Artificial kidney

Lore & Background

The first working artificial kidney was constructed by Willem Kolff in the Netherlands in 1943, during the early 1940s. Until the Second World War, kidney failure generally meant death for the patient, but several insights into kidney function and acute kidney failure were made during the war. The device, a dialyzer, allowed for the filtration of metabolic waste products from the blood, addressing the slow accumulation of nitrogenous wastes, salts, and water that disrupts the body's pH balance in kidney failure.

Modern development includes bio-artificial kidneys, such as the implantable bioartificial kidney (iBAK) co-developed by nephrologist William H. Fissell IV from Vanderbilt University Medical Centre and bioengineer Shuvo Roy from the University of California, San Francisco. This device uses silicon nano-pore membranes fabricated with MEMS technology to house living renal cells, allowing fluid and electrolyte transfer while protecting the cells from the immune system. In 2020, a proof-of-concept experiment showed that prototype iBAK devices remained blood-clot and rejection free during a 7-day trial in healthy juvenile Yucatan pigs.

Another proposed solution is the wearable artificial kidney (WAK), a portable dialysis machine designed for continuous use. The FDA approved the first human clinical trial in the United States for a WAK developed by Dr. Victor Gura and Cedars-Sinai Medical Center. The prototype is a 10-pound device powered by nine-volt batteries, using less than 500 mL of dialysate, and aims to allow patients to remain ambulatory while receiving treatment around the clock.

Reader's Guide

The artificial kidney has transformed the prognosis for patients with end-stage renal disease (ESRD), a condition that was fatal before the 1940s. With over 35.5 million American adults having kidney disease and more than 808,000 with kidney failure, the demand for dialysis drives continued innovation. The United States has the second-highest rate of dialysis among advanced countries after Japan, but also the highest mortality rate among ESRD patients, with 20% dying annually. The development of bio-artificial kidneys, such as the implantable iBAK, aims to overcome limitations of conventional hemodialysis, which is expensive, time-consuming, and space-inefficient. The iBAK could eliminate the need for lifelong immune suppression drugs and mimic natural kidney functions, including hormone regulation and urine production. The wearable artificial kidney seeks to provide continuous treatment, improving quality of life and reducing mortality. These advances address the scarcity of donor organs and the growing prevalence of diabetes and hypertension, the two most common causes of kidney failure. Experts predict that demand for dialysis will increase as diabetes prevalence rises, making the artificial kidney a critical area of medical research.

Did You Know?

• The first successful artificial kidney was developed by Willem Kolff in the Netherlands in 1943.
• One in three American adults are at risk for developing kidney disease, and about 37 million American adults have chronic kidney disease.
• The implantable bioartificial kidney uses silicon nano-pore membranes to protect living renal cells from the immune system.
• The FDA approved the first human clinical trial in the United States for a wearable artificial kidney developed by Dr. Victor Gura and Cedars-Sinai Medical Center.