The Future of Technology-Based Kidney Replacement Therapies: An Update on Portable, Wearable and Implantable Artificial Kidneys.

Abstract

Worldwide, the number of people needing lifesaving kidney replacement therapy (KRT) steadily grows, but about two thirds of them lack access to KRT and thus die. Access to KRT depends on economic, social, infrastructural, ecological, and political factors. Current KRTs include kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD). Xenotransplantation recently is opening promising new perspectives but needs improvement. Unfortunately, not all patients are suitable for transplantation. PD and HD will remain important KRTs, but they are expensive and strongly depend on infrastructure, with little fundamental changes since the 1980s. The KRT field might learn from the African mobile phone revolution that beat infrastructural limitations, lowered costs, and increased access. We provide a non-exhaustive overview of promising ways to increase the mobility of technology-based KRTs by dialysate regeneration, chip-based nanoporous filters, bioreactor-enabling technologies and using the gut as a "third kidney". In 2018, the Kidney Health Initiative published a Roadmap for innovative KRTs composed by leading innovators, but the pace of innovation is slower than targeted. Ambitious political statements about realizing this roadmap can only succeed if the granted funding matches the targeted time scale. Patient-centered international coopetition (the act of cooperation between competing entities) seems to offer the quickest pathway to success.