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Development of continuous implantable renal replacement: past and future.
- Source :
-
Translational research : the journal of laboratory and clinical medicine [Transl Res] 2007 Dec; Vol. 150 (6), pp. 327-36. Date of Electronic Publication: 2007 Jul 02. - Publication Year :
- 2007
-
Abstract
- Most of the 400,000+ patients in the United States with kidney failure depend on dialysis treatments in dedicated dialysis centers for 3 h to 5 h, usually 3 times a week, but they still suffer from accelerated cardiovascular disease and infections. Extended daily dialysis, for 6 to 8 hours every day, seems to be associated with better outcomes but would overwhelm the dialysis networks and severely limit patient activity. Technology to miniaturize and automate home dialysis will be necessary to offer extended daily dialysis to most dialysis patients. Miniaturization of existing hollow-fiber polymer membranes is constrained by requirements for high driving pressures for circulation and convective clearance. Recent advances in membrane technology based on microelectromechanical systems (MEMS) promise to enable the development of continuous implantable renal replacement therapy. Silicon nanoporous membranes with a highly monodisperse pore size distribution have been produced using protocols amenable to low-cost batch fabrication similar to those used to produce microelectronics. Hydraulic permeability of the flat-sheet membranes with critical pore sizes in the range of 8-100 nm has been measured to confirm that conventional fluid transport models are sufficiently accurate for predictive design for bulk liquid flow in an implantable hemofilter. Membrane biocompatibility was tested in vitro with human proximal tubule cells and revealed that silicon does not exhibit cytotoxicity, as evidenced by the formation of confluent cell layers with tight junctions and central cilia. Filtration characterization demonstrated that the nanoporous membranes exhibit size-dependent solute rejection in agreement with steric hindrance models. These advances in membrane technology are fundamentally enabling for a paradigm shift from an in-center to implantable dialysis system.
- Subjects :
- Biocompatible Materials chemistry
Cell Culture Techniques
Dialysis Solutions
Equipment Design
Forecasting
Hemofiltration
Humans
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic mortality
Kidney Tubules cytology
Kidney Tubules growth & development
Kidneys, Artificial
Materials Testing methods
Membranes, Artificial
Nanotechnology trends
Renal Replacement Therapy instrumentation
Renal Replacement Therapy methods
Silicon chemistry
United States
Uremia
Kidney Failure, Chronic therapy
Prostheses and Implants
Renal Dialysis instrumentation
Renal Dialysis trends
Renal Replacement Therapy trends
Subjects
Details
- Language :
- English
- ISSN :
- 1931-5244
- Volume :
- 150
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Translational research : the journal of laboratory and clinical medicine
- Publication Type :
- Academic Journal
- Accession number :
- 18022594
- Full Text :
- https://doi.org/10.1016/j.trsl.2007.06.001