Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing
Author:
Maheshwari Vaibhav1, Grobe Nadja1ORCID, Wang Xin1, Patel Amrish1, Cherif Alhaji1, Tao Xia1, Chao Joshua1, Heide Alexander2, Nikolic Dejan2, Dong Jiaming3, Kotanko Peter14ORCID
Affiliation:
1. Renal Research Institute, 315 East 62nd Street, 3rd Floor, New York, NY 10065, USA 2. Fresenius Medical Care, 61352 Bad Homburg, Germany 3. Fresenius Medical Care, Shanghai 200030, China 4. Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
Abstract
It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer’s dialysate compartment counter-currently to the blood of a healthy subject (referred to as a “buddy”) flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine’s ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure.
Funder
Renal Research Institute
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