sorbent system to hemodialysis and peritoneal dialysis. Artif Organs. 1979;3(3):230–6.
Hansen S. Sorbent dialysis in the third millennium. Nephrol News Issues 2006;20(1):43–5.
Capparelli AW, Roberts M, Lee DBN. Towards a wearable artificial kidney for continuous dialysis: ex-vivo sorbent regeneration of filtered peritoneal dialysate during intermittent peritoneal dialysis. J Am Soc Nephr. 1993;4:399A.
Hoff CM. In vitro biocompatibility performance of Physioneal. Kidney Int Suppl. 2003(88):S57–74.
Etteldorf JN, Dobbins WT, Summitt RL, Rainwater WT, Fischer RL. Intermittent peritoneal dialysis using 5 per cent albumin in the treatment of salicylate intoxication in children. J Pediatr. 1961;58:226–36.
Roberts M, Dinovo EC, Yanagawa N, Lee DBN. Can peritoneal proteins be regenerated and reused for binding toxins? J Am Soc Nephrol. 1999;10:228A.
Roberts M, Paul W, Yanagawa N, Corry DB, Lee DBN. Peritoneal dialysis of protein-bound toxins: feasibility of regeneration of spent dialysis proteins. Perit Dial Int. 1999;19(Suppl 1):S22.
Roberts M, Capparelli AW, Wong C, Lee DBN. Development of a wearable artificial kidney based upon sorbent regeneration of peritoneal dialysate. Perit Dial Int. 1995;15(Suppl 4):S88.
Petersen NJ, Carson LA, Favero MS, Marshall JH Jr, Aguero SM. Removal of bacteria and bacterial endotoxin from dialysis fluids by the media in a sorbent cartridge. Trans Am Soc Artif Intern Organs. 1979;25:402–3.
Levy E. Method of reducing contaminants in drinking water In: USPaT Office, ed. United States Patent Application Publication. USA, 2003.
Karl DW, Magnusson JC, Carr PW, Flickinger MC. Preliminary assessment of removal of pyrogenic lipopolysaccharides with colloidal zirconia adsorbents. Enzyme Microb Technol. 1991;13(9):708–15.
Sonderstrup J. On bacteriological problems in the REDY dialysis system. Scand J Urol Nephrol 1976(30 Suppl):19–22.
Murisasco A, Baz M, Boobes Y, Bertocchio P, el Mehdi M, Durand C, Reynier JP, Ragon A. A continuous hemofiltration system using sorbents for hemofiltrate regeneration. Clin Nephrol. 1986;26(Suppl 1):S53–7.
Shapiro WB, Schilb TP, Porush JG. Sorbent recycling of ultrafiltrate in man–a 45-week crossover study. Clin Nephrol. 1986;26(Suppl 1):S47–52.
Twardowski ZJ. Short, thrice-weekly hemodialysis is inadequate regardless of small molecule clearance. Int J Artif Organs. 2004;27(6):452–66.
Frampton JE, Plosker GL. Icodextrin: a review of its use in peritoneal dialysis. Drugs. 2003;63(19):2079–105.
Garcia-Lopez E, Lindholm B, Tranaeus A. Biocompatibility of new peritoneal dialysis solutions: clinical experience. Perit Dial Int. 2000;20(Suppl 5):S48–56.
Rozenberg R, Magen E, Weissgarten J, Korzets Z. Icodextrin-induced sterile peritonitis: the Israeli experience. Perit Dial Int. 2006;26(3):402–5.
Lai KN, Ho SK, Leung J, Tang SC, Chan TM, Li FK. Increased survival of mesothelial cells from the peritoneum in peritoneal dialysis fluid. Cell Biol Int. 2001;25(5):445–50.
Etteldorf JN, Montalvo JM, Kaplan S, Sheffield JA. Intermittent peritoneal dialysis in the treatment of experimental salicylate intoxication. J Pediatr. 1960;56:1–10.
Chiu A, Fan ST. MARS in the treatment of liver failure: controversies and evidence. Int J Artif Organs. 2006;29(7):660–7.
Bammens B, Evenepoel P, Verbeke K, Vanrenterghem Y. Removal of middle molecules and protein-bound solutes by peritoneal dialysis and relation with uremic symptoms. Kidney Int. 2003;64(6):2238–43.
Faybik P, Hetz H, Baker A, Bittermann C, Berlakovich G, Werba A, Krenn CG, Steltzer H. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning. Liver Int. 2003;23(Suppl 3):28–33.
Yokoyama K, Ogura Y, Kishimoto M, et al. Blood purification for severe sarin poisoning after the Tokyo subway attack. Jama. 1995;274(5):379.
Ash SR, Sullivan TA, Carr DJ. Sorbent suspensions vs. sorbent columns for extracorporeal detoxification in hepatic failure. Ther Apher Dial. 2006;10(2):145–53.
Winchester JF, Amerling R, Harbord N, Capponi V, Ronco C. The potential application of sorbents in peritoneal dialysis. Contrib Nephrol. 2006;150:336–43.
Tauer A, Zhang X, Schaub TP, Zimmeck T, Niwa T, Passlick-Deetjen J, Pischetsrieder M. Formation of advanced glycation end products during CAPD. Am J Kidney Dis. 2003;41(3 Suppl 1):S57–60.
Reddingius RE, de Boer AW, Schroder CH, Willems JL, Monnens LA. Increase of the bioavailability of intraperitoneal erythropoietin in children on peritoneal dialysis by administration in small dialysis bags. Perit Dial Int. 1997;17(5):467–70.
Schroder CH, Swinkels LM, Reddingius RE, Sweep FG, Willems HL, Monnens LA. Adsorption of erythropoietin and growth hormone to peritoneal dialysis bags and tubing. Perit Dial Int. 2001;21(1):90–2.
Schroder CH. The management of anemia in pediatric peritoneal dialysis patients. Guidelines by an ad hoc European committee. Pediatr Nephrol. 2003;18(8):805–9.
Ghosh S, Sharma A, Talukder G. Zirconium. An abnormal trace element in biology. Biol Trace Elem Res. 1992;35(3):247–71.
Schroeder HA, Balassa JJ. Abnormal trace metals in man: zirconium. J Chronic Dis. 1966;19(5):573–86.
Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials. 1999;20(1):1–25.
Sollazzo V, Palmieri A, Pezzetti F, Bignozzi CA, Argazzi R, Massari L, Brunelli G, Carinci F. Genetic effect of zirconium oxide coating on osteoblast-like cells. J Biomed Mater Res B Appl Biomater 2007.
Laden K. Introduction ahd history of antiperspirants and deodorants. In: Laden K, Felger CB, eds. Antiperspirants and deodorants. New York: Marcel Decker, 1988:1–13.
Chang PP, Henegbarth EA, Lang LA. Maxillary zirconia implant fixed partial dentures opposing an acrylic resin implant fixed complete denture: a two-year clinical report. J Prosthet Dent. 2007;97(6):321–30.
Tsukamoto R, Chen S, Asano T, Ogino M, Shoji H, Nakamura T, Clarke IC. Improved wear performance with crosslinked UHMWPE and zirconia implants in knee simulation. Acta Orthop. 2006;77(3):505–11.
Lappalainen R, Santavirta SS. Potential of coatings in total hip replacement. Clin Orthop Relat Res. 2005(430):72–9.
Schadel A, Thun G, Stork L, Metzler R. Immunodiffusion and immunohistochemical investigations on the reactivity of oxide ceramic middle-ear implants. ORL J Otorhinolaryngol Relat Spec. 1993;55(4):216–21.
Odell RA. Sorbent dialysis. In: Nissenson AR, Fine RN, Gentile DE, eds. Clinical dialysis, 2nd edition. Connecticut: Appleton and Lange, 1990:712–9.
U.S. Renal Data System, USRDS 2006 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Lee, D.B.N., Roberts, M. A peritoneal-based automated wearable artificial kidney. Clin Exp Nephrol 12, 171–180 (2008). https://doi.org/10.1007/s10157-008-0050-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-008-0050-9