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Are the days of kidney dialysis numbered?

A prototype implantable artificial kidney could, in the next decade, render costly and inefficient dialysis a treatment of the past, according to work out of UCSF.

There's no gentle way to put it. Chronic kidney failure is ugly and often deadly, and more people in the States are suffering from it every year, with increasing rates of diabetes and hypertension contributing to the problem.

Shuvo Roy UCSF

What's more, the treatment that keeps many waiting for kidney transplants alive--dialysis--involves several sessions per week, at several hours per session, during which blood pumps through an external circuit for filtration to replace just 13 percent of kidney function, leaving many patients exhausted both physically and financially.

(The U.S. Renal Data System estimates that dialysis costs roughly $75,000 per patient per year. With more than 350,000 patients on dialysis, Medicare--via taxpayers--spends 6 percent of its total budget on treatments for kidney failure alone.

Because of this burden on hundreds of thousands of individuals as well as the health care system as a whole, there is a lot of brainpower, money, and hope currently invested in a prototype model of the first implantable, artificial kidney, which was unveiled this week by researchers at the University of California San Francisco. The device is the result of collaboration by engineers, biologists, and physicians at research centers across the country.

"This device is designed to deliver most of the health benefits of a kidney transplant, while addressing the limited number of kidney donors each year," says Shuvo Roy, an associate professor in the UCSF School of Pharmacy who is leading the interdisciplinary effort. "This could dramatically reduce the burden of renal failure for millions of people worldwide, while also reducing one of the largest costs in U.S. health care."

The implantable kidney includes thousands of nanoscale filters that remove toxins from the blood, while a BioCartridge of renal tubule cells act as the metabolic and water-balancing control center. UCSF

Roy's team is essentially mimicking a proven treatment, which uses a room-sized external kidney developed in Michigan, but scaling it down to a size and form that could be implanted into the body without relying on dialysis or immune suppressant meds. In other words, it could enable patients who don't lead normal lives to start.

Roy says the team hopes to apply silicon fabrication technology with specially engineered compartments for live kidney cells so that the model will be roughly the size of a coffee cup. It will include thousands of microscopic filters and a bioreactor to act as the metabolic and water-balancing control center that is lost when a kidney fails.

The first phase of the project was to develop the technologies required to reduce the device to a size that could fit into the body, and to be able to test the components in animal models. Mission accomplished, so now the team is tweaking the device for human compatibility, and with the components and a visual model is hoping to secure federal and private support for clinical trials.

Roy's team is collaborating with 10 additional research teams, including the Cleveland Clinic, where he initially developed the idea; Case Western Reserve University; the University of Michigan; Ohio State University; and Penn State.