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  • Review Article
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Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges

Nature Reviews Nephrology volume 19, pages 481–490 (2023)Cite this article

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Abstract

Haemodialysis is life sustaining but expensive, provides limited removal of uraemic solutes, is associated with poor patient quality of life and has a large carbon footprint. Innovative dialysis technologies such as portable, wearable and implantable artificial kidney systems are being developed with the aim of addressing these issues and improving patient care. An important challenge for these technologies is the need for continuous regeneration of a small volume of dialysate. Dialysate recycling systems based on sorbents have great potential for such regeneration. Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of a broad range of uraemic toxins, with low levels of membrane fouling compared with currently available synthetic membranes. To achieve more complete therapy and provide important biological functions, these novel membranes could be combined with bioartificial kidneys, which consist of artificial membranes combined with kidney cells. Implementation of these systems will require robust cell sourcing; cell culture facilities annexed to dialysis centres; large-scale, low-cost production; and quality control measures. These challenges are not trivial, and global initiatives involving all relevant stakeholders, including academics, industrialists, medical professionals and patients with kidney disease, are required to achieve important technological breakthroughs.

Key points

  • Haemodialysis is expensive and is associated with high patient mortality and poor quality of life; portable, wearable and implantable artificial kidney systems are being developed to improve patient care.

  • An important challenge for designing portable or wearable artificial kidney systems is the continuous regeneration of a small volume of dialysate; recycling systems based on sorbents have great potential for dialysate regeneration.

  • Novel dialysis membranes composed of polymeric or inorganic materials are being developed to improve the removal of uraemic toxins, with low levels of membrane fouling.

  • Bioartificial kidney systems can provide important biological functions and thereby potentially improve patient outcomes; however, their implementation has manufacturing, feasibility and logistics challenges.

  • Important technological breakthroughs can be achieved via global initiatives involving relevant stakeholders including academics, industrialists, medical professionals and patients.

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Fig. 1: Dialysis technologies.
Fig. 2: Removal of urea using a mixed matrix membrane.
Fig. 3: A bioartificial kidney.

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Acknowledgements

D.L. Ramada acknowledges the financial support of the Top Sector Life Sciences & Health (Health~Holland), NODIAL project 21OP + 035). D. Stamatialis, S.M. Mihaila, R. Masereeuw, K. Gerritsen and N. Noor acknowledge the financial support of the Strategic alliance of the University of Twente, University of Utrecht, and University Medical Center Utrecht. D. Stamatialis and R. Masereeuw acknowledge the financial support of the “European Uremic Toxin working group” (EUTox) of the “European Society for Artificial Organs” (ESAO) endorsed by the “European Renal Association-European Dialysis Transplantation Association” (ERA-EDTA). K. Gerritsen, J. de Vries, R. Masereeuw and F. Wieringa acknowledge the financial support of the European Commission (KIDNEW, HORIZON-EIC-2022 Pathfinder program, grant agreement no. 101099092). The authors thank J.A.W. Jong (Neokidney BV) for critically reviewing the manuscript and Dr. A. Verschueren (IMEC) for creating the initial concept for Fig. 1.

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Authors and Affiliations

  1. Advanced Organ bioengineering and Therapeutics, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O Box 217, 7500, AE Enschede, The Netherlands

    David Loureiro Ramada, Nazia Noor, Odyl ter Beek & Dimitrios Stamatialis

  2. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands

    Joost de Vries, Jeroen Vollenbroek, Fokko Wieringa & Karin Gerritsen

  3. BIOS Lab on a Chip Group, MESA + Institute, University of Twente, Hallenweg 15, 7522, NH Enschede, The Netherlands

    Jeroen Vollenbroek

  4. Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

    Silvia M. Mihăilă & Rosalinde Masereeuw

  5. Department of Autonomous Therapeutics, IMEC, Eindhoven, The Netherlands

    Fokko Wieringa

  6. European Kidney Health Alliance (EKHA), WG3 “Breakthrough Innovation”, Brussels, Belgium

    Fokko Wieringa & Dimitrios Stamatialis

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  1. David Loureiro Ramada
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All authors researched data for the article, contributed substantially to discussion of the content, wrote the article and reviewed or edited the manuscript before submission.

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Correspondence to Dimitrios Stamatialis.

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Ramada, D.L., de Vries, J., Vollenbroek, J. et al. Portable, wearable and implantable artificial kidney systems: needs, opportunities and challenges. Nat Rev Nephrol 19, 481–490 (2023). https://doi.org/10.1038/s41581-023-00726-9

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