Providing Better Care for Kidney Patients

Authorities in the field of providing care for patients with severe kidney disease presented at the CIMIT Forum on Jan. 15 at Simches Research Center of Massachusetts General Hospital.

The title of the Forum was “The Quest for a Wearable Kidney and Renal Assist Devices: Will Nanotechnology Make a Difference.”

Nearly 400,000 patients in the U.S. have end-stage kidney disease requiring dialysis or transplantation. Health officials agree there is a scarcity of organs, so dialysis remains the major therapy.

Wearable dialysis units have been discussed for close to 40 years, and yet experts say little progress as been name. Now the advent of nanotechnology has infused new hope into this area of medicine.

Dr. Theodore Steinman, of Beth Israel Deaconess Medical Center, who is clinical professor of medicine at Harvard Medical School, spoke on “Continuously Functioning Artificial Nephron: The Promise of Nanotechnology.”

He suggested that nanotechnology researchers are getting close to developing a human nephron filter that mimics the function of the human glomerulus and tubule.

Compared to current technology, the newest nano-membranes will be two to three times greater in efficiency than current dialyzers, and will be more compact and lightweight so as to be adaptable for portable use. The goal for the future is to make such a device implantable.

Greg Erman, an entrepreneur who launched a company called Renalworks Medical Corp. to develop renal-care devices, said that progress has been slow in aiding dialysis patients despite the need. He said that developing a small, “wearable” dialysis unit has not been successful due to issues including infection and efficiency.

Erman said that that developing the implantable unit could be the best route aiding kidney-failure patients, given the complexity of the kidney and its functions.

     

Bringing a Wearable Kidney to Market

There exists a clinical need for a device that will deliver continuous dialysis therapy to stabilize the roller-coaster hemodynamics experienced by most patients receiving dialysis three times a week.  From a venture capital perspective, investing in the development of a wearable kidney has both advantages and disadvantages.  If an artificial kidney were ever brought to market, it could potentially be very lucrative, for per capita spending on patients with end-stage renal disease is enormous.  The extremely high costs currently associated with dialysis therapy would presumably encourage dialysis providers to adopt new technology.  Investors also see reasons, however, to be wary of backing research to develop this technology.  Continuous dialysis devices, even more so that today’s machines, would involve risks associated with blood access, such as bleeding, clotting, and infection.  Another reason for investors to pause before funding research is the fact that many patients receiving dialysis today seem resigned to their condition and unwilling to embrace new therapies.  There is also a widespread perception among investors that nephrologists are not aggressive technology adopters.  Finally, daily or continuous dialysis therapies are not currently reimbursed.  Thus, although continuous dialysis machines could result in enormous quality of life increases for patients, investors will not back product development until researchers have independently shown the devices to be safe and effective.          

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