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More than 2 million people worldwide receive treatment for end-stage renal disease (ESRD). Current modalities of renal replacement therapy include in-center hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplantation. Patient survival has gradually increased during the past 2 decades and efforts continue to improve mortality and quality of life for patients with ESRD. Developments in sorbent technology, nanotechnology, and cell culture techniques provide promise for new innovations in ESRD management. New modalities currently in testing include wearable (WAKs) and implantable artificial kidneys (IAKs). The automated WAK (AWAK) and WAK are devices that have undergone small trials in humans. Additional study is needed before regulatory approval, coverage decisions, and widespread clinical implementation. The IAK is a biohybrid combining artificial filters and living cells currently in preclinical testing. These portable devices reduce the need for large quantities of water and continuous electrical supply. This could lower some barriers to home dialysis, making self-care renal replacement therapy more accessible and desirable. If widely successful, these devices could reduce the need to build and staff dialysis facilities, thus lowering health care costs associated with dialysis. The potential advantages and shortcomings of the AWAK, WAK, and IAK are described here., (Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Acute kidney injury (AKI) is a serious complication, commonly occurring in the critically ill population, with devastating short- and long-term consequences. Despite standardization of the definition and staging of AKI, early recognition remains challenging given that serum creatinine level is a marker, albeit imperfect, of kidney function and not kidney injury. Furthermore, the delay in increase in serum creatinine level after loss of glomerular filtration also prevents timely detection of decreased kidney function in patients with AKI. During the past decade, numerous clinical investigations have evaluated the utility of several biomarkers in the early diagnosis and risk stratification of AKI. In 2014, the US Food and Drug Administration approved the marketing of a test based on the combination of urine concentrations of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 ([TIMP-2] × [IGFBP7]) to determine whether certain critically ill patients are at risk for developing moderate to severe AKI. The optimal role of this biomarker in the diagnosis, management, and prognosis of AKI in different clinical settings requires further clarification. In this perspective, we summarize the biological actions of these 2 cell-cycle arrest biomarkers and present important considerations regarding the clinical application, interpretation, and limitations of this novel test for the early detection of AKI., (Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Current renal substitution therapy with hemodialysis or hemofiltration has been an important life-sustaining technology, but it still has suboptimal clinical outcomes in patients with end-stage renal disease or acute renal failure. This therapy replaces the small solute clearance function of the glomerulus but does not replace the metabolic and endocrinologic functions of the tubular cells. This article shows that the combination of a synthetic hemofiltration cartridge and a renal tubule cell assist device (RAD) containing human cells in an extracorporeal circuit replaces filtration, metabolic, and endocrinologic functions in acutely uremic dogs. The RAD maintained excellent performance and durability characteristics for 24 hours of continuous use in the uremic animals. The RAD increased ammonia excretion, glutathione metabolism, and 1,25-dihydroxyvitamin D3 production. Cardiovascular stability in the animals was documented in these studies during this extracorporeal treatment. With these results, clinical evaluation of this device in the treatment of severely ill patients with acute renal failure in an intensive care unit has been initiated., (Copyright 2002 by the National Kidney Foundation, Inc.)